Definition and Overview

Hand surgery is a medical and surgical field that deals with the treatment of conditions, disorders, injuries, infections and diseases that affect the hands. The hand is one of the most important parts of the body since it contains plenty of nerves that provide a rich amount of sensory information. It is also quite a complex part to perform surgery on due to the number of its nerves, blood vessels, bones, tissues and muscles.

A hand surgery consultation, especially in a non-emergency situation, aims to inform the patient of the risks, complications and benefits of a prescribed surgical procedure. It also provides the patient with information on the complexities of surgical technique that will be used and how it can restore the function of the hand following treatment.

Who Should Undergo and Expected Results

Patients who have injuries, disorders, or diseases (listed below) that affect the function and motion of the hands are ideal candidates for hand surgery, and should undergo a pre-surgery consultation prior to the procedure.

  • Hand injuries, including those that require amputations of the hands or fingers, or replanting of fingers.

  • Carpal tunnel syndrome, a medical condition wherein the hand’s median nerve is compressed. This nerve travels from the wrist into the carpal tunnel causing mild to severe pain, tingling and numbness. In severe cases, the pain can extend to the forearm and shoulder. Individuals who are at risk of developing this condition include those who are diabetic, obese and pregnant as well as those with hypothyroidism or an abnormal carpal tunnel diameter.

  • Carpometacarpal bossing, or the presence of a small, unmoving bone mass often found in the joints connecting the metacarpus and carpus—known as the carpometacarpal joints. These joints can swell and appear as a bump on the wrist. Though often painless and does not affect hand movement and function, it can cause worry to the patient, who might mistake the swelling for a ganglion cyst.

  • Rheumatoid arthritis, a chronic autoimmune disorder that affects a variety of joints in the body, including in the hands. Like carpometacarpal bossing, the primary symptom of this disorder is swollen joints that are painful and stiffness that limits the mobility and function of the hands. The swelling can easily extend to the wrists, and cause other problematic conditions, such as anemia and inflammation around major organs, such as the lungs and the heart.

  • Dupuytren’s contracture, also known as Viking disease or morbus Dupuytren, affects many areas of the body. The contracture typically manifests in the fingers, which bends toward the palm and cannot be straightened or flexed. This condition typically affects the ring and little fingers, though all fingers can be involved.

  • Congenital hand deformities, which are present during the patient’s birth. Experts agree that hand deformities can be limiting to the child’s learning and development, as they can limit the patient’s sensory experience of his or her environment. Congenital hand deformities range from minor (such as malformation of the fingers) to severe (such as the total absence of bone, which affects both the structure and function of the hands). Examples include clubhand, syndactyly (some parts of the hand failed to separate during the foetal stage), polydactyly (having one or more extra fingers), underdeveloped digits and overgrown digits.

A hand surgery consultation helps the patient (or in the case of children and adolescents, their parents or legal guardians) to better understand the procedure including the key outcomes as well as the possible risks and complications that might occur after surgery. The patient will also be assessed if he or she is fit for the surgery to ensure patient safety and the success of the procedure.

How is the Procedure Performed?

A hand surgery consultation is not unlike an appointment with a primary care physician. The patient will be asked to discuss the condition that requires hand surgery, as well as his or her expectations of the procedure. Other medical conditions, medical treatments undergone in the past (including surgical treatments), medications currently taken and drug allergies will also be discussed.

The doctor will then proceed to evaluate the patient’s general health to identify pre-existing conditions and risk factors that might affect the success of the procedure. A physical examination of the hand will also be required. During the consultation, the doctor will discuss the patient’s options and recommend an ideal course of treatment according to the condition and its severity as well as the general health of the patient and his or her unique circumstances. Possible risks, complications and benefits of each option will also be discussed to help the patient make a well-informed decision.

Possible Risks and Complications

The consultation itself is generally safe and is required to ensure the safety and success of the surgical procedure.

Reference:

  • Webb CW. Metacarpal fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 4.
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