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Human body is a miracle

The human body is a true miracle. Our organ systems interact to sustain our life and lifestyle in truly amazing ways.

One of the most impressive body parts is the human hand. Its structure allows contact with our surroundings through our sense of touch.

Further, it performs most of activities of daily living, from playing a concert piano to performing delicate surgery. Hands perform hard labor, such as chopping down a tree with an ax or things as delicate as holding a loved ones hand while they are suffering illness.

An attestment to the importance of this structure, its healing capability and durability are truly remarkable. Unfortunately, occasional disorders do occur and often cause the need to visit an orthopedic surgeon.

Tendons perform much of the work of the hand. They are the structures which connect the forearm muscles to move the fingers and thumb. When friction causes fraying or thickening of a tendon, it can trigger. This can be after an injury or more often from overuse. The patient will report discomfort and a catching sensation at the base of a finger. Physical exam reveals a clicking sensation and tenderness at that site.

Initial treatment consists of splinting, anti-inflammatory medication, and occasional cortisone injection. When these fail, a surgical release can be performed of the band that is causing the friction. A similar problem occurs in the wrist at the base of the thumb with de Quervain’s tenosynovitis. Repetitive activity, such as casting a fishing rod or painting cause overuse and pain. Again, exam reveals tenderness in the area of interest and initial treatment is similar. If this fails, a surgical release can be performed.

Arthritis can affect any joint in the body. The carpometacarpal joint, or basal thumb joint, sees large loads. This is the most common joint of the hand that requires surgery. With years of use, the joint cartilage surfaces will wear out and become a source of pain. Patients report pain at the base of the thumb, increased with activity such as trying to open a bottle or jar, turn a door knob or a key, or other grasping activities.

As with many orthopedic conditions, initial treatment consists of activity modification, splinting, and anti-inflammatory use. Often, a cortisone injection will give relief.

If more conservative care fails, surgery can be contemplated. Depending on the age and activity of the patient, this can consist of a fusion or stiffening of the joint.

By removing the motion, the bone surfaces no longer rub and pain is removed. More commonly, some type of arthroplasty or replacement is performed. Most commonly, this is done using a portion of the patient’s own tendon to avoid any foreign material. Once recovered, patients report excellent relief of their pain.

Finally, the most common hand condition presenting to orthopedic surgeons is carpal tunnel. This can be associated with ulnar neuropathy at the elbow. Patients typically complain of numbness in their fingers that bothers them at night, as well as activity.

Although this can occur after injuries, most cases occur after repetitive use. Initial treatment includes physical therapy, activity modification, splinting, anti-inflammatories and vitamin B6. If these efforts fail, the patient is referred for confirmatory nerve conduction studies. This is similar to a human voltmeter measuring electricity in the nerve to determine how severe the compression is.

Depending on patient preference and results of the test, surgery may be offered. This consists of releasing the “roof” of the carpal tunnel, or moving the nerve to a more relaxed, less compressed, position at the elbow for the ulnar nerve. Again, most patients report excellent results once they have recovered.

Our hands perform innumerable duties in every day of our lives. Anyone who has suffered an injury to a hand and lost use for a time reports that even simple, taken-for-granted tasks, such as brushing one’s teeth, can be difficult.

People are identified as being right or left handed. The hand is often a symbol in logos, such as the peace sign or Winston Churchill’s V for victory.

Finally, over the last several years, hand transplant surgery has been performed. This further confirms how critical the hand is to one’s function. It puts the hand on par with the heart, kidneys, and lungs, which are more often transplanted.

The elegant design of the hand and its function is a true miracle.

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