Frequently asked questions

Hand surgery is a specialized medical field that deals with the diagnosis and treatment of bone, joint, tendon, nerve, blood vessel, skin, and soft tissue problems of the hand, wrist, fingers, and forearm.

This field is not limited only to surgery; in many cases, medication, splinting, physiotherapy, observation, or rehabilitation may also be recommended for the patient.

Because the hand has a complex functional structure, even a seemingly small injury can affect gripping, writing, working, and daily activities. For this reason, evaluation of hand and wrist problems by a specialized hand surgeon is one of the accepted principles of modern medical practice.

Microsurgery is a surgical technique that allows the repair of very small blood vessels, nerves, and tissues using magnification devices, micro-instruments, and fine suture materials.

There are many functionally important blood vessels and nerves in the hand. When these structures are injured, their precise repair is often possible through microsurgical techniques.

In addition to nerve and blood vessel injuries, in complex cases accompanied by tissue loss, vascularized tissue transfers and selected joint transfers are among the main surgical techniques performed with microsurgery.

For this reason, microsurgery is considered one of the an integral part of hand surgery. A hand surgeon’s mastery of microsurgical techniques expands the treatment spectrum for the patient and allows the treatment plan to be designed in a more individualized, functional, and tissue-preserving way.

Microsurgical experience has special importance in preserving and restoring hand function.

Although hand surgery mainly deals with diseases and injuries of the hand, wrist, fingers, and forearm, this field is not limited only to these anatomical regions. Since hand surgeons work closely with the anatomy, physiology, and repair of nerve tissue, they may also play an important role in the evaluation and treatment of peripheral nerve injuries of the upper extremity.

In particular, injuries to the nerves that begin from the neck and shoulder region and extend to the arm and hand - for example, brachial plexus injuries - can seriously affect hand and upper extremity function. In such cases, nerve repair, nerve transfer, tendon transfer, and subsequent reconstructive procedures may be part of the treatment plan.

In addition, hand surgeons with experience in peripheral nerve surgery may also participate in the evaluation of selected cases involving lower extremity nerve injuries, nerve compressions, and nerve tumors. This approach is planned individually according to each patient’s condition, the location and severity of the injury, and the surgical technique required.

For this reason, hand surgery should not be regarded simply as “surgery performed on the hand,” but rather as a specialized field that evaluates the nerve, tendon, blood vessel, joint, and soft tissue systems that support hand and limb function as a whole.

The formation of hand surgery as a modern specialty mainly arose from the need to treat complex injuries of the hand and upper extremity. In particular, during World War I and World War II, numerous hand injuries showed physicians that hand trauma was not merely a bone fracture or a skin wound; rather, it often involved complex functional problems in which tendons, nerves, blood vessels, joints, and soft tissues were injured together.

As a result of this need, hand surgery developed as a specialized field that evaluates bone, tendon, nerve, blood vessel, skin, and soft tissues not separately, but as a single functional system.

The main goal of modern hand surgery is not only to close a wound or correct a fracture, but also to preserve and restore the hand’s ability to grip, feel, move, and perform daily life functions as much as possible.

For this reason, hand surgery historically formed as a special field at the intersection of orthopedics, plastic and reconstructive surgery, microsurgery, nerve surgery, and rehabilitation. This multi-tissue and functional approach still forms the basic philosophy of hand surgery today.

In short, hand surgery historically developed as a functional response to multi-tissue injuries of the hand.

The orthoplastic approach is a reconstructive treatment principle in which bone, joint, blood vessel, nerve, skin, and soft tissue problems are evaluated together. This approach is especially important in complex trauma, open fractures, tissue loss, and cases accompanied by functional loss.

In some injuries, repairing the bone alone is not sufficient. To preserve limb function, soft tissue coverage, blood circulation, nerve function, tendon movement, and rehabilitation must also be part of the treatment plan. Therefore, the orthoplastic approach brings together the principles of orthopedics, plastic and reconstructive surgery, microsurgery, and rehabilitation.

