The hand is highly complex, made up of multiple joints, different types of ligaments, nerves, and tendons that can develop a range of disorders or suffer several kinds of injuries. With 27 bones in the hand and eight in the wrist, the hands require doctors who are dedicated to its complexity and the various conditions that can develop, which are known as orthopedic hand specialists.
What is an Orthopedic Hand Specialist?
Orthopedics is an area of medicine dedicated to the musculoskeletal structure in the body, which encompasses all the muscles, bones, and supportive structures and tissues in the body. Hand specialist doctors are those focused on the musculoskeletal structure of the hands and are a subtype of orthopedic doctors, often able to provide orthopedic hand surgery as well as non-surgical treatments and diagnosing disorders.
Conditions Hand Specialists Provide Care For
Hand specialists can diagnose and provide care for several hand and wrist conditions, including:
Medically known as stenosing tenosynovitis, the condition causes stiffness, pain, and a locking sensation when the finger is being bent or straightened. The direct cause of trigger finger isn’t known, but factors like diabetes, rheumatoid arthritis, and the forceful use of fingers and thumbs are known factors.
A common hand condition that develops when a major nerve in the hand is squeezed or compressed in the wrist. If left untreated, carpal tunnel worsens over time and develops into a permanent dysfunction that causes loss of sensation in the fingers and weakness in the hand.
This is a type of overuse injury of the thumb, though it can also be caused by rheumatoid arthritis. The tendons that run alongside the wrist and attach to the base of the thumb begin to swell, specifically where they are constricted by the sheath they run through from the wrist to the hand.
Medically known as basal joint arthritis, symptoms include pain at the base of the thumb and is the second most common type of hand arthritis. The condition can develop due to age or overuse.
Injuries like dislocations, fractures, and injuries that affect the soft tissues, tendons, or ligaments all fall within this category. They can be caused by a variety of circumstances and incidents, from playing sports to being involved in a car accident, even during regular household activities.
Orthopedic Treatments for Hand Conditions
Orthopedic hand specialists provide both non-surgical care and hand surgery. Hand specialists will often begin with a conservative approach unless the injury or condition requires surgery, such as with some fractures. Below is a list of common non-surgical treatments that are commonly recommended for different injuries:
- Splinting or Bracing: Immobilizing the affected joint or tendon can help reduce pain, inflammation, and further injury. Splints can be especially helpful for conditions like carpal tunnel syndrome, trigger finger, or thumb basal joint arthritis.
- Physical Therapy: Hand therapists or physical therapists can design specific exercises and treatments to increase strength, and mobility, and reduce pain or stiffness.
- Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be recommended to reduce pain and inflammation.
- Activity Modification: Advising patients on changing or reducing certain activities that aggravate symptoms.
- Hot or Cold Therapy: Applying heat or cold packs can reduce inflammation, pain, and muscle spasms.
- Joint Aspiration: Removing fluid from a swollen joint for relief and diagnostic purposes.
- Corticosteroid Injections: Injecting steroids into the affected joint or around tendons can significantly reduce inflammation and pain. These are commonly used for trigger fingers, carpal tunnel syndrome, and arthritis, among other conditions.
- Pain Management: This can include other medications or interventions specifically tailored to manage pain.
- Platelet-Rich Plasma (PRP) Injections: Some specialists may offer PRP injections, where a concentration of the patient's own platelets is injected into the injured area to promote healing.
- Compression Garments: These can help manage symptoms of swelling or lymphedema in the hand.
- Anti-rheumatic Drugs: For conditions related to rheumatoid arthritis or other autoimmune conditions affecting the hand.
Types of Hand Surgery
When conservative approaches to care don’t alleviate symptoms or help heal the condition, orthopedic hand specialists may recommend surgery. If qualified as an orthopedic surgeon, your doctor may perform it themself or recommend a surgeon to you. Below is a list of common hand surgeries:
- Carpal Tunnel Release: Surgery to alleviate pressure on the median nerve, providing relief from symptoms.
- Trigger Finger Release: Surgery to release the tendon sheath that's causing a finger or thumb to get stuck in a bent position.
- Dupuytren's Contracture Surgery: Removal or release of the thickened tissue in the palm causing fingers to bend into the palm.
- Fracture Repair: Surgical treatment of broken bones in the hand or wrist. This can include open reduction and internal fixation (ORIF) where hardware like plates and screws are used.
- Tendon Repair: Surgical repair of damaged tendons in the hand or wrist.
- Ligament Repair/Reconstruction: Surgery to repair or reconstruct torn or damaged ligaments in the wrist.
- Thumb Arthritis Surgery ( Basal Joint Arthroplasty): Surgery to help with osteoarthritis at the base of the thumb, which might involve removing bone or joint reconstruction.
- Joint Fusion (Arthrodesis): Surgically fusing bones together in a joint to alleviate pain, usually only done when arthritis is severe.
- Joint Replacement (Arthroplasty): Replacing a joint in the hand or wrist with an artificial one, similar to a knee or hip replacement.
- De Quervain's Release: Surgery to relieve pressure on the tendons at the base of the thumb, which can be constricted due to inflammation.
- Tendon Transfers: Surgery to restore function after nerve injuries by rerouting tendons from one location to another.
- Reconstructive Surgery: After trauma or congenital deformities, surgery may be needed to restore function and appearance. This might include skin grafts or flaps.
- Treatment of Infections: Sometimes, surgical intervention is needed to treat infections in the hand, including abscess drainage or debridement.
- Tenosynovectomy: Removal or release of inflamed tendon lining, often done in cases of rheumatoid arthritis affecting the hand.