Hand Surgery

Hand surgery and operations

Hand surgery is a speciality that deals with the treatment of extremely common pathologies and traumas of the hand. This specialised surgery responds to functional and aesthetic imperatives, and is the meeting of functional and aesthetic surgery.

The function of the hand

The anatomy of the hand is highly complex in order to ensure its multiple functions. The skeleton of the hand is highly developed and is made up of 27 bones(the wrist bones: the carpus, the metacarpals and the phalanges). There are many muscles, some of which have their muscular bodies in the palm of the hand, the small intrinsic muscles, and others in the forearm, the extrinsic muscles, which send their strong, powerful tendons to the phalanges. The nerve network is dense, like an electrical cable, providing motor control for the muscles and conveying sensitivity to the fingers, schematically via the median nerve for the first three fingers and the ulnar nerve for the last two. The fibrous network in the palm of the hand is highly developed, creating a veritable mesh to hold and grip objects without soaping the skin.

Hand pathologies

Apart from trauma, all the anatomical elements of the hand can be affected. These "cold" pathologies are usually the result of hypersollicitation or repeated microtrauma, generating conflict, blockage, compression, inflammation and wear and tear on the anatomical components of the hand:

• Damage to peripheral nerves: these pass along their path from the neck to the hand in osteofibrous tunnels where they can be compressed. By far the most common is carpal tunnel syndrome, which compresses the median nerve in the carpal tunnel, followed by ulnar nerve compression, where the critical area is at the elbow.
• Involvement of the tendons and synovium: very common, but not always requiring surgical treatment: blockages (finger jerks), tendon inflammation with all the tendinitises of the wrist and hand, including De Quervain's tendonitis, and cysts developing from the tunnels where the tendons slide.
• Osteoarticular damage: joint damage can take the form of degenerative wear and tear (arthrosis), particularly at the base of the thumb (rhizarthrosis), but also in the form of more localised capsular damage with the formation of cysts (arthrosynovial cysts), which are common in the wrist and finger joints near the nail.
• Fibrous involvement of the hand: this is Dupuytren's disease affecting the fibres of the palm of the hand, leading to digital retractions.

Other disorders: benign tissue tumours in more than 9% of cases.

Trauma to the hand is a separate issue. They are extremely common, both in the home and in the workplace, ranging from simple wounds with no underlying noble elements to major damage affecting all parts of the hand (nerves, bones, joints, skin, tendons, etc.). Treatment must be adapted and specific to each case.

Consult the pages :

Practitioners and team in orthopaedic and trauma surgery departments

www.clinique-arago.com/praticiens-et-equipes

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