Hand and wrist surgery

Wrist and hand injuries require the evaluation of different structures: bones, nerves, tendons, muscles and skin. There are different causes of damage to these structures: traumatisms, aging (osteoarthritis of a joint), autoimmune (i.e. rheumatoid arthritis) and tumors.

The most common hand disorders are:

• Carpal tunnel syndrome: compression of the median nerve at the wrist.
• Trigger finger: associated with manual work.
• Dupuytren’s disease: firm nodules and cords appear just beneath the skin of the palm of the hand. It is more common in men.
• Rhizarthrosis: basal thumb arthritis.
• Fractures or post-traumatic sequelae: stiffness or deformities may require specialized treatment.
• Tendon injuries: weakness or absence of movement. They usually require early treatment (surgical repair).
• Nerve injuries: to learn more about these nerve injuries here.

Wrist and hand disorders produce three main types of symptoms:

• Pain: mainly associated with articular degeneration or blows. For example: wear of the joint at the base of the thumb (rhizarthrosis), produces pain when
  picking up objects.
• Motor deficit: loss of strength may be due to nerve, tendon, or muscle damage. For example: inflammation of a tendon in the hand, can cause a trigger finger, which produce pain and loss of movement.
• Loss of sensation: usually associated with nerve damage. For example: compression of the median nerve at the wrist (carpal tunnel syndrome) causes numbness of the thumb, index and middle fingers.

The diagnosis of any hand pathology is based on:

1. Clinical history: the intensity and location of the symptoms, as well as the time of evolution are essential to focus the diagnosis.

2. Physical examination: certain maneuvers exacerbate symptoms. This allows to guide the diagnosis.

3. Imaging studies: X-ray of the hand or wrist, and other types of images such as computed tomography (CT) or magnetic resonance imaging (MRI) allow us to see the affected structures.

4. Electrophysiological studies: detailed analysis of the functioning of the nerves that control the hand and wrist.

The treatment of any hand injury must be personalized and consist of two levels of action:

1. Conservative treatment: rehabilitation exercises and / or corrective splints.
2. Surgical treatment: repairing, releasing or modifying the damaged structure through a surgical procedure. Any surgical treatment must be accompanied by conservative pre and post surgical treatment.