The formal name for the medical specialty commonly known as hand surgery is Hand and Upper Extremity Surgery. This specialized field focuses on the diagnosis, treatment, and management of conditions affecting the complex anatomy of the hand, wrist, forearm, and sometimes the elbow. The hand’s intricate arrangement of 27 small bones, multiple tendons, nerves, and vessels requires a dedicated surgical discipline to restore form and function after injury or disease.
Defining Hand and Upper Extremity Surgery
Hand and Upper Extremity Surgery is a distinct subspecialty addressing problems of the entire upper limb, from the fingertips to the elbow. The practice is concerned with the function and structure of the hand, wrist, and forearm, which are critical for daily activities. Surgeons in this field treat a wide spectrum of issues, including both acute trauma and chronic conditions.
This specialty synthesizes knowledge from multiple areas of medicine, particularly orthopedic surgery (focusing on the musculoskeletal system) and plastic surgery (dealing with soft tissue and reconstruction). Hand surgeons must be adept at both bone and joint repair, as well as the delicate handling of nerves, tendons, and blood vessels. The field relies heavily on advanced techniques like microsurgery, which uses magnification to repair minute structures such as small nerves and arteries.
Microsurgical techniques are necessary for complex procedures like replantation, which involves reattaching a severed finger or limb. This requires meticulously connecting vessels as small as a millimeter in diameter. The integration of these precise skills ensures that functional recovery is maximized after severe injury. This specialized approach allows practitioners to manage the full range of pathology in the upper limb, ensuring comprehensive care for both hard and soft tissue problems.
The Specialists Who Practice Hand Surgery
Hand Surgery is a subspecialty pursued after completing a foundational surgical residency, not a primary residency program. Practitioners typically originate from one of three primary surgical backgrounds: Orthopedic Surgery, Plastic Surgery, or, less commonly, General Surgery. This multi-disciplinary foundation speaks to the comprehensive nature of the hand and upper extremity.
Orthopedic surgeons bring expertise in the musculoskeletal system, providing a deep understanding of complex fractures, joint mechanics, and bone reconstruction. Plastic surgeons contribute specialized knowledge in soft tissue management, including skin coverage, wound healing, and intricate nerve and vessel repair. Regardless of initial training, all certified hand surgeons gain proficiency in both domains during their specialized training.
This combined expertise allows a hand surgeon to manage a severe crush injury, for example, by first stabilizing the bone structure and then performing delicate soft tissue and nerve reconstruction. The convergence of these different surgical skills is necessary because injuries and diseases of the hand rarely affect just one type of tissue in isolation. Therefore, the specialist is equipped to address the interwoven network of bones, tendons, nerves, and skin.
Scope of Treatment and Anatomical Boundaries
The anatomical scope of this specialty extends from the fingertips through the hand, wrist, and forearm, frequently encompassing the elbow. This upper extremity focus means the surgeon treats conditions affecting the small bones of the hand, the eight carpal bones of the wrist, and the radius and ulna of the forearm. Treatments cover an extensive range of injuries and chronic diseases that compromise the utility of the arm.
A major area of focus is trauma, including complex fractures and dislocations of the hand and wrist. Hand surgeons are often called upon for emergency care, such as repairing severe lacerations that damage tendons and nerves, or for the replantation of amputated digits or limbs. They also manage acute injuries like biceps tendon tears and elbow fractures that fall within the upper extremity’s anatomical boundaries.
Chronic Conditions
Chronic conditions form a substantial part of their practice, with common procedures addressing nerve compression syndromes. The most frequent is carpal tunnel syndrome, where pressure on the median nerve causes numbness and weakness, often requiring surgical decompression. Other prevalent conditions include trigger finger, a type of tendonitis, and Dupuytren’s contracture, a progressive disorder where tissue thickens beneath the palm, pulling the fingers inward.
Hand surgeons also manage arthritic conditions, performing joint reconstruction or fusion to alleviate pain and restore motion. They treat congenital differences, which are birth defects affecting the formation of the hand, and perform reconstructive procedures like tendon transfers to improve function in cases of paralysis. The goal of all these interventions is to restore the patient’s ability to grasp, feel, and manipulate objects.
Specialized Training and Certification
The path to becoming a recognized hand surgeon requires an extensive post-residency educational commitment. After completing the five to seven years of a primary surgical residency (Orthopedic, Plastic, or General Surgery), the candidate must complete a mandatory one-year Hand Surgery Fellowship. This accredited fellowship provides in-depth, focused training on the full spectrum of upper extremity conditions, integrating all necessary surgical techniques.
Following the fellowship, the surgeon is eligible to pursue the highest level of credentialing: the Subspecialty Certificate in Surgery of the Hand (SCSH). This certificate, formerly the Certificate of Added Qualification (CAQ), is a formal validation of specialized expertise. It is administered by the American Board of Medical Specialties (ABMS) through the surgeon’s original certifying board.
To earn this certification, the surgeon must pass a rigorous examination and submit a comprehensive case list demonstrating a high volume and diversity of procedures. Achieving the SCSH formally distinguishes a general orthopedic or plastic surgeon from a certified Hand and Upper Extremity Surgeon. This credential signifies that the practitioner has met the national standards for specialized knowledge and experience in this complex area.