HAND SURGERY AND HAND THERAPY
Dramatic advances have been made in recent years in treating patients with hand injuries,
degenerative disorders, and birth defects of the hand. At the forefront of these advances have
been plastic surgeons-specialists whose major interest is improving both function and
appearance. Plastic surgeons undergo intensive training in hand surgery, and they (along with
orthopedic surgeons and general surgeons) treat patients with a wide range of hand problems.
This information is designed to give you a basic understanding of the most common hand
problems-what they are, what plastic surgeons can do for them, and the results you can
expect. It can't answer all of your questions, since each problem is unique and a great deal
depends on your individual circumstances. Please be sure to ask your doctor if there is
anything about the procedure you don't understand.
If you're considering hand surgery, a consultation with a plastic surgeon is a good place to
start. The surgeon will examine you, discuss the possible methods of treatment for your
problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the
procedure in detail, including where the surgery will be performed (the surgeon's office, an
outpatient surgery center, or a hospital), the anesthesia and surgical techniques that will be
used, possible risks and complications, the recovery and rehabilitation period, and the
probable outcome in terms of function and appearance.
Don't hesitate to ask your surgeon any questions you may have during the initial consultation-
including any concerns you have about the recommended treatment and the costs involved.
(Since hand surgery is performed primarily to correct physical abnormalities, it usually is
covered by insurance. Check your policy or call your carrier to be sure.)
All surgery carries some uncertainty and risk.
Thousands of successful hand operations are performed each year. While the procedures
are generally safe when performed by a qualified and experienced plastic surgeon, complications
can arise.
In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.
Hand injuries
The most common procedures in hand surgery are those done to repair injured hands,
including injuries to the tendons, nerves, blood vessels, and joints; fractured bones; and
bumps, cuts, and other injuries to the skin. Modern techniques have greatly improved the
surgeon's ability to restore function and appearance, even in severe injuries.
Among the techniques now used by plastic surgeons:
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Grafting- the transfer of skin, bone, nerves, or other tissue from a healthy part of the |
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Flap surgery-moving the skin along with its underlying fat, blood vessels, and muscle |
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Replantation or transplantation-restoring accidentally amputated fingers or hands |
In many cases, surgery can restore a significant degree of feeling and function to injured
hands. However, recovery may take months, and a period of hand therapy will most often be
needed.
Carpal tunnel syndrome. The carpal tunnel is a
passageway through the wrist carrying tendons and one of the hand's major nerves. Pressure may build up within the tunnel because of disease (such as
rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions.
The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand,
often accompanied by numbness, aching, and impaired hand function. This is known as
carpal tunnel syndrome.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the
problem. If this doesn't work, however, surgery may be required.
In the operation, the surgeon makes an incision from the middle of the palm to the wrist. He
or she will then cut the tissue that's pressing on the nerve, in order to release the pressure. A
large dressing and splint are used after surgery to restrict motion and promote healing. The
scar will gradually fade and become barely visible.
The results of the surgery will depend in part on how long the condition has existed and
how much damage has been done to the nerve. For that reason, it's a good idea to see a doctor
early if you think you may have carpal tunnel syndrome.
Rheumatoid
arthritis, an inflammation of the joints, is a disabling disease that can affect the
appearance and the function of the hands and other parts of the body. It often deforms finger
joints and forces the fingers into a bent position that hampers movement.
Disabilities caused by rheumatoid arthritis can often be managed without surgery-for
example, by wearing special splints or using physical therapy to strengthen weakened areas.
For some patients, however, surgery offers the best solution. Whether or not to have surgery
is a decision you should make in consultation with your surgeon and your rheumatologist.
Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue
from inflamed joints, repositioning tendons, or implanting artificial joints. While your hand
may not regain its full use, you can generally expect a significant improvement in function
and appearance. Still, it's important to remember that surgical repair doesn't eliminate the
underlying disease. Rheumatoid arthritis can continue to cause damage to your hand,
sometimes requiring further surgery, and you'll still need to see your rheumatologist for
continuing care.
Dupuytren's contracture
is a disorder of the skin and underlying tissue on the palm side of the
hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the
fingers, pulling them toward the palm and restricting motion. The condition usually develops
in mid-life and has no known cause (though it has a tendency to run in families).
Surgery
is the only treatment for Dupuytren's contracture. The surgeon will cut
and separate
the bands of thickened tissue, freeing the tendons and allowing better finger movement. The
operation must be done very precisely, since the nerves that supply the hand and fingers are
often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to
replace tightened and puckered skin.
The results of the surgery will depend on the severity of the condition. You can usually
expect significant improvement in function, particularly after physical therapy (see Recovery
and rehabilitation.), and a thin, fairly inconspicuous scar.
HAND THERAPY
A hand therapist works with patients who may
have been affected by an accident or trauma
leaving them with wounds, scars, bums, injured tendons or nerves, fractures or even amputation
of the fingers, hands or arms.
A hand therapist also treats patients who are
disabled from the affects of repetitive motion
disorders—such as tennis elbow or carpal tunnel syndrome. Many patients seeking the care of a
hand therapist also suffer from such things as arthritis or a neurological condition.
A hand therapist works with the patient—in any
situation—to provide a continuum of care often
starting within days of the injury or surgery right through to the patient's return to work and/or
a productive lifestyle.
A qualified hand therapist can identify unique problems relative to the upper extremities and
can effectively treat and rehabilitate the patient through such methods as:
Post Operative Rehabilitation
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Management of open or sutured wounds to aid healing |
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Control of hypertrophic (raised and/or swollen) or hypersensitive scars |
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Reduction of swelling |
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Rehabilitation
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Management of acute or chronic pain |
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Desensitization following nerve injury or trauma |
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Sensory reeducation after nerve injury |
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Design and implementation of exercise programs to increase motion dexterity |
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Making splints to prevent or correct injury |
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Training in the performance of daily life skills through adapted methods |
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Conditioning prior to returning to work |
The end result of accurate assessments and
treatment made by a specialized hand therapist
equals a shorter treatment time. The hand therapist's specialized training and clinical expertise
provides a quick identification of pathology and complex problems to the upper extremity.
This translates into immediate care and the most
effective forms of treatment, resulting in a
faster recovery or rehabilitation. Additionally, since the hand therapist is prepared
to start patient care within days of an injury or surgery, the continuum of care often eliminates
the need for multiple medical providers, repeat examinations, fragmented and duplicated
care—translating into medical cost containment. Immediate care also results in faster recovery
and decreases medical costs.