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Conditions affecting the shoulder, elbow, wrist and hand are common causes of pain and disability particularly in working age and older adults. Surgical treatments for arthritis, nerve compression, joint contractures and instability are now widely used. 

The expansion of some types of surgery and choices between different types have evolved  without high quality evidence. There is also likely local and regional variation in the provision and access to surgical treatments, and potentially variation in the outcomes. 

With an aging UK population and more and more patients suffering with upper limb problems there are more referrals from general practice to hospital secondary care each year. One of our overall aims is to provide higher quality evidence on effectiveness of some upper limb surgical treatments, to understand which patients are most likely to benefit from surgical treatment, and to examine geographical variations in access and provision of care.

Current research studies

We are conducting a series of studies looking at upper limb musculoskeletal conditions including:

  • Patterns and variation in provision of different surgical treatments over time and by geographical location within England
  • Adverse outcomes of surgery – risks of reoperation, serious adverse events and mortality
  • Analysis of costs of treatment and variation in costs

We are using a large dataset of Hospital Episode Statistics with up to 19 years of follow-up to provide precise estimates of treatment incidence, costs, risks of surgery and long-term reoperation risks. Statistical modelling methods are used in risk association studies to adjust for the effects of confounding factors.


The results of our research will be disseminated in peer-reviewed publications and, where relevant, in patient-centred materials. We anticipate that the results will be of interest to all stakeholders including patients and healthcare professionals making shared decisions.


See a list of our publications

Related research themes