Hand Surgery

Problems or diseases of the hands can cause a large amount of concern, as use of the hands are a large part of carrying out daily tasks. Even a small degree of discomfort or a mild deformity can cause serious consequences. At the beginning of the 19th century, major advances were being made in the realm of general surgery, but there was little attention placed on the hand. Since that time, great progress has been made in understanding and treating problems with the hand. Plastic surgeons perform surgery on the hand with an interest in improving not only the function of the hand, but also the appearance of the hand.

How are hand conditions diagnosed?

Diagnosing many hand conditions may require surgery, depending on the underlying cause of the condition. In general, diagnostic procedures for hand conditions may include the following: 

Complete history and physical examination

Your physician will need to know your age, hand preference, occupation, and any history of other problems with the affected extremity. For injuries, your physician may also need to know the following:

Your past medical history (including tetanus immunization status and current medications)

In some cases, a diagnosis can be made simply based on a physical examination. However, the following tests may also be used to help confirm the diagnosis, or the extent of the problem: 

• arthrography - a contrast dye is injected into the hand to allow for better visualization of the joints on x-ray.
• bone scintigraphy - a dye is injected into a vein and images are obtained to show the distribution of activity of the dye in various tissues and structures. The study is usually conducted in phases, with images of the hand taken at different times after the injection of the dye.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• electromyogram (EMG) - a test that measures the electrical activity of a muscle or a group of muscles. An EMG can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; allows for visualization of the tendons, ligaments, vessels, and nerves in the hand.
• ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In the hand, ultrasound is useful for locating fluid collections, such as cysts.
• video fluoroscopy - a diagnostic test that allows visual examination of the movement of the hand that can be recorded on a video for repeated viewing. A fluoroscope is a device that takes an x-ray and allows for immediate projection of the image on a screen for examination.
• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

What can I expect after hand surgery?

Recovery after hand surgery depends greatly on the type of surgery that was performed and the underlying cause of the hand condition. Sometimes, repeat surgeries are needed. The hand is an intricate part of our lives and is very sensitive. Mild to severe pain may be expected after many types of hand surgeries. Pain medications may be given to help alleviate the discomfort. The following are some of the other possible outcomes that you may be told to expect following hand surgery: 
Your hand may be immobilized in a bandage or splint after surgery. Your physician will decide the length of time of the immobilization. After some surgeries, the hand may be immobilized for months at nighttime to enhance recovery.

There may be some restrictions placed on activities and work after the surgery. This also will be determined by your physician, based on an individual basis.

 Rehabilitation may be recommended to increase the strength and function of the hand. Rehabilitation may include physical therapy and/or occupational therapy. A trained specialist will be involved in your care to optimize recovery of the hand. 
Therapy of the hand may include the following:

• exercises for the hand
• heat therapy
• massage therapy
• splinting
• traction
• bandages to help control swelling
• nerve stimulation

In many cases, surgery is just the start of recovery. Intensive rehabilitation may be necessary to regain optimal functioning of the hand. It is important to follow all of the instructions given to you after surgery by your physician and any other specialists that are involved in your care.

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