Paul, a former chef from Wolverhampton, has spent nearly ten years with chronic pain so severe he couldn’t hold a knife or a fork, let alone do his beloved cooking.
This started with a diagnosis of skin cancer on his hand, which meant that he needed an amputation of his index finger. After the surgery he needed to remove the cancer, Paul experienced significant nerve pain: “I couldn’t hold a knife or a fork, a spoon. It was embarrassing. When going out for a meal you have no control whatsoever and it’s painful. It feels like getting a massive electric shock – day and night. You’d get a horrible tingling up the arm and every now and then you’d get a big jolt of electric shock.”
Several attempts to improve his pain with nerve procedures unfortunately didn’t work. In 2025 he was seen by Mr Paul Malone, Consultant Peripheral Nerve, Spasticity and Hand, Plastic Surgeon, at the Royal Orthopaedic Hospital. After multiple reassessments, despite all of the pain and hypersensitivity being mapped to the hand, Mr Malone subsequently carried out a procedure to release the median nerve in the forearm (pronator tunnel) and wrist (carpal tunnel), whilst leaving the most sensitive area in the hand, untouched.
A week after the surgery Paul could finally use his hand properly again, perhaps for the first time in ten years. He explained: “Before I left hospital I was told to do a series of exercises when I got home. Within five days at home and doing the exercises the hand was absolutely perfect, no pain. I can bend my whole arm, and even do up shirt buttons which I haven’t been able to do for a long time. I’ve got some scarring right across the wrist so I was worried about that being painful but it’s been great.”
For Paul, he’s finally getting his independence back. “It’s unbelievable. I can have a shave if I want,” He adds. “All things really – I was a chef, retired now, but I was a chef for 50 years. For the last few years I haven’t been able to do what I want to do. I can use my knives now and make sauces (I can even use a whisk one handed!). It might seem like lots of trivial things that I couldn’t do before but when you lose them it really impacts your mental health. I’d get annoyed not being able to do things myself, or dropping things. And then there was the pain on top of it. Now I’m pain free and I can do what I want to do again. I’m really happy and grateful.”
Paul’s surgeon, Mr Paul Malone, added: “Paul’s nerve pain has been very difficult to pin-down in terms of what exactly has been the biggest contributing factor. He had a typical scenario we term ‘double-crush phenomenon’, whereby there are multiple sites traumatising a nerve, and so a surgical plan is all about a stepwise approach, targeting the ‘easiest-to-treat’ sites first. For Paul, pressure on his median nerve in his neck, upper arm, elbow, forearm, wrist and hand, were all contributing to symptoms manifesting in his severe hand pain. We had a lot of consultations before we agreed to proceed, anticipating multiple staged operations, whilst accepting that he still may have residual pain. In the end, we undertook just one operation on his forearm and wrist, which revealed very tight compression points about his median nerve that could not be identified with any pre-operative imaging or nerve studies. We are all absolutely delighted that now five months following his surgery, he remains, in his own words, “100% pain free”.”
