In Canada, most of the hand surgery and medical management of complex hand health problems is performed by plastic surgeons.

Fractures

Most broken bones of the hand heal with casting for a period of 4 weeks. However, some fractures will require surgery to better align the broken fragments. These operations are performed by plastic surgeons. This is especially true if the break occurs into a joint where arthritis is more likely to occur if the broken fragments are not properly lined up.

Nerves

When nerves in the hand are cut accidentally, they are repaired by plastic surgeons. Fingers or thumbs are numb after nerve injuries. If a successful nerve repair operation is possible, some of the feeling does return to the involved finger or thumb tip several weeks or months after the operation. Patients are usually out of work 2-3 weeks with these injuries, but they must be careful to protect the numb parts until sensation returns.

Tendons

Tendons are the cords underneath the skin responsible for finger and thumb movement. When severed, these need to be repaired with plastic surgery in order to regain normal finger function. Tendon injuries usually result in several weeks of absence from work.

Carpal tunnel syndrome

Carpal tunnel syndrome is a very common hand problem affecting up to 3% of Canadians. With this condition, there is usually numbness of the thumb, index, long finger and half of the ring finger. The numbness often begins in the night and may respond to splinting the wrist straight while sleeping. However, it may progress to daytime numbness and sometimes associated pain. Carpal tunnel syndrome is not caused by work but it can be aggravated by work; it is explained by a lack of room for the median nerve in the carpal tunnel of the hand. Surgery has a greater than 90% success rate for this problem and usually requires a 4-8 week absence from work.

Trigger finger

Trigger finger is another hand problem where the finger becomes stuck as it flexes into the palm. The other hand is usually used to pull the finger out straight; this is accompanied by “popping” and pain. A tendon whose bulge becomes too big to smoothly traverse within its tunnel causes trigger finger. Trigger finger is curable with an operation under local anesthesia to release the tunnel and allow smooth tendon gliding.

Dupuytren’s contracture of the hand

Dupuytren’s contracture of the hand is a frequently inherited problem, which results in the gradual bending of the ring, small or other fingers into the palm with the inability to straighten it. Contracture is caused by tissue deposits in the hand. Surgery involves removing these contractile tissues, and although it does not cure this disease, relief and improved function with the ability to straighten the fingers often lasts many years following surgery.