When we talk about hand trauma, we mean major injuries that have been sustained to the hand. The primary treatment of hand trauma frequently requires access to microsurgical facilities for small vessel and nerve repair.  Such facilities need to be available on a 24 hour basis. 

What surgery is available, and what techniques are used?

• Burns and skin loss, for instance, will require surgical flaps and grafts, while the traumatic loss of digits may be treated by what is known as toe to hand surgery. 
• Toe-to-hand surgery involves the microsurgical transfer of digits from the foot to the hand. The absence of a finger does not usually have much effect on either the function or the appearance of the hand, but when the missing digit is a thumb, or when many digits are missing, surgery may be needed.
• Generally, the guideline in considering reconstruction is whether or not the overall function of the hand may be improved, although it is also natural and necessary to take into consideration the appearance of the hand.
• Whichever toe is transferred, its blood vessels (artery and nerve) must be successfully joined to similar vessels in the hand for it to survive.

Tendons (to allow movement where required), nerves (to allow feeling), and the bone must also be rejoined to suitable counterparts in the hand.

Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.

Risk factors for carpal tunnel syndrome include:

• Heredity:
  • The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.
• Repetitive hand use:
  • Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
• Hand and wrist position:
  • Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
• Pregnancy:
  • Hormonal changes during pregnancy can cause swelling.
• Health conditions:
  • Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms

• Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
• Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
• Pain or tingling that may travel up the forearm toward the shoulder
• Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
• Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

Treatment

• Nonsurgical therapy (If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome):
  • Wrist splinting:
    • A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness.
    • Nighttime splinting may be a good option if you’re pregnant.
• Nonsteroidal anti-inflammatory drugs (NSAIDs):
  • NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

Surgical Treatment: 

• Endoscopic surgery:
  • A telescope-like device with a tiny camera attached to it (endoscope) is used to see inside your carpal tunnel.
  • The surgeon then cuts the ligament through one or two small incisions in your hand or wrist.
  • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
• Open surgery:
  • The surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.

Symptoms:

• Dupuytren’s contracture typically progresses slowly, over years.
• The condition usually begins as a thickening of the skin on the palm of your hand.
• As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm, this lump might be sensitive to the touch but usually isn’t painful.
• In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.
• The two fingers farthest from the thumb are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely.

Treatment:

Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways: 

• Needling:
  • This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger.
  • The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually, very little physical therapy is needed afterwards.
• Enzyme injections:
  • Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. 
• Surgery:
  • Surgically remove the tissue in your palm affected by the disease.
  • The main advantage of surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods.
• In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases, a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterwards.