Thursday, February 6th, 2020
Hand Surgery is an unusual specialty. Among other things, it is a specialty shared by General Surgery, Orthopedic Surgery and Plastic Surgery, each doing the same things. Also, though officially a surgical specialty, care of the hand actually involves more medical care than surgery. Care can be divided into several categories, trauma care, arthritis and inflammatory processes, congenital problems, and miscellaneous problems.
This can be mostly surgical initially, involving repair of cut or injured tendons, muscles, nerves or vessels. However, many injuries do not involve transection of a structure and require only observation and retraining. Even initial surgical repairs require more follow up than most injuries elsewhere because of the necessity of retraining the brain. Many initial repairs may require only minor surgery to achieve later function. Retraining is achieved through cooperation of the patient, a specially trained hand therapist and the doctor.
This is probably the largest group of problems and the one with the least actual surgical procedures. Rheumatoid arthritis and osteoarthritis are well known problems, but other processes like psoriasis, gout, and autoimmune disease can also cause similar symptoms. Part of all the arthritides is inflammation of the synovium, the tissue surrounding the joints. This tissue also surrounds the tendons and other structures in the hand and arm and can become inflamed without joint problems. Common examples of this is tenosynovitis, trigger finger, De Quervain’s, and, even, carpal tunnel and other nerve compression syndromes. Though many of these, including carpal tunnel, are generally considered surgical problems, medical treatment is actually best.
Most of these are, indeed, surgical, to correct the congenital problem. Though Dr. Buchanan did a large numbers of these while at Children’s Hospital in Oklahoma City, he believes these problems generally need to be treated by those who do so frequently.
These are almost all other problems that can occur in the hand and upper extremity. Many of these, such as Dupuytren’s contracture have gone from usually surgical to frequently medical. In the case of Dupuytren’s, an injection into the contracting band instead of cutting it essentially melts the scar, releasing the contracture.
In addition to plastic surgery, Dr. Buchanan is board certified in hand surgery and taught it for many years. He still cares for many patients with hand problems. If you have a problem with your hand or upper extremity, call the Center for Plastic Surgery at 828-526-3783 to learn more or for an appointment.