A hand specialist is a physician who focuses on the entire upper extremity, treating conditions from the fingertips up through the hand, wrist, forearm, and often the elbow. This specialization is unique because it is not a single, direct path from medical school, but rather a subspecialty that draws from multiple surgical fields. The complexity of the hand, which contains 27 bones, numerous joints, tendons, and nerves, requires a highly focused level of expertise that goes beyond general surgical training.
The Medical Backgrounds of Hand Specialists
The majority of hand specialists begin their careers within one of two primary surgical residencies: Orthopedic Surgery or Plastic Surgery. A third, less common pathway involves completing a General Surgery residency before pursuing specialized training. The initial residency choice often influences the surgeon’s foundational perspective on the upper limb.
Orthopedic surgeons typically spend five years training with a focus on musculoskeletal structures, meaning their expertise often centers on the bones, joints, ligaments, and tendons of the body. Their initial experience heavily involves managing complex fractures, joint replacements, and ligamentous injuries. This background provides a strong mechanical understanding of the hand and wrist’s biomechanics.
Plastic surgeons, conversely, complete five to seven years of training that emphasizes soft tissue coverage, skin grafts, and microvascular surgery. Their focus often includes the intricate repair of nerves, blood vessels, and soft tissue defects, as well as the reconstruction of congenital deformities. Despite these different starting points, once they enter specialized hand training, their practices quickly overlap to cover the full spectrum of upper extremity conditions.
Specialized Training and Certification
What truly unifies these physicians as specialized hand surgeons is the completion of an intensive, post-residency training program called a Hand Surgery Fellowship. This is a dedicated, additional year of training accredited by the Accreditation Council for Graduate Medical Education (ACGME). The fellowship ensures that the physician gains comprehensive experience across all areas of hand surgery, regardless of their original residency background.
Following the fellowship, the most defining step is achieving the Subspecialty Certificate in Surgery of the Hand, often still referred to by its former name, the Certificate of Added Qualifications (CAQ). This certification is granted after passing a rigorous examination administered jointly by the American Boards of Orthopaedic Surgery, Plastic Surgery, and Surgery. Obtaining the CAQ signifies that the surgeon has demonstrated expert knowledge and competence in the full range of hand and upper extremity pathology, distinguishing them from a general orthopedic or plastic surgeon.
Conditions Treated by Hand Specialists
Hand specialists treat conditions that threaten the function and dexterity of the upper limb, broadly categorized into traumatic injuries, chronic disorders, and congenital abnormalities. In the area of trauma, they routinely manage complex hand and wrist fractures, such as distal radius breaks or metacarpal fractures. They are also the experts for severe crush injuries, tendon lacerations, and the microvascular surgery required to reattach severed digits or limbs.
Regarding chronic and degenerative issues, a hand specialist frequently treats nerve compression syndromes like Carpal Tunnel Syndrome, which causes numbness and tingling in the hand due to pressure on the median nerve in the wrist. They also manage Cubital Tunnel Syndrome, where the ulnar nerve is compressed at the elbow, leading to symptoms in the ring and little fingers. Degenerative conditions like osteoarthritis at the base of the thumb or rheumatoid arthritis affecting the finger joints are commonly addressed through both non-surgical and surgical interventions.
They also treat tendon issues such as Trigger Finger, where a tendon sheath thickens and causes a finger to catch or lock, and Dupuytren’s contracture, where tissue in the palm tightens and pulls the fingers into a bent position. Hand specialists also address congenital differences (abnormalities present at birth), including Syndactyly (fused fingers) and Polydactyly (extra fingers).