🩺 Carpal Tunnel Syndrome

Pain, numbness and weakness caused by median nerve compression in the wrist.

• Symptoms: Numbness, night waking, grip weakness
• Diagnosis: Physical examination, nerve conduction studies (EMG)
• Conservative: Splinting, steroid injections
• Surgery: Carpal ligament release; 30-minute minimally invasive procedure

🖐 Trigger Finger

Locking and clicking in finger due to inflammation of flexor tendon sheath.

• Symptoms: Locking, morning stiffness, pain
• Risk Groups: Diabetic patients, repetitive hand use
• Conservative: Corticosteroid injection (60-70% success)
• Surgery: A1 pulley release; 10-minute simple procedure

🔪 Tendon Lacerations

Tendons can be easily damaged by cutting injuries. Require emergency surgical repair.

• Open cuts:Injuries from knives, glass; repair ideal within 24 hours
• Flexor tendons:Finger flexion function; cutting leads to movement loss
• Extensor tendons:Finger extension function; located on dorsal surface
• Outcome:Splinting and early motion programs optimize healing

🧬 Nerve Injuries

Median, ulnar and radial nerves in hand and wrist. Injuries cause numbness and weakness.

• Median nerve:Numbness in thumb, index and middle fingers
• Ulnar nerve:Numbness in ring and little fingers
• Microscopic repair:Aplied to nerves at least 1 mm diameter under microscope
• Nerve grafts:Nerve transplantation may be needed for long gaps

Early diagnosis and microscopic repair improve functional outcomes.

🩹 Reattachment of Severed Limbs

The most striking application of microsurgery is reattachment of severed fingers or limbs.

• Time Window:12-24 hours for fingers, 6-8 hours for arm/leg
• Surgical Process:Bone shortening, tendon repair, microscopic vessel and nerve repair
• Success Rates:80-90% for finger amputations, 60-70% at wrist level
• Outcome:Gains function over time; generally does not reach full normal function

🧬 Congenital Hand Anomalies

Hand and finger anomalies in newborns can be treated.

• Syndactyly:Fused fingers; surgical separation
• Polydactyly:Extra fingers present; amputation or reconstruction
• Camptodactyly:Permanent flexion position; surgical correction
• Timing:Some in infancy, others planned at 4-6 years old

🎯 Hand Tumors and Cysts

Ganglion cysts are the most common hand cysts. Benign tumors treated with surgical excision.

• Ganglion cysts:Fluid-filled sacs near joints or tendons
• Lipomas:Benign tumors from fatty tissue
• Malignant Tumors:Rare; require early diagnosis and wide excision
• Treatment:Surgical excision, reconstruction if needed

Cyst recurrence seen in 5-10% of cases.

🔍 Microsurgery Techniques

Advanced surgical method requiring repair of blood vessels and nerves 1-3 mm diameter under microscope.

• Surgical Microscopes:6-40x magnification, illumination system
• Micro Instruments:Micro scissors, forceps, 10-0 sutures
• Vessel Repair:End-to-end anastomosis; with 8-0 or 9-0 nylon sutures
• Outcomes:Requires specialized training and practice

🏥 Postoperative Rehabilitation

Post-hand surgery rehabilitation is key to treatment success.

• Splinting:Protective splint for tendon and nerve repair
• Exercise Programs:Range of motion, muscle strength exercises
• Edema Management:Elevation, compression bandages
• Timeline:6-12 weeks rehabilitation; full function in 3-6 months