Peripheral Nerve Injury Unit

• Exploration, repair and non-operative treatment in adult brachial plexus injury
• Exploration, repair and non-operative treatment in obstetric brachial plexus injury (OBPP)
• Peripheral nerve injury in upper or lower limbs
• Nerve tumours
• Palliative upper limb surgery after central nervous lesion i.e. reconstruction of spastic deformity
• Injuries to the lumbo-sacral plexus
• Surgical reconstruction of limb function after peripheral nerve injury

For Urgent referrals you must call the PNI department directly on 0203 947 0051 as well as submitting the Pathpoint referral form through this 'PATHPOINT' link 

From May 2022, the RNOH Peripheral Nerve Injury service committed to using ‘PATHPOINT’, an electronic referral and pathway management system, for all Consultant-led referrals from secondary and tertiary care organisations.

General Practitioners should continue to refer to RNOH using the UK Electronic Referral System (ERS)- please see below.

PATHPOINT offers significant benefits to referrers:

·  Secure, streamlined, electronic referral forms

·  Receive updates and notifications in real time

·  Increased visibility of all referrals and triage outcomes

To submit a referral to the Peripheral Nerve Injury unit please access the 'PATHPOINT' link (within your Secure hospital network) and follow the steps below:

1.    Register with your personal NHS email address for a PATHPOINT account to manage your referral/s

2.    Login to your account with your credentials by clicking the 'PATHPOINT' link

3.    Input your referring organisation, and patient PID details

4.    Click the drop down list of referral pathway forms and select EITHER:

“Tertiary Brachial plexus injury referral” or “Tertiary Peripheral Nerve injury / Tumour referral”

Then click "Go to referral form" to launch the form

5.    Fill in all fields of either the Tertiary Brachial plexus injury referral form or the Peripheral Nerve injury / Tumour referral form and click "Save Tertiary referral" to submit

NB: You will receive notification emails to your NHS email account from PATHPOINT from the Peripheral Nerve Injury unit with updates about the status of your referral if further information is required. 

To give your feedback, or for any further questions, please email the relevant contact below: 

PATHPOINT Technical Support: support@openmedical.co.uk 

For further information on the PATHPOINT system, please click here

Referrals are accepted from GPs and consultants. If you are a GP referring to the RNOH please use the NHS e-Referral Service system, e-RS.

• Referral guidelines: Birth Brachial Plexus Palsy / Proning advise and pathway for COVID19 patients
• Proning advice and pathway for COVID19 patients

**Please note: All referrals should be accompanied by scan/diagnostics/results**

All  correspondence should be addressed to the Stanmore branch of the hospital on rnoh.nerveinjury@nhs.net 

Unit co-ordinator:

Telephone 020 3947 0622

Mr Michael Fox's secretary:

Tel: 020 3947 0051

Email anna.halsey@nhs.net

Dr Marco Sinisi's secretary:

Tel: 020 3947 0051

Email elizabeth.hare1@nhs.net

Mr Ashley Simpson's secretary:

Tel: 020 3947 0051

Email: juliettehoughton@nhs.net

Miss Anna Panagiotidou’s secretary:

Tel: 020 3947 0051

Email lisa.karr2@nhs.net

Peripheral Nerve Injury 

Mr Mike Fox - Peripheral nerve, shoulder, and complex nerve injuries and associated trauma, and obstetric brachial plexus lesions

Mr Marco Sinisi - Obstetric and adult brachial plexus lesions, nerve traumatic lesions, tumours and reconstructive work after paralysis.

Miss Anna Panagiotidou – Traumatic Brachial Plexus Injuries (TBPI), Nerve Tumours, Complex Nerve Injury Reconstruction, Obstetric Brachial Plexus Palsy’s (OBPP).

Mr Ashley Simpson - Adult and Paediatric Brachial Plexus and Peripheral Nerve Injuries, Nerve Sheath Tumours, Thoracic Outlet Syndrome

The Peripheral Nerve Injury Unit at NOHl offers an observership program, welcoming qualified doctors and medical students with a dedicated interest in peripheral nerve injury surgery.

Our observerships range from 2 weeks to 3 months and provide a unique opportunity to observe specialised cases and innovative management approaches in a renowned national referral centre for brachial plexus and peripheral nerve injuries.

