Exploring Hand Surgery - Improving Strength, Function, and Flexibility

Introduction

The hand is a unique part of the human body that has multiple functions. Impaired hand function, strength, or flexibility can have serious implications on a person’s life. Apart from functionality, a lot of importance is placed on the aesthetics of the hand in the present day. While minor issues of the hand are usually treated using medications and exercises, some may require surgical intervention to restore function or appearance.

What Is Hand Surgery?

Hand surgery is a fairly complicated procedure that is carried out by an experienced and qualified hand surgeon. The hand comprises bones, ligaments, tendons, nerves, muscles, and blood vessels which makes it an extremely delicate part that is prone to injury. There is also a high chance of error during surgery due to its complicated structure.

Hand surgery can treat a wide range of conditions including:

1. Arthritis of the Fingers, Hand, and Wrist: It is also called hand osteoarthritis. It is an inflammation that causes pain and stiffness in the joints of the hand, wrist, and fingers.

Most cases with mild and moderate symptoms can be treated successfully with medication and physiotherapy. In cases where other options are exhausted, surgery is resorted to improve the condition and restore function to the affected part of the hand.

2. Carpal Tunnel Syndrome: This condition often causes pain, tingling, or numbness in the hand. It is caused due to median nerve compression which is a major nerve of the hand. Carpal tunnel syndrome can cause permanent loss of function in the hand if left untreated. Various activities and medications are advised to cure the symptoms. In cases where these methods fail to alleviate the symptoms, surgical decompression of the nerve is performed and found to be beneficial.

3. Cubital Tunnel Syndrome: This syndrome is a result of ulnar nerve entrapment at the elbow. There are several non-surgical treatment options available to treat the condition. If these treatment options fail to deliver the desired results, surgical interventions are opted for.

4. Fractures of the Hand, Fingers, or Wrist: Since the hand, wrist, and fingers contain numerous small bones, mobilization using pins and screws may be needed in some cases. Hand surgery is done to implant these pins and screws to promote healing. Surgery might also be needed to remove retained hardware (pins, screws, plates) after healing.

5. Ganglion Cysts of the Hand and Wrist: A ganglion cyst is a fluid-filled mass or lump that commonly occurs in the hand or wrist. These cysts can disappear or change in size very quickly. Most cases do not need any intervention, but if symptoms persist and daily functions are interrupted, surgery helps to drain and in cyst removal.

6. Trigger Finger: Also called stenosing tenosynovitis, the trigger finger affects the tendons of the fingers and interferes with the flexibility of the fingers. The ring finger and thumb are the commonly affected fingers. If the symptoms do not get better with non-surgical options, surgery can be considered.

7. Congenital Hand Defects: These defects are present during the birth of a child or congenitally and they are:

• Syndactyly: Two or more fingers joined together by skin or soft tissue.

• Polydactyly: This condition is characterized by the presence of one or more extra fingers on the hand.

• Upper Limb deficiency: Hands or arms that are smaller or missing at birth.

• Amniotic Band Syndrome: Amniotic bands can encircle the developing baby's fingers or other body parts.

8. Hand and Wrist Infections:

Hand infections are very common. Most cases can be treated with antibiotics and rest. Surgical drainage may be required if there is an abscess to remove the pus.

9. Nerve Injuries:

Three main nerves (ulnar, median, and radial nerves) are responsible for innervating the hand. Damage to these nerves might require surgery to repair them.

10. Tendon Injuries:

Any injury that results in the rupture of a tendon or a tendon that ruptures due to rheumatoid arthritis would require surgical repair to correct the damage.

What Are the Different Types of Hand Surgery?

Different types of hand surgery can be performed depending on the underlying cause and concerns of the patient.

1. Skin Grafts - Healthy skin grafts are taken from other parts of the body called donor sites and attached to the injured area or recipient site. It is most commonly done for fingertip injuries or amputations or wherever there is missing skin.

2. Skin Flaps - It is similar to skin grafts, which involve taking healthy skin from other parts of the body and using it on injured sites. The only difference is that the skin that is used has its own blood supply. Flaps are usually used when there is extensive tissue damage and there is no blood supply.

3. Tendon Repair - The fibers that connect muscles to bones are called tendons. Tendon repair is usually undertaken to correct tendon injuries due to infection, trauma, or rupture. There are three types of tendon repair.

• Primary repair.

• Delayed repair.

• Secondary repair.

4. Closed Reduction and Fixation - This is mainly used in cases of fracture of bones of the hand, wrist, or fingers. It is necessary to immobilize the broken bone to promote healing. This is done using screws, pins, and plates that can be implanted during surgery.

5. Nerve Repair - Nerves in the hand can be injured and they need to be repaired through surgery. If left untreated, these injuries can lead to permanent damage.

6. Fasciotomy - Fasciotomy is done to treat compartment syndrome in the hand. This syndrome causes pain and increased pressure in a specific area, which can worsen with time. It can result in changes in the color of fingers and nail beds. Surgery can help remove the pressure and provide symptom relief.

7. Surgical Drainage or Debridement - Surgical drainage is resorted when there are infections with abscesses and pus. In severe cases, debridement is also necessary to remove dead cells and tissues to promote healing.

8. Joint Replacement - It is also called arthroplasty. This procedure is done in severe cases of arthritis, where the affected joint is replaced with an artificial joint.

9. Replantation - The surgery is used to reattach a part of the hand that has been completely detached or severed. It is a complex surgery that utilizes microsurgical procedures and tools to accomplish the results. The main goal of the procedure is to restore as much function as possible.

What Are the Risks and Complications of Hand Surgery?

The procedure has its own set of risks and complications. The patient should be well-informed about these risks and the surgeon can help in making an informed decision. The complications of the procedures are:

• Anesthesia risks and allergies.

• Bleeding.

• Blood clots.

• Loss of sensation postoperatively.

• Damage to underlying structures - nerves, muscles, blood vessels.

• Deep vein thrombosis.

• Infection.

• Persistent pain.

• Poor or delayed healing.

• Risk of revisional surgery.

• Irregularities in skin contour.

• Skin discoloration.

• Swelling.

• Scarring.

Conclusion

With the advancement in technology, newer and improved diagnostic and treatment techniques are available to the patients. These developments leave little room for error providing much hope to patients worldwide. Although these are considered a boon, the risks and complications that come along with them should be carefully considered and appropriate precautions should be taken to ensure the successful outcome of the surgery.