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Services

Injuries and degenerative conditions of the upper limb can lead to persisting pain and loss of function.  Dr Tiedgen provides expert care and personalised treatments for a comprehensive range of upper limb conditions to treat you. He is also a specialist in general Orthopaedic trauma.

Hand & Wrist 

Trigger Digits

Inhibition of the hand flexor tendon gliding due to impingement within its tunnel (pulley). This can cause pain, clicking, catching and locking of the finger or thumb. Treatments includes splinting, cortisone injections and surgical release.

Finger and thumb arthritis

Arthritis is common in the fingertips (distal interphalangeal joints) and the base of thumb (1st carpometacarpal joint), however can occur anywhere in the hand. This can cause pain, stiffness and deformity. Operative treatments range from fusion to joint replacement tailored to the patient and the joint affected.

Hand tumours

Masses/lumps in the hand can be of great concern and need prompt evaluation by a hand surgeon such as Dr Tiedgen. After investigation and if causing symptoms treatment may involve a surgical excision.

Carpal Tunnel Syndrome

Compression of the median nerve at the wrist. This can cause night pain, numbness in the fingers, and weakness. Treatments include splinting, cortisone injections, and surgery which can be performed open or keyhole (endoscopic).

Dupuytren's Disease

A proliferative progressive condition where the lining of the hand/finger (Fascia) contracts. This can cause hand/finger contractures and painful nodules. Treatment often involves surgery if the contracture is affecting the patient's function.

Wrist pain

Wrist pain can develop due to injury or arthritis with many specific causes. Dr Tiedgen will performed a thorough examination and often further imaging investigations to reach a diagnosis. He will then tailor his treatment for you based on the cause to give you the best outcome.

Elbow

Elbow arthritis

Degenerative joint disease causing pain and stiffness. Common causes include osteoarthritis and post traumatic. Treatment can range from non operative measures such as medication and steroid injection, to operative interventions including arthroscopic (keyhole) debridement or joint replacement surgery.

Cubital Tunnel syndrome

Compression of the ulnar nerve at the level of the elbow. This can lead to pain, numbness in the little and ring fingers, and weakness of the hand. Treatment includes splinting or surgery involving a release of the nerve from where it is compressed.

Elbow instability

Instability can occur following trauma (elbow dislocation) or following chronic overuse from sports. Symptoms include pain, feeling of giving way, clicking and catching. Treatment involves physiotherapy and if symptoms continue may require surgery (either direct ligament repair or reconstruction using a tendon graft).

Elbow stiffness/contracture

Stiffness of the elbow can lead to a loss of function in performing daily activities. This can occur following arthritis, trauma, loose bodies in the joint or ligament contracture. Treatment includes physiotherapy or operations such as arthroscopic (keyhole) debridement or open joint release.

Distal biceps rupture

When the flexed elbow is forced straight against resistance the biceps tendon can tear off its' insertion. This is often felt as a pop and causes pain and weakness of the arm. An MRI is often performed to confirm diagnosis. If the weakness is not acceptable to the patient then surgery is offered and involves reinsertion of the tendon.

Medial and lateral epicondylitis

Medial epincondylitis (golfer's elbow) and lateral epicondylitis (tennis elbow) are overuse syndromes leading to inflammation of tendons around the elbow. This causes pain worsened by some wrist/forearm movements. Treatment is mainly non operative however if symptoms are persistent then surgery may help.

Shoulder

Rotator cuff tear

The rotator cuff are the muscles surrounding the shoulder that contribute to movement and stability. A torn rotator cuff is a common source of pain and weakness in the shoulder. This can occur after an acute trauma in the young or as a degenerative process in the elderly. Treatment depends on the chronicity of symptoms, severity of tear, age of patient and their functional demands. This may be physiotherapy or surgery (arthroscopic/keyhole repair or mini open repair).

Shoulder instability

Instability may continue following a traumatic shoulder dislocation. This can also lead to pain and repeated dislocations. Repeated dislocations. leads to damage to the stabilising structures around the shoulder. Treatment may be operative or non operative depending on chronicity of symptoms, risks factors for recurrence and severity of damage to stabilising structures (bone and soft tissue). Surgery may be arthroscopic (keyhole) stabilisation or an open stabilisation.

Acromioclavicular joint arthritis/instability

Arthritis can develop in the acromioclavicular joint from repetive motion and lead to pain. Treatment includes cortisone injections and modifying activities, however if this fails then the distal portion of the clavicle is excised (either keyhole or open)

Instability can occur following trauma due to disruption of stabilising ligaments. If the acromioclavicular joint is severely displaced it may require repair (or reconstruction in chronic cases).

