This is a typical consulting room where you may see me. The important thing that we have at this time is that I really want to take time listening to you about what your hand problem is, and in fact most of the diagnoses I make are from actually just talking to you and listening to what you are telling me. After we have listened to you, talked to you, and understand what your problem is, I will then examine your hand and wrist, and maybe even your elbow, shoulder and your neck. Once I have examined your hands, looking particularly where the problem is, whether it be a catching tendon, pain, or pins and needles from a nerve-type problem, we often have the diagnosis, but occasionally we need to do special investigations, and these may start with a simple plain X-ray, an ultrasound scan, or an MRI scan, and on occasions I arrange special nerve tests just to see whether a nerve is trapped somewhere in your upper limb. I am very mindful about organising special tests such as scans because they do cost people money, whether it be you as a self-pay patient, the health service in an NHS patient, or private medical insurance, so I will only do the investigation if I think it adds to your clinical management.