Hand Surgery and Microsurgery
In the Hand Surgery and Microsurgery department of BHT CLINIC Istanbul Tema Hospital, the diagnosis and treatment of patients with problems related to the hand, wrist, elbow, and arm are performed by specialized physicians.
What is Hand Surgery?
Hand surgery is a sub-branch of the main discipline of orthopedics and traumatology. Hand surgery is a branch that covers the treatment and surgery of all diseases in the region from the shoulder to the fingertip, including the hand, arm, and fingers.
Our hands are the most functional part of the musculoskeletal system. Being unprotected and exposed to diseases and injuries is one of the main reasons for the frequent occurrence of hand-related diseases. Therefore, it is very important that they are treated by physicians specialized in this field.
Hand Surgery Diagnosis and Treatment Areas:
- Hand and Finger Amputations
- Tendon and Nerve Injuries
- Finger Fractures
- Hand Tumors
- Congenital Hand and Finger Anomalies
- Nerve Entrapments
- Congenital or Injury-Related Hand and Arm Paralysis
What are Hand Surgery Diseases?
1) Hand, Wrist, and Forearm Injuries
a. Finger and Limb Amputations
Amputations of fingers, hands, forearms, arms, feet, and legs are within the interest of this scientific discipline.
The success of reattaching amputated parts depends on;
How the amputation occurred: Different injury types range from clean and smooth cuts to crushing, crush/avulsion injuries, and dirty wounds/burns.
The time elapsed from the moment of amputation to replantation and restoration of blood supply.
The correct transportation of the amputated part.
b. Artery, Nerve, and Tendon Injuries
Vascular injuries, besides being a cause of bleeding, also pose a risk of tissue death (necrosis) due to lack of blood supply. Nerves transmit motor commands and carry sensations. Tendons transfer the power of muscles to bones to create movement. Partial and complete transections of these tissues are repaired surgically.
c. Fractures and Dislocations:
The field of Hand Surgery includes all fractures of the upper extremity. This includes fractures/dislocations of the hand, wrist, forearm, and elbow, ligament tears, and fractures of the arm bone. They are treated with a cast, closed reduction, or surgical methods depending on the type of fracture, the patient's age, and other factors.
2) Nerve and Tendon Entrapments
a. Carpal Tunnel Syndrome
It occurs as a result of the compression of the median nerve at the wrist level for various reasons. There is pain, and numbness/sensation deficit in the first three fingers and part of the 4th finger. In advanced stages, symptoms such as loss of strength in the fingers and dropping objects appear. Treatment includes medication, splinting, local injections, physical therapy, and surgical methods.
b. Ulnar Tunnel Syndrome (Cubital Tunnel Syndrome)
This involves the compression of the ulnar nerve at the elbow level. Numbness is in the 4th and 5th fingers. Its treatment is similar to the methods used for carpal tunnel syndrome.
c. De Quervain's Tenosynovitis
It occurs as a result of the compression of the tendons that lift the thumb at the wrist level. It is frequently seen in diabetes, rheumatic diseases, and the postpartum period. If medication and splinting are insufficient, surgical release is performed.
d. Trigger Finger
It occurs when the flexor tendons of the fingers thicken and get compressed as they connect to the palm. There is catching and pain during finger movements. There are both non-surgical and surgical treatment methods.
e. Other
Besides these, nerves and tendons can be compressed at other levels.
3) Tumors and Tumor-Like Formations of the Hand and Upper Extremity
a. Tumor-Like Formations
The most common are cysts called "ganglions," which form on the wrist and tendon sheaths. They are diagnosed by ultrasonography or MRI. Although they may benefit from medication when they cause pain, surgical removal is recommended.
Palmar-plantar fibromatosis (Dupuytren's Disease): It is seen on the palm and sole of the foot. By spreading within the connective tissue, it can cause tissue contracture and the inability to extend the fingers. Attempts are made to resolve it with local injections and minimal surgical methods. In advanced cases, surgical cleaning is necessary.
b. Benign Tumors:
These include cysts seen in bone and soft tissue, giant cell tumor of the tendon sheath, and benign tumors originating from vessels and nerve sheaths. Following clinical and radiological diagnosis, a definitive diagnosis must be made with a biopsy and pathological examination, followed by the final surgical procedure to remove the mass.
c. Malignant Tumors
They should be treated like other malignant bone and soft tissue tumors of the skeletal system. A multidisciplinary approach should be taken, with hand surgery and orthopedic oncology working together.
4) Rheumatic, Inflammatory, and Infectious Diseases
The joints most affected by rheumatic diseases are the hand and wrist joints. Although it is the subject of Rheumatology and Physical Therapy specialties, surgical interventions are applied in advanced deformities.
Besides rheumatic causes, chronic fatigue and microorganisms are also causes of arthritis and tendinitis.
5) Congenital Anomalies and Birth Injuries
As in other parts of our body, congenital anomalies are frequently seen in the hand and upper extremity. Although their frequency has decreased thanks to close monitoring of pregnancies, it is not possible to prevent them completely. These include polydactyly (extra fingers), syndactyly (webbed fingers), synostosis (fused bones), and complex anomalies. Surgical intervention is usually required.
The most common injury during difficult births is a clavicle fracture. It usually heals without problems. Fractures can also occur in other bones. Damage to the nerves in the armpit manifests as paralysis in certain parts of the arm and hand. Treatment is attempted with surgery and physiotherapy methods.
