Hand Surgery Health Article

Definition

Hand surgery refers to procedures performed to treat traumatic injuries or loss of function resulting from such diseases as advanced arthritis of the hand.

Purpose

The purpose of hand surgery is the treatment of a broad range of problems that affect the hand, whether they result from cuts, burns, crushing injuries to the hand, or disease processes. Hand surgery includes procedures that treat traumatic injuries of the hands, including closed-fist injuries; congenital deformities; repetitive stress injuries; deformities caused by arthritis and similar disorders affecting the joints; nail problems; and tendon repair.

The central priority of the hand surgeon is adequate reconstruction of the skin, bone, nerve, tendon, and joint(s) in the hand. Proper repair of any cuts, tears, or burns in the skin will help to ensure a wound free of infection and will provide cover for the anatomical structures beneath the skin. Early repair and grafting is an essential component of hand surgery. Nerve repair is important because a delay in reconnecting the nerve fibers may affect the recovery of sensation in the hand. Restoration of sensation in the hand is necessary if the patient is to recover a reasonable level of functionality. Next, the bones in the hand must be stabilized in a fixed position before the surgeon can repair joints or tendons. Joint mobility may be restored by specific tendon repairs or grafts. In some cases, the patient's hand may require several operations over a period of time to complete the repair.

Demographics

The demographics of hand injuries and disorders depend on the specific injury or disorder in question. Repetitive stress injuries (RSIs) of the hands are often related to occupation; for example, nurse anesthetists, dental hygienists, keyboard instrumentalists, word processors, violinists, and some assembly line workers are at relatively high risk of developing carpal tunnel syndrome or tendinitis of the fingers related to their work. Nearly 17% of all disabling work injuries in the United States involve the fingers, most often when the finger strikes or is jammed against a hard surface. Over 25% of athletic injuries involve the hand or wrist.

In terms of age groups, children under the age of six are the most likely to be affected by crushing or burning injuries of the hand. Closed-fist injuries, which frequently involve infection of the hand resulting from a human bite, are almost entirely found in males between the ages of 15 and 35. Pain or loss of function in the hands resulting from osteoarthritis, however, is found most often in middle-aged or older adults, and affects women as often as men.

Some specific categories of conditions that may require hand surgery include:

Congenital malformations. The most common congenital hand deformity is syndactyly, in which two or more fingers are fused together or joined by webbing; and polydactyly, in which the person is born with an extra finger, often a duplication of the thumb.

Infections. Hand surgeons treat many different types of infections, including paronychia, an infection resulting from a penetrating injury to the nail; felon, an inflammation of the deeper tissue under the fingertip resulting in an abscess; suppurative tenosynovitis, an infection of the flexor tendon sheath of the fingers or thumb; and deeper infections that often result from human or animal bites.

Tumors. The most common tumor of the hand is the ganglion cyst, which is a mass of tissue fluid arising from a joint or tendon space. Giant cell tumors are the second most common hand tumor. These tumors usually arise from joints or tendon sheaths and are yellow-brown in color. The third type of hand tumor is a lipoma, which is a benign tumor that occurs in fatty tissue.

Nerve compression syndromes. These syndromes occur when a peripheral nerve is compressed, usually because of an anatomic or developmental problem, infection or trauma. For example, carpal tunnel syndrome develops when a large nerve in the arm called the median nerve is subjected to pressure building up inside the carpal tunnel, which is a passageway through the wrist. This pressure on the nerve may result from injury, overuse of the hand and wrist, fluid retention during pregnancy, or rheumatoid arthritis. The patient may experience tingling or aching sensations, numbness, and a loss of function in the hand. The ulnar nerve is another large nerve in the arm that runs along the little finger. Compression of the ulnar nerve at the elbow can cause symptoms that typically include aching pain, numbness and paresthesias.

Amputation. Some traumatic injuries result in the loss of a finger or the entire hand, requiring reattachment or replantation. Crushing injuries of the hand have the lowest chance of a successful outcome. Children and young adults have the best chances for recovery following surgery to repair an accidental amputation.

Fractures and dislocations. Distal phalangeal fractures (breaking the bone of a finger above the first joint towards the tip of the finger) are the most commonly encountered fractures of the hand. They often occur while playing sports.

Fingertip injury. Fingertip injuries are extremely dangerous since they comprise the most common hand injuries and can lead to significant disability. Fingertip injuries can cause damage to the tendons, nerves, or veins in the hands.