Batra Hospital has taken the lead in establishing a Hand Clinic so as to provide concerted, co- coordinated care to patients with hand problems. The clinic is co-ordinated by Fellowship trained Hand Surgeon along with Hand therapists with input from Orthopedic department, whenever needed. The aim of the clinic is to make all hands functionally useful and back to work as soon as possible.
The spectrum of patients seen in the clinic can be divided into various subsections-
Trauma, Infection, Tumor, Congenital, Nerve and Metabolic/Inflammatory.
Missed injuries may require major secondary reconstruction. Early consultation after sustaining major traumas may enable the surgeon to make use of the discarded parts which may help in regaining lost function. A mangled, severely injured hand may require complex microsurg. reconstruction (free flap/ vasc.bone transfer).
Infections of the hand (abscess or tenosynovitis) or if ignored, major complications like osteomyelitis (bony infection) are also seen. Once it is dealt properly, it can save a lot of bother and preserve the hand function. Sec. infections following chronic illnesses like Diabetes need close monitoring and individualized care for salvage of the extremity, which can become life threatening if ignored.
The commonest tumor observed in the hand is ganglion, seen either on the dorsal wrist or volar surface, occasionally on the finger and needs loupe dissection to prevent recurrence. The other common tumor is the giant cell tumor of the flexor sheath, a soft tissue tumor often encircling the neurovascular bundle & needs proper dissection. The commonest bony tumor is osteochondroma (enchondroma) which needs bone grafting & fixation.
Congenital hand problems need to be dealt early i.e. before going to school to avoid adopting bad practices which are then difficult to correct. The deformities that can be surgically corrected are polydactyly (duplication of digit), syndactyly (webbing of fingers or thumb), radial club hand, absent or hypoplastic thumb as well as other rare anomalies (pterygium elbow) & many more but needs trained handling.
Nerve injury in the form of nerve laceration is treated with either microsurgical repair or a microneural cable graft. Long standing pressure on the nerves may present as chronic compression, of ulnar, radial or median nerve (pain syndromes or paralysis). Intractable cases need surgical intervention in the form of release of compression if early, or tendon transfers in case the treatment gets delayed, also for missed out or delayed lacerations.
Rheumatoid arthritis patients can move around and function quite well with deformed looking hands; their only indication of operation is loss of function or incapacitating pain. Patients may need joint replacement, synovectomy, soft tissue reconstruction or tendon transfers to improve the situation. Dupuytren’s contracture involving the fingers, palm and thumb can be corrected surgically. Other problems like trigger finger, Dequervain’s disease are dealt on a day care basis.
Apart from fractures there can be closed ligamentous injuries of the wrist which are diagnosed by clinical examination, X-rays and arthroscopy. They need ligamentous reconstruction. Often the injury is severe and open/ complicated and requires microsurgical intervention. Salvage procedures (arthrodesis or proximal row carpectomy) or pain relieving procedures may be done as a last resort.
Success of any hand surgery is highly dependent on after care and motivated physiotherapy. We have dedicated therapists who work out an individualized regime depending on the injury and work in conjunction with consultants to reproduce optimum results.