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Hand Surgery

Hands is of the important part of the body that serves many purposes like help us eat, dress, write and to do many other essential activities. It is made up of bone, joints, ligaments, tendons, muscles, nerves, skin, and blood vessels which all need to be in a good working condition for the proper functioning of the hand. Any or all of these delicate elements can impair the use of the hand due to any injury or disease. Surgery may treat the disease that causes pain; impair the function and flexibility of the wrist and fingers. It may restore the proper functioning of the fingers and hands injured by trauma or to correct the congenital abnormalities.

Team of hand surgeons may include orthopedic, plastic or general surgeons who have additional training in hand surgery. They can treat conditions like carpel tunnel syndrome, arthritis, nerve and tendon injuries, wrist pain, cuts on the fingers and hand, injuries caused by sports, trigger finger, fracture or congenital defects whereas some hand surgeons have specialization in the elbow, arm and shoulder problems. Some hand problems don’t require surgery but often can be treated by non-surgical methods like medicines, splints, physical therapy or injections. Hand surgery can be done on people of any age, who doesn’t have any medical conditions or illness that can hamper the healing process.

There are different types of surgeries done depending on the underlying cause of the problem. Some of them are as following:

1. Close reduction and fixation – if there is a fracture in any part of the hand including fingers, this type of surgery attempts to realign the fractured bone and immobilize the area with internal fixtures (such as wires, rods, splints, and casts) during the healing period.
2. Tendon Repair – are fibers that attach muscle to bone and are of two main groups that control the hand and wrist:

• Flexor tendons – these enables the person to grip and to curl fingers to form a fist.
• Extensor tendons – helps in opening the fingers up.

Tendon injury can occur due to infection; trauma or sometimes it can tear or snap which is called tendon rupture. It is usually a result of rheumatoid arthritis or other inflammatory arthritis that may require early treatment to protect the other tendons from rupturing. It needs at least six weeks to heal the repaired tendons.

3. Nerve repairs – there are many nerves in the hand and damage to these nerves from injury may decrease the ability to move the hand. Some severed injured nerves may heal on their by reattaching it directly to the other end of the nerve and some damaged nerves may require surgery.

4. Ganglion removal – a thick synovial fluid helps joints and tendons move slowly. This fluid when leaks out of the joints or tendons, becomes very thick and may form cysts called ganglion. Ganglions can feel firm and hard on pressing, commonly formed on the back of the wrist, can form due to osteoarthritis. They can sometimes disappear on their own but minor surgery may be required to remove them if they become painful. It is likely that they will re-occur.

5. Rheumatoid arthritis – of the knuckles that can deform fingers (fingers drift sideways away from the thumb), cause pain, and impair movement. Surgery to replace injured knuckle with artificial joints that act as flexible hinges is recommended if there is any difficulty in using hand.

6. Trapeziectomy – a bone in the wrist at the base of the thumb is known as trapezium. Simple task and movement can become difficult and painful if a person has arthritis in the joint. That may require a surgery to remove the joint and the trapezium if the pain is persistent.

Doctor may evaluate some tests (X-rays) before performing the surgery. Anesthesia and other pain medications will be given to comfort the patient during the surgery. Surgeon may perform surgery depending on the hand problem (injury). Bandages or dressings may be used to keep the surgical area clean to avoid infection and splints may be used if required. Post surgery medications and hand therapy will be given to the patient. Proper care and follow-up visits should be done.

There are also some risks and complications involved, but are not limited to, as following:

1. Infection at the surgery site
2. Poor healing
3. Blood clots
4. Scarring
5. Change in sensation
6. Swelling or discoloring of the skin
7. Injury to blood vessels, tendons or nerves
8. Deep vein thrombosis
9. Persistent pain
10. Cardiac and pulmonary risks

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