During this observership, participants gain comprehensive exposure to both our operating lists at the Stanmore site and clinics at our Central London outpatient unit. Our program enables you to witness first-hand the intricacies of managing complex nerve injuries, such as traumatic brachial plexus and obstetric brachial plexus injuries. The experience not only allows insight into the clinical and surgical approaches but also includes the chance to participate in research initiatives within our unit, enriching your understanding and knowledge in this niche field.

Our observerships are self-funded, but letters of support can be provided for travel grant applications, and applicants must be qualified doctors in their home countries or medical students on elective placement. Candidates should demonstrate a genuine interest in peripheral nerve surgery and a commitment to enhancing their expertise in this specialty.

This experience is an exceptional opportunity to observe and learn from a multidisciplinary team dedicated to cutting-edge treatment and research in peripheral nerve injury. We welcome you to join us in exploring the challenging and rewarding field of nerve injury management.

Please submit your CV along with a covering letter and proposed observership dates for the attention of Mr Ashley Simpson to his secretary Juliette Houghton.

The Peripheral Nerve Injury Fellowship at RNOH provides advanced training in the assessment and management of complex brachial plexus and peripheral nerve injuries. We offer two fellowship posts: 1x national and 1x international.

These structured programs offer and unparalleled opportunity to gain extensive experience in surgical and non-surgical treatments of nerve injuries, working alongside a highly skilled multidisciplinary team at one of the UK’s leading nerve injury units.

Fellows participate in operative cases at our Stanmore facility and outpatient clinics in Central London, covering a wide range of nerve conditions including traumatic, obstetric, and iatrogenic nerve injuries. The fellowship emphasises hands-on learning, from microsurgical techniques to nerve transfers, and offers exposure to innovative treatments in nerve repair and reconstruction.

Research and academic involvement are integral parts of the fellowship, with opportunities to collaborate on clinical studies, present at conferences, and contribute to publications. Fellows benefit from a supportive environment that encourages growth and knowledge sharing, equipping them with the expertise to excel in nerve surgery.

Case Mix Includes:

• Supra and infraclavicular brachial plexus exploration
• Peripheral nerve exploration / neurolysis / neurectomy
• Nerve repair and grafting
• Nerve transfers
• Thoracic outlet decompression
• Anterior release for birth-related brachial plexus injury
• Glenoplasty for complex paediatric shoulder dislocations
• Proximal humerus and forearm rotational osteotomies
• Excisional biopsy of nerve sheath tumours
• Tendon transfers following nerve injury
• Amputation

Requirements

• Completion of FRCS(Orth) / FRCS (Neurosurgery) / equivalent training in Home Country
• An enthusiastic junior surgeon with good subspecialty skills in upper limb surgery
• Experience of microsurgical techniques desirable
• Motivated to attain independence in operating and clinical decision making
• Eligible for General Medical Council registration
• Keen to optimise research and medical education opportunities
• A desire to enjoy the bustling, gastronomical and multicultural city of London

Supervisor Profiles:

• Mr Marco Sinisi
• Mr Mike Fox
• Mr Anna Panagiotidou
• Mr Ashley I. Simpson
• Mr Kapil Sugand (Locum)

Duration: 12 months

Commencement: October

Renumeration: ~£62000

Oncall: No formal oncall commitments; Daily triage of acute PNI referrals

Example Timetable:

RNOH, Stanmore Hospital

Bolsover Street – Central London

Flexible Location

Application: Post will be advertised on NHSJobs.com approximately 6 months prior to commencement

Declaration of Interest - FAO: Mr Ashley I. Simpson – Consultant Peripheral Nerve Injury Surgeon – via Secretary – Juliette Houghton. Please provide CV, a covering letter expressing your interest in this particular fellowship and 2 letters of recommendation.

