HAND SURGERY PHILOSOPHY


The human hand is probably the most intriguing and complexly engineered bio-advanced miracle known to the human mind.

It is therefore not hard to believe the theory that the brain developed secondary to the hand. The wealth of sensory input from the hand feeds the brain, creating millions of new pathways and synapses that have advanced the human brain beyond our comprehension.

The hand has 27 bones, with three main nerves, 15 muscles, 18 tendons and 2 blood vessels. The anatomy and biomechanics of the hand are very complex and probably the most advanced and intricate part of the human body.

The human hand has the ability, not only to grip an object in the palm, but even more so, it has the ability to pinch. The pinch grip is made possible by the thumb that can move in all directions (circumduction) and can hold objects against the index finger. The ability to hold something between your index or even little finger and thumb, is truly the most advanced form of life and a miracle!

When this miracle is crippled by an injury, pain or chronic disease, one suffers a great deal. A sense of loss and disability can affect the mind as well. People only realise the multitudes of functions and the need for the hand in all activities of daily living, once it is injured, crippled by arthritis or immobilised for any reason.

Surgery of the hand is complex and highly specialized. It deals with pain, loss of function, delicate anatomy, complex biomechanics and to some extent, an intuition or understanding of the complexity of the real problem beyond what is commonly presented. This intuition is probably about listening to the patient properly and then listening again. The solution is not always clear at first and might never be. The solution is not always surgery. It may be intensive hand therapy or sometimes adequate rest from sport, work or even a long holiday.

When the solution is surgery, in selected cases, the hand surgeon needs to apply all the foundations of the anatomy and patho-anatomy (when the anatomy goes wrong). This, combined with the science, art and surgical skill of both orthopaedic (bone and joints) and plastic (soft tissue i.e. nerves, muscles, blood vessels and tendons) surgery principles, aims to restore the normal biomechanics required to play the flute or hit the tennis ball!

This can be a challenging job, but because Hand Surgeons have received specialised training in the treatment of hand conditions, beyond their board certified speciality training in orthopaedic, plastic and general surgery, this speciality, together with meticulous attention to detail and application of basic principles, can successfully provide great relief for the patient.

My endeavour remains to guide and inform the patient, beyond the painful or injured hand, to make an informed decision regarding the best treatment modality. For me, it is an honour paired with a huge responsibility to operate on any hand, and I will follow those principles laid down by the fathers of hand surgery.

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