Hand surgery has established itself as its own specialty in medicine. The anatomy of our hand is very complex and with it various clinical pictures have come into focus. How is the correct diagnosis made and what are the diseases?
What is hand surgery?
Hand surgery is the treatment of diseases and injuries of the hand and forearm. Hand surgery is the treatment of diseases and injuries of the hand and forearm. Modern hand surgery was founded by the American Sterling Bunnel after World War II. Since 1993, hand surgery has been an additional specialty and can be obtained by specialists in orthopedics, surgeons and plastic surgeons. The main feature of hand surgery is based on the acute and chronic damage or injury of the upper extremity or hand. The upper extremity includes the entire arm: shoulder, upper arm, forearm and the hand. The hand is again divided into individual subsections: the carpus, the metacarpus, and the fingers. The aim is to establish an indication, that is, to determine whether there is a reason for the use of a therapeutic or diagnostic measure. It also includes the prevention, detection and treatment of diseases, malformations and tumors of the hand. Reconstruction after injuries and diseases is also included in the field of hand surgery.
Treatments and therapies
The clinical pictures of our hand are very complex and so is the treatment of each disease. Most commonly treated are injuries to the bones of the fingers, the tendons (connective tissue part of the muscle) and the ligaments. A fracture of the wrist, for example that of the carpus, the ulna-spoke joint or the forearm is a common injury. In the case of a fracture, the affected area is splinted or fitted with a cast. These injuries can be straightened with conservative therapy, and surgery is necessary only for complicated fractures. If blood vessels or nerves are also injured, surgery cannot be ruled out. The care of the patient in burns of the upper extremities is also part of hand surgery. Treatment for chronic diseases of the joints has taken on a very important role. Osteoarthritis, the wear and tear of the joints, is damage to the articular cartilage. Primary osteoarthritis mainly affects women after menopause and the cause of the damage is unknown. It is very obvious that the change in hormonal balance plays a major role. Secondary arthrosis is the result of metabolic disorders and crystal deposits (gout) or arthritis (an inflammatory disease of the joints). Osteoporosis (bone loss) can also lead to secondary osteoarthritis. Overuse of the joints or lack of exercise can promote osteoarthritis. In rheumatoid arthritis, pain occurs in the little fingers and wrist at the beginning. Other joints of the human body can also be affected. Carpal tunnel syndrome is one of the best known compression syndromes. It is a compression syndrome of the median arm nerve in the region of the carpus. The pain or discomfort occurs in the hand and may radiate throughout the arm. The discomfort becomes increasingly acute and can lead to muscle atrophy in the ball of the thumb. Weakness in grasping and a diminished sense of touch are also associated symptoms. The mild form of carpal tunnel syndrome can be treated without surgical therapy. Treatment areas of hand surgery also include infections of the soft tissue (tendon sheath inflammation) and the bone, as well as in cases of tumors and cyst formations on the hand and arm and congenital malformations. Children suffering from infantile malformations, rheumatics and care of patients with prostheses and rehabilitation of patients with hand injury is also included in the treatment.
Diagnosis and examination methods
In order to make a conscientious diagnosis, an X-ray examination is ordered for the initial history. The anatomy of the hand is shown in detail on an X-ray. Projection images are obtained in two planes and are used for the detection and therapeutic progression of inflammatory, traumatic, degenerative, and tumorous diseases of the bones and joints of the hand. In order to fully clarify a possible disease, a CT is ordered after an X-ray.Computed tomography uses X-rays to produce slice images. The X-ray and CT images are evaluated by a radiology specialist. To confirm a more accurate diagnosis or rule out disease, an MRI is performed. Magnetic resonance imaging makes it possible to diagnose rheumatic diseases or assess their progression. Joint inflammation and tendonitis are directly visualized. Before the MRI, the patient drinks a contrast medium, which allows the visualization of inflamed joints and tendons. Depending on the diagnosis, the form of therapy that the attending physician arranges varies. After surgery on the hand, complex and consistent follow-up treatment is necessary. The greatest progress is achieved with occupational therapy. Physiotherapy can be prescribed to support this. Physiotherapy is prescribed for conditions such as osteoarthritis. To relieve pain, anti-inflammatory painkillers such as diclofenac or ibuprofen are taken. To prevent stomach and liver disorders, the natural herb devil’s claw may also be administered for pain relief. Injections into the joints is a therapy option, but it can also lead to side effects. If none of the therapies work, surgery may be a way out. After any hand injury or surgery, the goal is to relieve pain and train and fully restore movement. A treatment plan is developed individually for each patient. The attending physician and the hand therapist are always in close contact to better assess the healing process.
