Hand surgery

Doctors working in the hand surgery department treat disorders of the hand. These can be caused by acute or chronic conditions. Hand injuries are sustained in 30% of accidents. These injuries and their long-term effects are also treated by hand surgeons. 

Clinical pictures and patient groups

The most common operation in hand surgery is to treat carpal tunnel syndrome. This involves exposing the nerves and relieving the pressure on them. This alleviates numbness in the fingers, loss of strength and shooting pains in the arm. 

Pains in the hands restrict movement in day-to-day life. Causes include arthrosis, ganglions and cysts, tendonitis or other illnesses.

Older people are often affected by this, but, young patients can also suffer from loss of function in the hands, usually due to injuries or undue stress. The nerves can be subject to compression damage during pregnancy. If children have to have hand surgery, this is usually as a result of congenital disorders. 

Treatment options and procedures

Hand surgeons require broad specialist knowledge and precise knowledge of the human locomotor apparatus.

Since the nerves, tendons and joints of the hand are very delicate, precision and skill are important. The hand surgeon operates with the help of magnifying glasses or a microscope. 

The patient benefits from a range of procedures. The doctor can implant joint prostheses for damaged joints, treat cuts, and straighten fractures in the fingers, the wrist, the metacarpus, or the bones in the forearm.

Treatment process and recovery

Not all hand conditions require an operation. Occupational therapy on the hand or other measures can often help before surgery is required.

Different medical disciplines work closely together; the hand surgeon can discuss the treatment plan with rheumatologists, neurologists, orthopaedic surgeons and trauma surgeons. If required, they can also consult with pain specialists and internists. 

The goal of any treatment is to be able move the hand without any pain. The patient regains feeling, strength, and flexibility in the fingers. 

Which patients come to the hand surgery department?

Doctors in the hand surgery department treat disorders of the hands and arms but not the shoulders.

The following complaints in the hands are common:

  • tingling
  • loss of sensation
  • restricted movement
  • pain
  • muscle weakness
  • paralysis
  • injuries
  • deformities
  • strains
  • swelling
  • tumours

There is a wide variety of causes. Carpal tunnel syndrome, arthrosis or tenosynovitis can cause these impairments, for example. However, conditions like tennis arm or golfer’s elbow can also be treated in the hand surgery department.

If the patient has trigger finger, this means they can no longer fully extend their finger(s). Rheumatism also leads to changes in the hands over the years.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the most common operation in hand surgery.

The cause is located in the wrist:

The median nerve (Nervus medianus) runs from the arm through the middle of the hand to the finger tips. In the wrist, it runs under a wide band of strong connective tissue like a tunnel. This area is known as the carpal tunnel. In carpal tunnel syndrome, the different structures in the wrist press against the median nerve.

The patient feels tingling and/or experiences loss of sensation or loss of strength in the hands. They wake up in the night with pains or sensory disturbances. The hand surgeon uses a splint to immobilise the wrist. If this does not help, the surgeon makes an incision in the wide band at the wrist and releases the pressure on the nerve.

What is the procedure for the hand surgery?

The hand surgeon examines the patient and asks them about their complaint. It is often necessary to visualise the hand using imaging procedures such as X-ray, MRI, or computer tomography. The doctor explains the findings in a consultation and decides what action will be required.

For certain conditions, it is necessary to immobilise the hand. The occupational therapist demonstrates exercises and massages painful hands. Injected medications help to relieve inflammation in the joints. The patient may need inpatient treatment in the hand surgery department for an operation. Smaller operations can be performed as outpatient procedures. For more major procedures, an overnight stay in the hospital is advisable.

What do I need to be aware of following an operation in the hand surgery department?

Many hand surgery operations are outpatient procedures. You come into the hospital in the morning. After the operation, you are cared for until feeling returns to the arm or the general anaesthetic wears off. If you are well enough, you are discharged.

For more major interventions, you will be kept in the hospital for a longer period. You will be cared for by specialists the entire time. Occasionally, following an operation, the arm will be put in a plaster cast, a splint, or a compression bandage. This immobilises the wound and allows it to heal. However, a lack of movement can damage the joints. You will be taught how to move your hands again during follow-up treatment.

What risks are involved in an operation on the hand?

The doctors in the hand surgery department are experts in their field and highly specialised professionals. The hand surgeon works with microsurgery as the structures in the hand are very delicate. This means they are often operating in the millimetre range.

The team in the hand surgery department is meticulous in its work. Nonetheless, as with every operation, there is always a minimal risk of an infection or bleeding. The doctor discusses the treatment, the potential risks and complications with each patient. They also explain the anticipated result and highlight treatment alternatives.