Hand Surgery at a Glance

1. Diseases of the Tendons and Tendon Sheaths

Inflammation of the tendon sheaths most often occurs in the hand and wrist. One must distinguish between the acute and chronic forms of tendon sheath inflammation.

1.1 Tendon Entrapment Syndromes

Usually, the only way to treat chronic tendon sheath inflammation is through surgery. The common consequences of chronic tendon sheath inflammation, which are termed differently according to where they appear on the body, are called tendon entrapment syndromes. The most common of these are as follows:

1.2 Tendinopathy

Strong muscles are fixed to the bones by tendons. These anchor points in the bone may, through excessive stress on the corresponding extremity, become weak points. Continual, repetitive stress can eventually lead to bone formation. This can result in painful nerve conditions or an unpleasant rubbing or grinding when moving. The most common tendon complaints are as follows:

2. Nerve Compression Syndromes

The arm and hand are essentially innervated by 3 main nerves. These are the median nerve, ulnar nerve and radial nerve. Any of these three large nerves can develop compression syndromes at specific narrow areas in the forearm. Symptoms depend on which part of the nerve is affected. The predominant symptoms range from abnormal sensations (pins and needles) through pain to paralysis. Therefore, if symptoms occurring in the forearm and hand are vague, nerve compression syndromes in these areas may be a possible cause. Through differential diagnosis and additional electrophysiological testing, a diagnosis is usually conclusive. The initial therapy is immobilization, and corticoid injections are justified. However, if symptoms persist then the need for surgical intervention must be made in good time, otherwise it could lead to permanent nerve damage.

3. Dupuytren’s Disease

Dupuytrens disease is a special case in which the tissue on the inside of the hand, the so-called palmar fascia, becomes diseased to the point where it causes a bending of the finger towards the palm.

4. Congenital Anomalies

The forming of our hands in the womb is a highly complex process which is particularly prone to disorders. Therefore, deformities or abnormalities of the hands and/or feet can vary considerably.

Diagnosis and Surgical Planning

5. Scaphoid Bone

Due to its exposed position and scope of movement, the scaphoid bone is the carpal bone that most often breaks. If such a break is overlooked and not adequately treated it can lead to chronic problems.

6. Kienböck's Disease

Kienböck’s disease occurs when the lunate bone (one of the small carpal bones in the wrist) is damaged due to blood supply disorders.

7. Ganglion Cyst

A ganglion cyst is a fluid-filled lump on the hand that can reach up to a few centimetres in size.

8. Skier’s Thumb

The so-called skier’s thumb is a common thumb-ligament injury. The cause is through forced abduction of the thumb (thumb moving away from palm), which hyperextends or even rips a ligament.

9. Tendon Injuries of the Hand

The finger tendons lie just below the skin so they are often severed in cutting injuries. However, extensor tendon rips can also occur through seemingly harmless injuries such as stubbing the end of the finger.

10. Nerve Damage and Nerve Reconstruction

If the arms or hands are injured in an accident, it is common for some sort of damage to nerves leading to paralysis and touch sensibility impairment in the affected area.

11. Arthrosis of the Finger and Hand Joints

Broadly speaking, the term arthrosis describes the wear and tear of joints. The causes of the damage can be varied and the conditions that it leads to can affect various joints.

12. Rheumatoid Arthritis

A synonym for this disease is chronic polyarthritis (CP). It is chiefly the inflammation and damage to joints, usually in several localized areas.

13. Hand Infections

Infections of the hand are often caused through seemingly trivial injuries.

14. Carpal Ligament Injury

Injuries to hand ligaments which have not been recognised and adequately treated cause structural disorders, which in turn can cause long-term abnormal loading or misuse of the joint surfaces.

15. Techniques