Institut du Poignet
Clinical expertise
The practice covers the full range of traumatic, degenerative and ligamentous conditions of the hand and wrist, with a particular concentration on complex and previously treated wrists.
Frequent reasons for referral
Persistent pain with normal imaging
MRI does not exclude a wrist lesion. Dynamic instability, partial ligament tears and cartilage lesions are frequently missed on static imaging and require specialised clinical assessment.
Sprains that fail to settle
Wrist pain persisting beyond six weeks after a fall is rarely a simple sprain. Occult scaphoid fracture and scapholunate injury are the two diagnoses not to miss.
Ulnar-sided wrist pain
TFCC lesions, ulnocarpal impaction, distal radioulnar joint instability and ECU tendon pathology share a narrow anatomical territory and overlapping symptoms.
Failed previous surgery
Persistent symptoms after a first procedure warrant reassessment of the original diagnosis before any revision is considered.
Conditions treated
Carpal instability
Scapholunate and lunotriquetral ligament injuries, dynamic and static instability, DISI and VISI deformity, chronic reconstruction.
Scaphoid
Acute fractures, delayed union, nonunion with or without humpback deformity, avascular necrosis of the proximal pole, SNAC wrist.
Ulnar-sided pathology
TFCC tears, ulnocarpal impaction syndrome, distal radioulnar joint instability, extensor carpi ulnaris instability.
Trauma and sequelae
Distal radius fractures, malunion, post-traumatic stiffness and carpal collapse.
Nerve compression
Carpal tunnel syndrome including endoscopic release, cubital tunnel syndrome, revision neurolysis.
Tendon and soft tissue
De Quervain tenosynovitis, trigger finger, dorsal and volar ganglion cysts, glomus tumour.
Surgical approach
Minimally invasive and arthroscopic techniques are preferred whenever the pathology allows. Beyond smaller incisions, wrist arthroscopy provides direct assessment of ligament and cartilage lesions that imaging characterises poorly, and preserves the capsular blood supply on which healing depends.
Each case is planned individually. Where reconstruction is no longer appropriate, the objective shifts to relieving pain and preserving functional motion.
Second opinions
A substantial part of the practice consists of second opinions on wrists that have already been investigated or operated on elsewhere. Patients and referring colleagues are welcome to send imaging and operative reports ahead of consultation.