A hand specialist is a medical doctor who has achieved subspecialty training to diagnose, manage, and treat complex conditions affecting the hand, wrist, and forearm. This physician focuses on the intricate anatomy of the upper extremity, including bone, joints, tendons, nerves, and blood vessels. Hand specialists complete specialized residency training followed by intensive fellowship education. This focused training allows them to address problems ranging from traumatic injuries to degenerative diseases, providing both surgical and non-surgical solutions.
Three Foundational Training Paths
A hand specialist starts with a rigorous surgical residency in one of three primary disciplines. The most common pathway is through Orthopedic Surgery, a five-year residency focusing on the musculoskeletal system. This includes the diagnosis and treatment of fractures, joint problems, and degenerative bone conditions. These surgeons gain extensive experience in the structural integrity of the upper limb.
Another foundational route is Plastic Surgery, which involves a residency lasting five to seven years. This specialty provides expertise in soft tissue management, skin coverage, microvascular surgery, and reconstructive techniques. A plastic surgeon specializing in the hand is adept at nerve repair, tendon transfers, and complex wound closure.
The final, though less frequent, initial path is General Surgery, a five-year program that provided a broad surgical foundation. While less common for direct entry into hand surgery today, a general surgeon may pursue a subsequent fellowship before specializing in the hand. Regardless of the initial residency, all three paths require further specialized training to be recognized as a certified hand specialist.
The Specialized Hand Surgery Fellowship
The defining step in the training of a hand specialist is the completion of an accredited Hand Surgery Fellowship. This additional year of training after the initial residency focuses on the complete spectrum of upper extremity conditions. The fellowship provides experience in trauma, congenital differences, and the micro-surgical techniques required for fine structures like nerves and small blood vessels.
Upon completion of this fellowship, the surgeon must obtain the Subspecialty Certificate in Surgery of the Hand, formerly known as the Certificate of Added Qualification (CAQ). To qualify, the surgeon must already be board-certified in their foundational specialty (Orthopedic, Plastic, or General Surgery). They must also submit a detailed log of cases demonstrating the volume and diversity of their surgical experience. This certification validates the surgeon’s expertise and comprehensive knowledge in the field of hand surgery.
Comprehensive Scope of Practice
The specialized training of a hand specialist is necessary due to the delicate and complex nature of the hand and wrist, which requires precise treatment for optimal function. Their scope of practice covers a wide array of conditions, including nerve compression syndromes such as Carpal Tunnel Syndrome and Cubital Tunnel Syndrome. They manage traumatic injuries, including complex fractures, tendon lacerations, and amputations that may require replantation surgery.
Hand specialists also treat degenerative conditions like arthritis, which can affect the joints at the base of the thumb or the fingers, often requiring joint reconstruction or fusion. They manage common issues like trigger finger and Dupuytren’s contracture, as well as congenital deformities. Treatment is not exclusively surgical, as many conditions respond to non-operative management such as steroid injections, medication, or prescribed hand therapy to restore movement and strength.