Hand & Wrist

Mr Grieve has extensive expertise and experience in hand and wrist surgery. He is a member of the Irish Hand Surgery Society, British society of Surgery of the Hand, the American Hand Surgery Society and the European Wrist Arthroscopy Society. He offers a very modern approach to hand and wrist conditions and has a large wrist arthroscopy practice which includes arthroscopy of the small joints of the hand and wrist (keyhole surgery) and endoscopic (minimally invasive) nerve releases. All patients are referred to Blackrock Clinic's hand therapist, Louise Murray to maximise their outcomes.

Below are listed the common hand and wrist conditions treated:

HAND   More Info...

Dupuytren's Contracture
This bothersome and functionally limiting condition is caused by thickening and contracture of the natural bands of tissue that hold the palmar skin firmly in place. Often called the 'Celtic hand' or 'Vikings curse' it can become a serious issue when the fingers are involved badly. I offer the most modern treatment in the form of Xiapex injections or minimally invasive needle fasciotomy as well as the established standard treatment of fasciectomy and the radical treatment of dermo-fasciectomy (both of which involve surgery to remove the diseased tissue).
Trigger Finger or Trigger Thumb
This condition causes the finger or thumb to stick like a trigger and can be treated with an injection or released with a very small operation.
Lumps and Bumps
These are often caused by ganglion cysts (seed ganglions) or benign tumours and can be removed if symptomatic. Skin cancers on the hand are best treated by plastic surgeons and an onward referral will be made.
Finger or Hand Lacerations/Nerve Injuries
These can be very minor or devastating injuries. Nerves, vessels and tendons can be cut and all will need repair. Rehabilitation by our hand therapist is essential for the best outcomes. The repair often needs the use of an operating microscope. Amputations of digits can be serious and may need onwards referral.
Tendon Injuries (Lacerations and Avulsions)
Both flexor tendons (on the palm side) and extensor tendons (on the back of the hand) can be repaired. Avulsions of tendons such as 'Jersey Finger' and 'Mallet Finger' are treated with surgery if need be. Tendon repairs need proper rehabilitation by our hand therapist for optimal outcomes.
Arthritis
I treat arthritis of the fingers if painful and symptomatic. I perform modern pyro-carbon finger joint replacements if needed and offer injections for painful joints in the first instance.
Thumb Base Arthritis
This common condition is readily treatable with injections in the first instance. Multiple options exist once injections no longer work including: thumb base arthroscopy and interposition grafting; excision of trapezium (trapeziectomy) with or without suspension; Mini tight-rope suspension following trapeziectomy and even joint replacement.
Fractures
See fracture section

WRIST   More Info...

Wrist Arthroscopy (Keyhole Surgery)
Wrist arthroscopy is a modern and advanced method of diagnosing and treating all kinds of acute and chronic wrist disorders. It is an operation in which the surgeon looks directly at the joint surfaces with a specialised telescope and a can see the cause and treat wrist disorders. Wrist arthroscopy has led to the diagnosis and classification of injuries that were previously not well understood or described (such as wrist ligament injuries). I use it for diagnostic purposes and as an aid to the treatment of wrist ligament injuries, wrist fractures and triangular fibrocartilage complex (TFCC) problems. It is minimally invasive and leaves only tiny, often imperceptible scars.
Scaphoid Fractures and Scaphoid Non-union
The scaphoid is an important bone in the wrist proper (the carpus). It has a vulnerable blood supply and when fractured often needs surgery to ensure proper healing. I perform this often using a minimally invasive technique (4mm scar to insert a 20-26mm screw under x-ray guidance). When the scaphoid is broken and fails to heal properly it requires fixation often with bone grafting to affect a repair. Sometimes the bone graft requires micro-surgery and I perform these operations to prevent the development of severe wrist arthritis.
Carpal Dislocations
Falls and injuries can cause dislocations of the carpal bone as well as fractures. These very serious injuries need prompt treatment and can lead to many complications. See below.
Wrist Arthritis
Wrist arthritis may develop for many and various reasons. Often is secondary to an (unnoticed or minor) injury or a fracture. There are many options to treat wrist arthritis but my first line is often injection to ease the symptoms. I have had excellent results with wrist denervation to rid patients of disabling pain. Partial wrist fusions (making painful immobile joints into painless immobile joints by sticking them together surgically) and total wrist fusions are offered but only after failure of other means as they cause a decreased range of motion. Recent advances in pyrocarbon wrist replacements also allow for this option if needed.
Wrist Denervation
This operation has been popular in Europe for many years but has been relatively slowly accepted in the English speaking regions. Through my experience in London, Paris and Germany I have come to adopt it as a first line treatment for disabling wrist pain. It involves cutting the tiny nerves that innervate the wrist only in order to break the pain signals. Pre-operative assessment by a hand therapist is essential prior to embarking on this route.
Carpal Ligament Injuries (Wrist Sprain)
These injuries can be trivial or potentially disastrous depending on the ligament involved and the severity of the injury. A broken bone has more predictable healing than a ligament and often these are more serious than a fracture. Early prompt diagnosis is essential. Two important ligamnets that can be damaged are the scapho-lunate ligament or luno-triquetral ligament (both import stabilising ligaments in the carpus). I use MRI, MRI arthrogram and wrist arthroscopy to diagnose and treat. Often a cast is needed and extensive post-operative rehabilitation.
The Triangular Fibrocartilage Complex (TFCC)
The TFCC is a complicated ligamentous structure on the ulnar (opposite to the thumb) side of the wrist. It is responsible for the stability of the distal radio-ulnar joint (DRUJ) which allows rotatory movements of the forearm. It can be injured by falling or through arthritis. I use MRI, MRI arthrogram and wrist arthroscopy to diagnose and treat the problems.
The Distal Radio-ulnar Joint (DRUJ)
In see and treat injuries to this region. Symptoms include inability or pain on rotation of the forearm.
Carpal Tunnel Syndrome
This common nerve entrapment can be relieved by endoscopic means (keyhole surgery) or open means. The symptoms are very obvious with pain, pins and needles, sometimes numbness and weakness in the thumb, Index, Middle and half the ring finger often at night.
De Quervain's Tenosynovitis
This painful condition is often amenable to injection. It is caused by tendonitis of the radial (thumb) side of the wrist and on moving the wrist in particular ways. Sometimes surgery is required to relieve the symptoms.
Ganglion Cysts
These lumps and bumps on the back of the wrist or less commonly the front near the thumb are benign and do not necessarily need removal. The old treatment of hitting them with the family bible is no longer recommended! I remove them by keyhole surgery if possible.
Undiagnosed Wrist Pain
The wrist can be involved with any inflammatory or other type of arthritis and may only be one joint affected out of many. Referral to a rheumatologist can be arranged if so.

An Important Note from Mr. Grieve



As per the Hippocratic Oath I firstly endeavour to 'do no harm' by my treatment. However no surgery is without complications and this must be recognised. All my fracture patients will receive follow up by a physiotherapist and/or hand therapist to maximise their results after surgery.