Hand surgery deals with the diagnosis and treatment of all diseases and injuries of the upper limb. In some countries, it is already a separate medical specialty.
It is practiced by specialized orthopedic or plastic surgeons and is based on microsurgical techniques, using magnifying glasses or a microscope, essential tools for the majority of procedures.
The Microsurgeon specializes in the repair of injuries, such as fractures, tendon and nerve ruptures, and vascular anastomoses. The most complex procedures include the fusion of amputated limbs.
At the same time, he treats chronic conditions such as arthritis, carpal tunnel syndrome, trigger finger, and ganglion.
Medical Services
Hand surgery aims to restore the functionality of the Hand and Upper Extremity, through surgical or conservative treatment. The conditions treated often make the person’s daily life difficult. Injuries and chronic diseases are the main causes. Upper extremity injuries cover up to 70% of work accidents, given that the hand is particularly exposed and vulnerable.
Injuries can be simple (e.g. fracture) or complex (with concomitant damage to nerves, tendons, bones, skin, etc.). Early treatment of these increases the chances of full recovery. Chronic conditions include overuse syndromes, systemic diseases, tumors, etc.
Knowledge of Arthroscopic techniques is now essential, since many elbow conditions and shoulder conditions are treated minimally invasively.
Medical services include:
- Treatment of all injuries of the Upper Extremity, from simple to fusion of amputated limbs.
- Surgical treatment for hand conditions, elbow conditions and shoulder conditions.
- Nerve damage repair.
- Treatment of brachial plexus injuries and obstetric paralysis.
- Transfer of vascularized or innervated tissues (free flaps).
- Covering skin defects.
- Treatment of systemic diseases, such as rheumatoid arthritis.
- Removal of tumors of the upper and lower extremities.
- Diagnostic and therapeutic Arthroscopy.
- Microsurgical procedures for complex conditions, such as femoral head necrosis.
- Surgery for congenital malformations of the upper limb.
- Shoulder, Elbow, Wrist and Finger Arthroplasty.
- Functional rehabilitation with Microsurgery techniques throughout the body.
Diseases
Carpal Tunnel Syndrome
One of the most common problems of the upper extremities, especially in women, is Carpal Tunnel Syndrome, first described by James Paget in 1863.
Anatomy
The median nerve crosses the palmar surface of the forearm and passes through the carpal tunnel to reach the fingers. This tunnel is formed by the bones of the wrist and the transverse ligament. Inside it, the median nerve and 9 tendons coexist. The space is limited, any swelling causes pressure on the nerve.
Causes
The main causes include:
- Overuse of hands or repetitive wrist flexion
- Fractures/dislocations
- Inflammatory diseases (e.g. rheumatoid arthritis)
- Hormonal and endocrine disorders (menopause, pregnancy, hyperthyroidism)
- Diabetes mellitus
- Anatomical abnormalities or local tumors
Diagnosis
The first symptoms include numbness in the thumb, index, middle and part of the ring finger. At first they are temporary, but gradually become permanent, especially at night. They are often accompanied by pain that radiates to the elbow or shoulder. Inability to hold objects and “stiffness” are also common.
The diagnosis is based primarily on clinical examination and is confirmed, where necessary, by electromyography. However, the clinical picture remains decisive.
Treatment
The treatment approach can be conservative or surgical. Mild cases are treated with night splints, rest, avoidance of bending, and anti-inflammatory medications. Local cortisone injection helps in more severe cases.
If conservative treatment fails or symptoms are severe, surgical decompression of the nerve is recommended. The procedure is performed under local anesthesia and involves transection of the transverse ligament.
Recovery is short: soft bandage for 2-3 weeks and full return to activity in approximately 4-6 weeks.
