Hand injuries are very common: one fifth of all visits to A&E departments in England are currently for hand trauma.
In addition, elective hand surgery for hand conditions such as carpal tunnel syndrome, Dupuytren’s disease and osteoarthritis is set to increase by 39% over the next 10 years. To help address this demand, patients need to be seen quickly by the right specialist to ensure correct initial treatment.
Hand specialists can help identify and address problems more accurately and more quickly, which can prevent unnecessary tests and appointments. Referral to the wrong specialist may lead to delayed treatment, at a cost both to the patient and the NHS.
The hand is incredibly complicated, with 27 bones, 24 muscle groups and three major motor and sensory nerve pathways. This helps us carry out a huge range of functions including feeling, gripping, manipulation, stability and communication. The hand is also important aesthetically as it may be the only part of us on display at all times (apart from our faces).
The surgical treatment of hand conditions involves more diverse skills than many other surgical disciplines. It includes small bone fixation, microsurgery, keyhole surgery of joints and soft tissues, joint replacement and the reconstruction of skin, muscles, tendons and nerves. Some cases require complex surgery, and hand specialists are often at the forefront of innovation.
For example, hand specialists at Leeds Teaching Hospitals NHS Trust recently performed a double hand transplant for the first time on a woman in the UK. Their efforts provided a breakthrough for a 42-year-old woman who lost both hands and her left arm to sepsis and was convinced she would have to use prosthetics for the rest of her life.
Yet with research and development leading to new techniques, the title ‘hand surgeon’ no longer truly reflects the role and scope of hand specialists. Surgery is now an increasingly small part of treatment. With early assessment by a hand specialist, many conditions do not require surgery.
Injections or hand therapy are the first lines of treatment and often resolve problems without the need for surgery. For example, the commonest condition in hand surgery, carpal tunnel syndrome, was previously almost always treated surgically. Yet evidence now suggests that some patients can be treated successfully with steroid injections. And, unlike in the legs, hand arthritis can often be treated with injections – avoiding joint replacement.
The role of the team is crucial to ensuring the best possible outcomes for patients with injured or disordered hands. Members of the British Society for Surgery of the Hand combine skills from orthopaedic and plastic surgery, as well as emergency medicine, and work alongside other specialist disciplines – such as rheumatology, neurology, neurophysiology, pain medicine and psychology.
Rheumatoid arthritis is increasingly successfully treated by rheumatologists with medication, reducing the need for surgery. Neurophysiologists provide support helping with the diagnosis of complex neurological problems in the hand.
Complex regional pain syndrome (CRPS) is a common problem to address in the hand; pain specialists provide support in the management of these difficult problems. Specialists play a crucial and constantly developing role in ensuring the best outcomes for patients
Grey Giddins is a member of the British Society for Surgery of the Hand