Hand Surgery

The function of the hand

The hand is an extraordinary organ ! The ultimate link to the upper limb, the organ of touch, of relationship to others, it can replace speech for people with certain disabilities, an organ of precision and object of beauty, sensuality or even fantasy … It combines dexterity, fineness, gracefulness but also strength and power. There are as many hands as individuals, trades, arts, sports: pianist hands, guitarist, farmer, builder, seamstress, goldsmith, surgeon, dancer hands…

In order to complete these multiple functions the anatomy of the hand is very complex. The skeleton of the hand is elaborate; it’s made up of 27 bones (wrist bones: carpus, metacarpals and phalanges). Muscles are numerous, some have their muscular body in the palm of the hand, they are the small intrinsic muscles and others have it in the forearm; they’re called extrinsic muscles that insert their strong and powerful tendons to the phalanges. The nervous network is dense, like electric wiring, it drives muscle coordination and conveys finger sensitivity, via the median nerve for the first three fingers to put it simply and the ulnar nerve for the last two. The fibrous network in the palm of the hand is very elaborate and makes up a real mesh to ensure the ability to hold and grasp objects without the skin being soaped.

Hand disorders

Except for traumatic injuries, all the elements of the hand can anatomically be affected. These « cold » or degenerative disorders are usually the consequence of muscle and tendon overuse or repetitive stress injuries generating conflicts, blocking, compression, inflammation and wear of the anatomical features of the hand:

Damage to peripheral nerves : these nerves run along their way from neck to hand through osteofibrous tunnels where they can be compressed. The most frequent disorder is by far the carpal tunnel syndrome compressing the median nerve in the carpal tunnel and in second position the compression of the ulnar nerve whose critical zone lies at the elbow.
Tendons and synovium damage: very common conditions but not necessarily requiring surgery: blocking (trigger finger), tendon inflammation with a number of tendonitises of the wrist and hand including De Quervain’s tendonitis and cysts developing from the tunnels where the tendons glide.
Osteoarticular damage : the damage to the joint can occur in the form of degenerative wear (osteoarthritis) especially at the base of the thumb (rhizarthrosis) but also in the form of more localized capsular attacks with cyst formations (arthrosynovial cysts) frequent on the wrist and on finger joints near the nail.
Fibrous damage to the hand : this condition is called Dupuytren’s disease and affects the fibres of the palm of the hand resulting in digital retractions
Other disorders: benign tissue tumors in more than 9

Hand traumas make up a separate chapter. They are extremely frequent, whether in domestic or professional setting, ranging from the simple wound without affecting underlying noble elements, to major damage affecting all the elements of the hand (nerves, bones, joints, skin, tendons …). Care must be adapted and specific to each case.

Surgery and Hand Operations

Hand surgery is a specialty that deals with the treatment of hand conditions and traumas which are extremely common. This specialized surgery meets functional and aesthetic requirements; it is the encounter of functional surgery with plastic surgery.