Nationwide Independent, CPR Part 35-compliant expert evidence for Claimant and Defendant

Hand & Wrist Medicolegal  /  Carpal tunnel syndrome

Expert witness reports

Carpal tunnel expert witness reports

Independent, CPR Part 35-compliant expert evidence on carpal tunnel syndrome, carpal tunnel release and median nerve injury, for personal injury and clinical negligence claims. Instructed by Claimant and Defendant across the United Kingdom.

4 studies
Peer-reviewed research on return to work and sickness absence after carpal tunnel release
BMJ Open
Multicentre prospective cohort study, 2021
Systematic review
Scandinavian Journal of Work, Environment & Health, 2018
30+ years
In continuing full-time practice as a hand surgeon
Why this expert

Published research on the exact question quantum turns on

How long someone is genuinely off work after carpal tunnel release

Where a carpal tunnel claim turns on how long the Claimant could reasonably have been off work, that is not a matter of impression. Professor Warwick is a co-author of four peer-reviewed studies on return to work and sickness absence after carpal tunnel release, including a multicentre prospective cohort study in BMJ Open and a systematic review in the Scandinavian Journal of Work, Environment & Health.

That body of work also covered what UK hand surgeons and hand therapists actually advise patients, published in the Journal of Hand Surgery (European Volume). Where a report needs to say what reasonable advice looked like, that evidence is directly on point.

He remains in full-time clinical practice, running five clinics and five operating lists each week, so an opinion on what a reasonable surgeon would have done rests on current operative practice rather than recollection.

Scope

What the report can address

Three questions are addressed in every report: whether the treatment chosen fell within the range a reasonable hand surgeon would have offered, whether a complication reflects a recognised risk or a departure from acceptable practice, and what is attributable to the natural history of the condition rather than to the treatment given. Beyond those, the report addresses the issues pleaded, and states a range of opinion where one genuinely exists.

Clinical negligence

Whether the decision to operate, the timing of surgery and the technique used fell within the range a reasonable hand surgeon would adopt for the severity of compression demonstrated.

Whether injury to the median nerve, a motor branch or a digital nerve represents a recognised complication of a properly performed decompression or a departure from acceptable practice.

Whether persistent or recurrent symptoms reflect incomplete release, the natural history of the condition, or a diagnosis that was never carpal tunnel syndrome.

Diagnosis and delay

Whether the diagnosis should reasonably have been made earlier, and what difference earlier treatment would have made to the outcome.

The weight properly given to nerve conduction studies where they conflict with the clinical picture.

Causation

Whether an index injury or occupational exposure caused, accelerated or is unrelated to the development of the condition.

Where the scientific literature does not support a confident conclusion either way, the report says so plainly rather than overstating the position.

Condition, prognosis and quantum

Residual sensory loss, grip and pinch strength, cold intolerance and scar tenderness, and the effect on work and daily activities.

A view on reasonable time off work grounded in published evidence rather than impression, and on the likelihood of further surgery.

Published work

Peer-reviewed research

A selection of Professor Warwick's published work in this area, all indexed on PubMed.

Sickness absence after carpal tunnel release: a multicentre prospective cohort study
BMJ Open · February 2021 · PMID 33568370
Return to work after carpal tunnel release surgery: a qualitative interview study
BMC Musculoskeletal Disorders · May 2019 · PMID 31113433
Sickness absence after carpal tunnel release: a systematic review of the literature
Scandinavian Journal of Work, Environment & Health · November 2018 · PMID 30110115
Return to work recommendations after carpal tunnel release: a survey of UK hand surgeons and hand therapists
Journal of Hand Surgery (European Volume) · October 2018 · PMID 30005582
DASH and Boston questionnaire assessment of carpal tunnel syndrome outcome
Journal of Hand Surgery (British & European) · April 2004 · PMID 15010164
Instructing

How to instruct

Instructions are accepted from Claimant and Defendant solicitors, insurers and medico-legal agencies, and as Single Joint Expert. Examinations are held in Southampton, Winchester and Jersey, and the practice accepts instructions nationwide.

Separate rates apply for NHS Resolution panel solicitors. Fixed report fees and deferred payment terms are available. Professor Warwick's medico-legal work is fully indemnified by Sempris, and he is registered with the General Medical Council with entry on the Specialist Register.