Although the term hand surgery suggests otherwise, conservative therapy is also part of hand surgery. It is always used when the impairment is not yet too severe for the patient. If the patient can no longer move their fingers or hand properly and/or has severe pain over a longer period of time, surgery is required.
The medical field of hand surgery is extremely wide-ranging. Hand surgeons treat burns, injuries, malformations, deformities, inflammations, chronic degenerative diseases, chronic pain and tumors on the hands, fingers and arms. Thanks to their specialist qualifications, they are also able to amputate phalanges and parts of the hand and replace them with the appropriate prostheses.
Accidental injuries not only cause damage to bones, but also to soft tissue (muscles, tendons, nerves, blood vessels). The affected person then not only suffers from limited hand mobility and pain. They may also experience numbness and paralysis, which must be treated by a hand surgery specialist.
Overuse can also cause pain and changes in the position of structures in the arms and hand. This can lead to tendon attachment problems (golfer's elbow, tennis elbow).
Sometimes the hand surgeon also has to deal with congenital deformities such as polydactyly: Patients - usually young children - have too many fingers on their hand. In the course of life, the excess number of fingers can cause problems, so that one or more are surgically removed.
A very common condition treated in the clinic or medical center is ganglion. In this case, a joint or tendon is protruding outwards. This protrusion contains an accumulation of tissue fluid. As the ganglion cannot be treated conservatively, surgery is necessary.
Dupuytren's contracture, which affects 6 to 9 times more men than women at an older age, is also one of the more common clinical pictures in hand surgery. The patient suffers from an increasing curvature of several fingers over the course of his or her life, which increasingly restricts the mobility of the hand. The disease, the cause of which has not yet been scientifically clarified, leads to a strong proliferation of the subcutaneous connective tissue on the inside of the hand. If conservative treatment using the enzyme collagenase does not help, the hand surgeon removes the excess tissue surgically. Collagenase is obtained biotechnologically from a type of bacteria (Clostridium).
By Efstathios Chronopoulos, Nikolaos Ptohis, Christos Karanikas, Alkis Kalliakmanis, Spyros Plessas, Ioannis Neofytou, Fotios Laspas, Ioanna Tzovara and Athanasios Chalazonitis - Efstathios Chronopoulos, Nikolaos Ptohis, Christos Karanikas, Alkis Kalliakmanis, Spyros Plessas, Ioannis Neofytou, Fotios Laspas, Ioanna Tzovara and Athanasios Chalazonitis: Patient presenting with lipoma of the index finger: a case report. In: Cases Journal 3, 2010, 20. doi:10.1186/1757-1626-3-20 PMID 20205806(Open Access), CC BY-SA 2.0, Link
Tendonitis is one of the inflammatory diseases that hand surgeons treat. It is caused by an infection of the soft tissue, overuse or injuries (strains) to the hand or wrist. Chronic courses of tendon sheath inflammation must be treated surgically to prevent the tendons from becoming trapped later on.
If the patient suffers from polyarthritis (rheumatic inflammation of the joints that affects the entire body), the joint inflammation destroys the entire joint as the disease progresses and requires treatment by a hand surgeon.
Thumb arthrosis often occurs after accidents or due to naturally loose joint ligaments. Signs of wear and tear of the thumb saddle joint are more common in patients aged 40 and over and cause pain and limited functionality of the thumb. If the administration of pain-relieving medication no longer helps, the thumb saddle joint is surgically removed.
Pinched nerves are also a specialty of the hand surgeon. For example, if the median nerve (middle hand nerve) runs through a constricted bone canal, this compresses it and causes pain, numbness and sometimes even paralysis.
Carpal tunnel syndrome occurs in women in connection with hormonal changes (menopause, pregnancy) and can also be congenital. If conservative treatment is unsuccessful, a carpal ligament release is performed in the clinic.
If the other two hand nerves are impaired, this is referred to as Loge de Guyon syndrome or supinator syndrome. To avoid permanent nerve damage, surgery is performed after unsuccessful corticosteroid therapy.
Circulatory disorders of bones and soft tissues such as lunate malacia are also part of hand surgery. Sometimes the hand surgeon even has to remove benign or malignant tumors in the hand, arm and shoulder area. Enchondroma, for example, is a benign growth of cartilage tissue on the bone of the hand. It often occurs in large numbers.
If too much tissue is destroyed, amputation is often the only remaining option. A phalanx, the entire finger or the whole hand is removed from the patient in the clinic. Other patients are implanted with a missing phalanx or an endoprosthesis to replace the damaged joint that has been removed.
In Germany, hand surgeons are licensed specialists for
After their specialist examination, they complete 36 months of further training in hand surgery. As you can easily imagine, this specialty originated from surgery and orthopaedics.
