Research Quesion

Can advanced MRI techniques (dMRI and PDMRI) improve the sensitivity and specificity of detecting surgically significant nerve injuries in BPBI compared to current MRI protocols?

Brief background

During childbirth, some babies injure nerves controlling arm movements, causing weakness or loss of movement. Deciding if these babies need surgery currently involves waiting months and performing scans under anaesthetic, which carries risks. We aim to develop safer, clearer MRI scans without anaesthetic, helping doctors quickly identify babies truly needing surgery. This approach reduces unnecessary operations, anxiety, and hospital visits, improving family wellbeing. Ultimately, our research seeks to enhance early diagnosis, improve recovery, and ensure better long-term arm function and quality of life for affected babies.

Awaiting first report

Research question

Is a trial of personalised follow-up vs standard care safe and feasible, in either carpal tunnel decompression or thumb-base steroid injections?

Brief background

Patient-centred follow-up has the potential to:

• Detect clinical issues earlier, leading to improved patient outcomes
• Identify unmet needs in hard-to-reach populations, reducing healthcare inequality
• Reduce missed clinic appointments and waiting list times
• Save taxpayer costs
• Empower patients with data about their symptom severity
• Reduce the environmental impact of in-person follow-up, in-line with James Lind Alliance priorities for greener surgery

We have chosen carpal tunnel syndrome and thumb-base osteoarthritis as clinical substrates for this work because they are common. Subsequently, we will expand this work to include other pathology in hand surgery and beyond.

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Research question

How do members of the UK population value health states described by the Patient Evaluation Measure?

Brief background

Delivering value-based hand surgery is essential in a budget constrained NHS, with limited resources and growing demand. Defining a preference-based hand-specific outcome measure will inform shared decision-making between surgeons and patients, at the individual patient level. Our work will permit cost-effectiveness analysis of treatments using existing datasets such as the UK Hand Registry, and in future, data from large randomized trials. This will enable us to better define the clinical value of interventions for hand conditions. This will have significant implications on the appraisal of new health technologies and the commissioning of hand surgery services on a national level.

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Research aim

• To develop an improved classification of PIPJ intra-articular fractures which provides a useful, evidence based guide for the management of these injuries
• Design further studies to establish what is the optimum treatment for PIPJ intra-articular fractures

Brief background

Intra-articular fractures of the proximal interphalangeal joint (PIPJ) are associated with poor outcomes. A wide variety of treatment techniques are used and there is minimal high quality evidence regarding the optimum treatment method. At present there is no evidence based classification of this fracture pattern which provides the treating clinician with a suggested management plan depending on the type and severity of the injury. PROJECT is a large multi-center UK wide service evaluation, supported by the BSSH and designed to collect data on the epidemiology, fracture patterns, treatment and outcome for these injuries.

Final report awaited

Research aim:

To develop and validate a deep learning algorithm that can detect scaphoid fractures on scaphoid view radiographs.

Brief background

Scaphoid fractures are the commonest carpal bone fracture and are easily missed on initial radiograph. Expert review by MSK radiologists is often not available acutely, and many patients have an occult fracture that is not visible on x-ray. An integrated AI diagnostic aid may help to improve diagnostic accuracy for junior clinicians in the ED, and may be able to predict occult fractures, allowing hospitals to triage patients to MRI more effectively. This study will also provide an important proof-of-concept for AI integration in x-ray interpretation, encouraging further research in other common fracture types.

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Research question

Is it feasible to conduct a randomised controlled trial to investigate the management of ulnar collateral ligament injuries of the thumb; specifically comparing surgery vs. non-operative treatment

Brief background

Acute injuries of the ulnar collateral ligament (UCL) of the thumb are common, accounting for more than 50 per 100,000 emergency department presentations. A recent systematic review identified no prospective evidence comparing surgery to non-operative treatment for acute complete ruptures of the thumb UCL. In addition to this there is no clear consensus in the literature regarding the most effective way to manage these injuries; including the role of clinical examination, modality of imaging, the role of surgery, the type of splinting and the rehabilitation protocol. This lack of evidence poses a great challenge to treating clinicians, as well as making decisions difficult for the affected patients.

Research question

To what extent do the extrinsic finger flexors and extensors influence motion at the wrist? The hypothesis is that these muscles significantly influence both resultant kinematics and the forces in other muscles that control the wrist.

Brief background

The position of and force on the fingers are closely inter-related with those of the wrist joints.1,2 The finger extrinsic muscles are located within the forearm and the forces of their tendons affect all articulations they traverse. The effect of these muscles cannot be underestimated; e.g., flexor digitorum profundus (FDP) comprises 12% of the tension capability of muscles below the elbow.3 Moving proximally, moment arms increase at each joint, so forces at the fingertips have a comparatively larger effect on the wrist than the interphalangeal joints. However, the extrinsic finger muscles’ effect on wrist motions and stability is unknown.

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Research question

• Can patient estimate their hand function accurately? What is the correlation between objective (Sollerman function test) and Subjective (MHQ) hand assessment tools?
• How does the correlation between objective (Sollerman) and subjective (Michigan Hand
• Questionnaire) hand assessment scores change over time when assessed six weeks later?

Brief background

Patient reported outcome measures (PROM) in hand surgery assesses patient function by asking questions about hand grip along with patient’s estimation of disability. Recent evidence has shown that these PROMs could introduce recall bias and inaccurately estimate function despite the convenience of their use (Stepan et al, JBJS 2013; Singh et al, 2014 JHS (E)). Random error related to the duration of time elapsed since initial assessment could introduce recall bias (Howell et al, J Arthroplasty 2008). The main aim is to quantify whether patients accurately estimate their hand function by measuring the correlation between subjective PROM (MHQ) questionnaire and objective hand function test (Sollerman). The secondary aim is to identify the recall accuracy within six weeks between subjective and objective assessment tests.