The Peripheral Nerve Injury (PNI) Unit RNOH has a long-standing history of excellence in the treatment and management of adult and paediatric peripheral nerve injuries. Established to serve as a national centre for the care of complex nerve injuries, the Unit has grown to become a world-renowned facility for clinical innovation, research, and patient care in the field of peripheral nerve surgery including the following:

• Brachial/lumbosacral plexus surgery including obstetric (birth) injuries,
• Neurogenic thoracic outlet decompression (+/- excision of cervical or first rib),
• Brachial plexus/peripheral nerve open biopsy,
• Nerve sheath tumour excision biopsy
• Nerve exploration, decompression and neurolysis
• Nerve repair (neurorrhaphy),
• Nerve grafting,
• Neurectomy,
• Nerve transfer,
• Paediatric anterior shoulder release,
• Paediatric botulinum toxin injections,
• Paediatric shoulder reconstruction for instability/dislocation (glenoplasty),
• Paediatric derotation osteotomies of the upper limb
• Secondary reconstruction with tendon transfer
• Amputation for plexus injuries
• Revision and staged surgery

The roots of the PNI Unit trace back to Professor Herbert Seddon, who established the Peripheral Nerve Injury surgery at Oxford. Seddon’s work on nerve injuries laid the foundation for modern peripheral nerve surgery. Collaborating with biologists J.Z. Young and Peter Medawar, Seddon developed and advanced techniques for nerve repair, including his internationally adopted classification of nerve injuries into neurapraxia, axonotmesis, and neurotmesis. His publications in the 1940s became essential texts, and his 1954 monograph for the Medical Research Council was widely used to educate medical students on nerve injury principles.

In 1948, Seddon became Director of Postgraduate Studies at the Institute of Orthopaedics at the University of London and Clinical Director of the Royal National Orthopaedic Hospital. In 1965, he was appointed the first Professor of Orthopaedics at the University of London. His leadership in orthopaedic research and education, particularly his innovative postgraduate teaching programmes, earned national and international recognition.

During the 1980s and early 1990s, Professor Rolfe Birch and Mr. George Bonney collaborated to further to refine the understanding of nerve injuries, creating a dedicated Peripheral Nerve Injury Unit, originally at St. Mary’s Hospital, Paddington. They developed a simplified classification of nerve injuries as either conduction block/non-degenerative or degenerative lesions, building upon the work of Seddon and Sunderland. This refinement helped streamline the classification process, improving clinical diagnosis and management.

Upon Mr. Bonney’s retirement in 1991, Professor Birch moved the clinical unit to the Royal National Orthopaedic Hospital in Stanmore. This move further strengthened the unit’s collaborations with specialists at Queen’s Square, National Hospital for Neurology and Neurosurgery, and The Hammersmith Hospital. Professor Birch fostered a collaborative environment, facilitating transparency, open communication, and advancements in the field of nerve injury treatment.

In 2003, Professor Birch was appointed Consultant-in-Charge at the War Nerve Injuries Clinic at the Defence Medical Services Rehabilitation Unit, Headley Court, and he became Professor of Peripheral Neurological Surgery at University College London. Even after retiring from the NHS, his dedication to the field remained strong, as he continued running the clinic and contributing to the research of the department he founded.

Another key figure in the unit’s history is Professor Thomas Carlstedt, whose research into the reimplantation of avulsed spinal nerve roots into the spinal cord marked a major breakthrough in treating high brachial plexus injuries. His work continues to shape the management of severe nerve injuries and brachial plexus reimplantation.

Today, the PNI Unit is run by four full-time substantive Consultant Surgeons: Dr. Marco Sinisi, Mr. Mike Fox, Ms. Anna Panagiotidou, and Mr. Ashley Simpson. The Unit remains a hub of multidisciplinary collaboration, bringing together specialists in Orthopaedic surgery, Neurosurgery, Neurology, Radiology, and Rehabilitation medicine with frequent support from Vascular Surgery. Pioneering research, published in peer-reviewed PubMed-indexed journals and international conference presentations, has led to advances in nerve repair, including nerve grafting, transfers, and advanced diagnostics including electromyography (EMG) and MRI neurography. The publication of the surgical technique of glenoplasty in complex paediatric shoulder dislocation in 2011 was the first of its kind. The Unit is also exploring the application of artificial intelligence in diagnosing and predicting outcomes in peripheral nerve injuries.

As part of the RNOH’s commitment to innovation and education, the PNI Unit continues to train the next generation of surgeons and healthcare professionals offering both a national and international fellowship, thus maintaining its dedication to providing world-class care for even the most complex nerve injuries.