Our sense of touch, the movement of objects, our gestures … all examples of  life essentials that depend on our hands

What  we need to do these things them remain secret: bones, joints, tendons, nerves,

Blood vessels, skin, and hand muscles must work in isolation and combined. Only a small failure can cause the entire functioning structure to collapse. Sometimes the smallest injury like a bruise, a fall, a burn may break a bone, tear tendons, nerves, ligaments, and vessels. Diseases such as infections or arthrtis articular rheumatism also lead to significant impairments of the hand.

Such injuries, diseases and malformations are treated by hand surgeons.

Hand surgery is a special area of medicine medicical part that requires both operative and conservative treatment. At the end of hand surgery and / or therapy is the maintenance or restoration of a feeling-assisted, grippable, movable and pain-free hand.

Hand surgery involves doctors who have completed a specific training in order to be able to work as a specialist in this field (hand surgery).

What is possible with this special surgery?

Unstable joints can be strengthened by strapping or joint stiffening.

Joint wear can be reduced.

Unhealed fractures are retrospectively retreated by an operation.

Microsurgical nerve transplants solve nerveproblems.

Tendon problem can be minimized by  displacement, replacement or solution.

Skin transplants conceal skin defects and scars.

Surgeons are often confronted with the following disorders

Dupuytren’s disease

Crooked fingers, thickened strands, knots in hand.

Between the visible skin  and the tendons or nerves in the hand lies a strand-shaped tissue layer. It protects the sensitive tendons and nerves in the hand. If a Dupuytren’s contracture occurs, this intermediate layer changes: it becomes thicker in the form of a strand, develops nodes, and is shortened with the result that the fingers become more and more curved. The cause has not yet been clarified. However, it is clear that heredity plays an important role in this process. An operation is carried out, if one or more fingers can not be stretched out anymore.

Sulcus Ulnaris syndrome

The Sulcus ulnaris syndrome or cubital tunnel syndrome is an irritation and paralysation of the ulnar nerve, which is triggered by a narrowing at the  elbow . This will weaken the supplied forearm and hand muscles. This critical position is known as the so-called “musician bone". If you push here, a strong, very unpleasant stimulus is triggered, pulling the forearm down into the fingertips. In the case of sulcus ulnaris syndrome, the chronic narrowing of the nerve at the elbow produces a comparable feeling, more or less permanently.

With a surgical procedure, we are able to resolve these complaints. Depending on the findings, the operation can be performed in outpatient with regional anaesthesia.

Epicondylitis humeri radialis (tennis elbow )

The tennis elbow is a localized inflammation in the region of the extensor muscles of the forearm and the hand. From the medical point of view, this is a so-called epicondylitis (humeri radialis). It belongs on the one hand to the insertion endopathies (disease of the tendons, tendon sheaths and ligaments), on the other hand also to the myotendinoses (disease of the muscle unit); (Myo and tendon = Tendo). Accordingly, the epicondylitis (humeri radialis) is a disease of the tendons and ligaments, with the involvement of the adjacent musculature.

Tendopathies (tendon inflammation) may cause painful changes to tendons in the area of ​​a muscle origin, muscle, ligament or capsule attacks.

Tendopathy can  occur almost all over the body. In the case of the tennis elbow, as a result of an overloading of the muscles producing characteristic pain, the affected arm may be extremely painful to use. The tennis elbow affects men as well  as women alike, most often in the middle age. The tennis elbow can be treated both conservatively and surgically. As a rule:  first attempt to treat the clinical picture conservatively. This implies treatment methods such as: resting, electromechanical stimulation, cortisone injections, bandages. If the conservative treatment does not work, an operation may become necessary. The muscles needed to stretch the arm (“forearm extensors") are loosened by notching the tendon shoulder.

Carpal tunnel syndrome

Tingling fingers, nocturnal pain and numbness.

The carpal tunnel syndrome results from the pinching of a nerve, which lies at the level of the wrist.

The pinched nerve hurts especially at night and over time may cause a permanent numbness in the fingers. The cause of this disease is usually not ascertainable. If the neurologist detects a delayed distal motor latency of the median nerve, it should be discussed via an OP to prevent a later major injury. The operation is performed on an outpatient basis in regional anesthesia

Ganglion

Upper leg swelling, blisters and pain.

The symptom comes from a cell that can be like an over growth on the wrist. These cysts

Can grow and break through the skin. If the cyst breaks through the skin it creates an open wound and there is a risk that bacteria will migrate into joints and lead to severe joint infections.

An operation is necessary if the cyst is older than six months

It is frst drained then completely removed during an operation.

Trigger thumb or trigger finger

If you try to stretch the thumb or a finger after a long rest, the disease will suddenly abruptly move upwards into the stretching position. A variant is characterized by which the person concerned has difficulties to close the hand without pain. Causes are tendons which catch and are disengaged by force in small jerks.  Frequently, this disease arises after previous, unaccustomed high stress on the hand. The operation is a relatively small and relatively uncomplicated procedure.

de Quervain’s Tenosynovitis

Just behind the wrist a tunnel lke canal runs from elbow to wrist. Through this channel several tendons extend to the thumb, usually two. In the case of a de-Quervain’s disease, this channel is narrowed through overuse or inflammation, When the thumb moves, these tendons must pass through the canal. When the canal narrows, the cords of the tendons and the canal walls are affected, causing severe pain. In individual cases, an anatomical anomaly may also be the cause of de Quervain’s disease, in which there are not two, but more than two tendons in the canal. As a rule, de Quervain’s disease is easily recognizable for the skilled hand surgeon. The strong thickening in the area of ​​the canal (1st stretcher) is clearly visible on the outside. If symptoms and a certain test (Finkelstein test) are positive at this point, the de Quervain’s disease can be well diagnosed.

Modellprojekt Hand-surgical care of professional associations

Approximately 45% of the injuries are related to the hand. As a rule, they are provided by physicians who do not have the additional name “Handchirurgie" according to the training regulations. The “Hand Surgery" model project is intended to ensure adequate care while providing contractual possibilities. Thereupon minor cases can be detected and injuries to the further care supplied by a hand surgeon. Minor cases can be detected and further injury prevented by consultng a well qualifed specialist hand surgeon.The possibility of a near-term hand-surgery consultation supplements the current services. The cooperation in “Modellprojekt Handchirurgie" of the Berufsgenossenschaften and the continuing education powers for hand surgery are testimony and recognition for our qualified work in this field.