An opinion grounded in the evidence base itself
Not a general orthopaedic opinion applied to Dupuytren's disease
Dupuytren's disease is a specific interest rather than an incidental one. Professor Warwick holds a second doctorate — a Doctor of Medicine awarded by the University of Southampton in 2020, by amalgamation of published research, for a body of work titled Dupuytren's Disease: My Journey. He is Editor of the European Textbook of Dupuytren's Disease (2015), and an Honorary Lifetime Member of the International Dupuytren Society, the first ever recipient of that honour, in recognition of his international contribution to the field. He has twice been appointed to examine doctoral theses on Dupuytren's disease, in Sweden and the Netherlands.
He is a co-author of the DISC trial — the randomised controlled trial comparing collagenase injection with limited fasciectomy, published in the New England Journal of Medicine in 2024 and reported in full for the NIHR Health Technology Assessment programme. Where a claim turns on whether the treatment offered was reasonable, that evidence base is the one the court is likely to be referred to.
He remains in full-time clinical practice, running five clinics and five operating lists each week. An opinion on what a reasonable hand surgeon would have done is therefore grounded in current operative practice rather than in retrospective review alone.
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 treatment selected — needle fasciotomy, collagenase injection, limited fasciectomy or dermofasciectomy — fell within the range a reasonable hand surgeon would offer for the stage of disease presented.
Whether operative injury, most commonly to a digital nerve or artery, represents a recognised complication of a properly performed procedure or a departure from acceptable practice.
Whether recurrence, incomplete correction or stiffness reflects the natural history of the disease or the standard of the treatment provided.
Consent
Whether the risks, benefits and reasonable alternatives were discussed in the terms required following Montgomery, including the materially different recurrence and recovery profiles of the available treatments.
Professor Warwick has written and lectured on consent in hand and wrist practice, including for the British Orthopaedic Association.
Causation
Whether an index injury or occupational exposure caused, accelerated or is unrelated to the development of the disease — frequently the central issue where Dupuytren's is alleged to follow a hand injury or a period of manual or vibratory work.
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
Current functional deficit, grip and dexterity, and the effect on work, hobbies and daily activities.
Likely progression, the probability and timing of recurrence, the prospect of further surgery, and reasonable costings for future treatment.
Peer-reviewed research on Dupuytren's disease
A selection of Professor Warwick's published work on the condition, all indexed on PubMed.
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.