Shoulder arthritis

Arthritis is loss of the normal joint cartilage surface leading to pain and stiffness. This is most commonly due to osteoarthritis or chronic rotator cuff tear. This is often evaluated with imaging including an X-ray, CT scan and MRI scan. Treatment involves non operative measures such as physiotherapy and cortisone injections, but if this fails the treatment is a shoulder joint replacement.

Frozen shoulder

Also known as adhesive capsulitis, it is a condition characterised by stiffness of the shoulder and pain. It is more common in diabetics or following an injury. Treatment is primarily physiotherapy, however if this fails to improve range of motion after sufficient time then surgery (arthroscopic release) may improve symptoms.

Shoulder pain

The shoulder joint is complex and there are multiple causes for pain other than arthritis, instability, rotator cuff tear, or acromioclavicular joint pathology. This can include bursitis, biceps tendonitis, SLAP tears, calcific tendonitis and many more. Dr Tiedgen will perform a thorough examination and through further investigations come to a diagnosis to the most likely cause. He will then tailor his management to you to give you the best outcome possible. 

Fractures & Trauma

Upper limb fractures

Dr Tiedgen treats all upper limb fractures- this includes forearm fractures (radius and ulna), fractures about the elbow (radial head, olecranon, distal humerus), humeral shaft fractures, fractures about the shoulder (proximal humerus, scapula/glenoid) and clavicle fractures.

Non union and Malunion

Non union is when fractures do not heal in the expected time. This may due to innapropriate treatment, patient factors such as smoking, or injury factors. Treatment can involve revision fixation or bone grafting.

Malunion is when fractures heal in an incorrect position. If this causes a loss of function then a corrective osteotomy can be performed- this is when the bone is 're-broken' and set in a correct position. 

Lower limb fractures

Dr Tiedgen treats fractures of the lower limb in addition to upper limb. This includes hip fractures (including those requiring joint replacement), femur fractures, fractures about the knee (distal femur, tibial plateau), tibial shaft fractures, ankle fractures, and fractures of the foot.

Hand and Wrist Fractures

Hand and wrist fractures are common. They are also complex and if not managed appropriately can lead to loss of function. The key to the treatment of these injuries is solid fixation to allow early motion guided by hand therapy. Treatment is determined by the type of fracture but includes splinting, K wires, screws and plates. 

Tendon injuries of the hand

Tendon injuries can occur from forced resistance (also known as jersey fingers or mallet fingers) or from laceration. Repair of tendons is essential to restore hand function. If  treatment is delayed, or tendon rupture occurs due to attrition (continued abrasion) surgery may require tendon reconstruction or tendon transfer.

Soft tissue lacerations

Soft tissue lacerations can lead to injury to tendon, nerve and ligament- all of which Dr Tiedgen is skilled at repair. Particularly in the hand, lacerations can lead to a soft tissue defect. Dr Tiedgen has expertise of local flap options to reconstruct fingertip defects following trauma.

Peripheral Nerve 

Nerve repair

Following a laceration, nerves may be injured. This can include sensory nerves (commonly digital nerve in the finger) or larger nerves that contribute to movement in the hand as well. Dr Tiedgen uses microsurgical techniques under magnification/miscroscope for the most accurate repair. In cases of delayed repair or segmental loss of the nerve, then a nerve graft may be required. 

Tendon transfer

Chronic nerve injury or compression can lead to irreversible muscle weakness in the hand. If this is affecting patient function then a tendon transfer can be performed. This utilises muscles which are still working and inserting their tendons into those affected by the nerve injury.

Nerve decompression

Nerves can be compressed at sites around the body leading to pain, numbness and weakness. This is most commonly carpal tunnel syndrome (median nerve at the wrist) and cubital tunnel syndrome (ulnar nerve at the elbow). Other nerve compression syndromes Dr Tiedgen treats include radial tunnel syndrome, PIN compression, pronator syndrome, and AIN compression.

Neuroma surgery

Neuroma can be a cause of ongoing pain and sensitivity following a laceration or fingertip amputation. This occurs if a cut nerve is close to the surface of the skin causing irritation. Treatment involves desensitisation or surgery (either repair of previously cut nerve or by resecting the nerve further away from the skin and burying deeper in local soft tissues to prevent recurrent irritation.

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