Published authority on the instability that precedes the arthritis
Where a claim turns on whether an injury started the process
Professor Warwick is first author of Diagnosis and Treatment of Carpometacarpal Instability, published in Hand Clinics in 2022. Where a claim alleges that an injury caused or accelerated thumb base arthritis, the question is usually whether instability was set up at the time of injury, and that paper addresses it directly.
He has also published on midcarpal instability following excision arthroplasty and on the in vivo performance of wrist arthroplasty implants, and has written the wrist arthritis chapters in the Oxford Textbook of Orthopaedics and Trauma and in Apley & Solomon's System of Orthopaedics and Trauma.
Thumb base arthritis is extremely common in the general population, which makes the apportionment question, how much is attributable to the index event and how much would have occurred anyway, the issue on which these claims are usually decided.
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.
Causation and apportionment
Whether the index injury caused, accelerated or is unrelated to the arthritis now complained of, given how common thumb base arthritis is in the general population.
Whether ligament injury at the time of the index event set up the instability that led to degeneration.
Where the literature does not support a confident conclusion either way, the report says so plainly rather than overstating the position.
Clinical negligence
Whether the instability or arthritis was reasonably diagnosed and investigated, or attributed to a soft tissue sprain without adequate assessment.
Whether the procedure selected fell within the range a reasonable hand surgeon would adopt for the stage of disease demonstrated.
Condition, prognosis and quantum
Pinch and grip strength, pain on loading, deformity, and the effect on work, hobbies and daily activities.
The likelihood and timing of further surgery and reasonable costings for future treatment.
Peer-reviewed research
A selection of Professor Warwick's published work in this area, 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.