THE HAND

The hand is a highly complex structure consisting of 27 bones, multiple joints, ligaments, tendons, muscles, nerves, and blood vessels that work together to provide fine motor skills and dexterity. It is divided into three main regions: the wrist (carpus), the palm (metacarpus), and the fingers (phalanges). The intricate network of joints in the hand, including the carpometacarpal, metacarpophalangeal, and interphalangeal joints, allows for a wide range of movements such as gripping, pinching, and precise manipulation of objects. Muscles and tendons in the hand work together to control both gross and fine movements, while sensory nerves provide touch sensation, enabling the hand’s highly coordinated functions.

Orthopedic surgeons specializing in hand conditions address a variety of injuries and disorders, including fractures, ligament tears, tendon injuries, nerve compression (such as carpal tunnel syndrome), and arthritis. Treatment may involve non-surgical approaches like physical therapy, splinting, or injections, as well as surgical interventions like fracture fixation, tendon or nerve repair, and joint reconstruction or replacement. The goal of hand surgery is to restore function, relieve pain, and improve the patient’s ability to perform everyday tasks, ensuring both strength and dexterity are preserved or regained.

Some of the most common Elbow conditions include:

  • Carpal Tunnel Syndrome

  • Trigger Finger (Stenosing Tenosynovitis)

  • De Quervain’s Tenosynovitis

  • Dupuytren’s Contracture

  • Thumb Arthritis (Basal Joint Arthritis)

  • Tendon Injuries

  • Mallet Finger

  • Ganglion Cysts

  • Skier’s Thumb (Ulnar Collateral Ligament Injury)

  • Hand Fractures

COMMON CONDITIONS

Carpal Tunnel SYNDROME (CTS)

Carpal tunnel syndrome (CTS) is a condition caused by the compression of the median nerve as it travels through the carpal tunnel in the wrist. This tunnel is a narrow passageway formed by bones and ligaments, and when it becomes narrowed or swollen, it can exert pressure on the median nerve. Symptoms of CTS typically include numbness, tingling, and weakness in the hand, particularly in the thumb, index, middle, and part of the ring finger. The condition is often aggravated by repetitive hand movements, such as typing or using hand tools, making it common among office workers and certain manual laborers.

When conservative treatments like splinting, activity modification, and anti-inflammatory medications fail to relieve symptoms, orthopedic intervention may be necessary. An orthopedic surgeon may recommend carpal tunnel release surgery, which involves cutting the transverse carpal ligament to alleviate pressure on the median nerve. This procedure can provide significant relief from symptoms and restore function to the affected hand. After surgery, patients typically undergo a rehabilitation program to regain strength and flexibility, and many experience a full return to their daily activities.

Tendon Injury (Flexor Tendon Injury)

A flexor tendon injury occurs when one of the tendons that bend the fingers or thumb becomes cut, torn, or ruptured. These tendons are responsible for enabling gripping and flexing motions, allowing the fingers to curl toward the palm. Flexor tendon injuries are often caused by sharp objects, such as knives or glass, but can also result from sports injuries or other trauma to the hand. Symptoms typically include pain, swelling, and an inability to bend the affected finger or thumb. In some cases, a "bowstringing" effect may occur, where the tendon becomes detached from the bone, leading to visible deformity.

Orthopedic intervention is essential for flexor tendon injuries, especially if the injury is severe. Surgical repair is often necessary to reattach the torn tendon and restore function. The procedure involves suturing the tendon ends together and may require additional techniques to reinforce the repair. After surgery, a carefully structured rehabilitation program is crucial for recovery, as it typically includes splinting and physical therapy to restore strength and range of motion. Patients are often encouraged to start passive motion exercises early to prevent stiffness and facilitate healing. With timely and appropriate treatment, most individuals can regain significant function in the affected hand.

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COMMON PROCEDURES

Carpal Tunnel Release Surgery

Carpal tunnel release surgery is a procedure performed to relieve pressure on the median nerve, which is compressed in the carpal tunnel of the wrist, causing symptoms like numbness, tingling, and weakness in the hand. The procedure involves making an incision in the wrist and cutting the transverse carpal ligament to enlarge the carpal tunnel and reduce pressure on the nerve. This can be done through an open approach or a minimally invasive endoscopic technique, depending on the patient's condition and the surgeon’s recommendation.

Recovery from carpal tunnel release surgery typically involves wearing a splint or brace for a few weeks to protect the wrist and allow the ligament to heal. Physical therapy may be recommended to restore strength and range of motion in the hand and wrist. Most patients experience significant relief of symptoms and improved hand function after surgery, although full recovery can take several months. The procedure is highly effective, especially for those who have not responded to conservative treatments such as splinting, medications, or corticosteroid injections.

Tendon Repair Surgery

Tendon repair surgery is performed to treat ruptured or severed tendons in the hand, which are responsible for connecting muscles to bones and enabling movement of the fingers and thumb. Tendon injuries can occur from trauma, lacerations, or overuse, and may lead to impaired function, weakness, and inability to fully move the hand or fingers. During the procedure, the surgeon carefully reattaches the torn ends of the tendon, often using sutures or grafts, to restore continuity and allow the tendon to heal properly. In some cases, damaged surrounding tissue is also repaired or reconstructed.

Recovery from tendon repair surgery involves a prolonged period of immobilization, followed by a tailored rehabilitation program that includes physical therapy and exercises to regain strength and flexibility. The hand is often placed in a splint or cast initially to protect the tendon while it heals. Tendon healing can take several weeks to months, and full recovery requires dedication to therapy to prevent stiffness and regain normal hand function. While tendon repair surgery is generally successful, complications like scar tissue formation or reduced range of motion may occur if post-operative care is not carefully followed.