Hand surgery is very close to orthoplastic thinking in its philosophy. This is because a hand surgeon evaluates bone, tendon, nerve, blood vessel, skin, and soft tissues not separately, but as one functional system. Even a small blood vessel, nerve, or tendon injury in the hand can seriously affect gripping, sensation, writing, and daily activities.

In complex trauma of the lower extremity, the orthoplastic approach is often carried out as multidisciplinary teamwork. In the upper extremity, hand surgeons apply this multi-tissue reconstructive way of thinking in daily practice.

Hand surgeons with microsurgical and reconstructive experience may also participate, in selected cases, as part of the team in the evaluation of lower extremity nerve, soft tissue, and reconstructive problems.

For this reason, hand surgery is not merely “surgery on the hand,” but an orthoplastic and reconstructive system of thought focused on preserving function.

In short, hand surgery is one of the most natural examples of orthoplastic thinking in the upper extremity.

An orthopedic-traumatologist is a physician specialized in diseases and injuries of the musculoskeletal system. This field includes a very broad range of topics such as bones, joints, ligaments, muscles, tendons, the spine, and limb trauma.

The rapid growth of knowledge, technology, and surgical techniques in modern medicine has increased the need for narrower specialization within orthopedics and traumatology. This is because each anatomical region has different structure, biomechanics, and treatment principles. For example, the load-bearing biomechanics of the foot and ankle are not the same as the movement and stabilization principles of the shoulder joint. In spine surgery, special precision is required because of the proximity of neural structures.

In sports injuries, the goal is not only to treat the injury, but also to return the professional athlete safely to a level as close as possible to their previous performance.

For this reason, in international orthopedic practice, subspecialty areas such as arthroplasty and joint reconstruction, sports injuries, pediatric orthopedics, spine surgery, orthopedic oncology, hip preservation surgery, foot and ankle surgery, orthopedic trauma, shoulder surgery, limb lengthening and complex reconstruction, as well as hand and upper extremity surgery, have developed separately.

Hand surgery is also one of these specialized areas. A hand surgeon is a specialist who evaluates together the bone, joint, tendon, nerve, blood vessel, skin, and soft tissue problems that affect the function of the hand, wrist, fingers, forearm, and upper extremity.

Because these structures are located in a very small area of the hand and are closely connected to each other, simply repairing the bone or wound may not be sufficient. The main goal is to preserve and restore the movement, sensation, grip strength, and daily life function of the hand as much as possible.

In short, an orthopedic-traumatologist is a specialist covering the broad field of the musculoskeletal system; a hand surgeon is a specialized surgeon within this broad field who focuses on the function of the hand, wrist, forearm, and upper extremity, and evaluates nerve, tendon, blood vessel, bone, and soft tissue problems together.

In many healthcare and medical insurance systems, the rules for direct access to a hand surgeon may differ. In some cases, the patient may first need to be evaluated by a family physician, orthopedic-traumatologist, or another relevant physician and then referred to a hand surgeon.

Nevertheless, in the following situations, a specialized evaluation in the field of hand surgery may be useful.

If there is pain, numbness, weakness, limited movement, swelling, deformity, sensory loss, or reduced grip function in the hand, wrist, fingers, forearm, or upper extremity, evaluation by a hand surgeon may be beneficial.

Reasons to consult a hand surgeon are not limited only to trauma. Congenital hand anomalies, finger curvatures and deformities, nail deformities, nail bed injuries, peripheral nerve pathologies, nerve palsies, brachial plexus injuries, nerve injuries, tumors of the hand and upper extremity, finger fractures and intra-articular fractures, wrist ligament injuries, Kienböck disease, post-burn scars and contractures, as well as other hand and wrist problems may be evaluated within the field of hand surgery.

In particular, inability to bend or straighten a finger, change in finger shape after trauma, finger curvature or progressive deformity, nail deformity after trauma, nail bed injury, persistent numbness in the hand, nighttime tingling, difficulty holding objects, long-lasting wrist pain, stiffness and limited movement in the fingers after burns, or findings suggestive of nerve injury should be evaluated without delay.

In cases of open wounds, serious bleeding, finger amputation, suspected blood vessel injury, rapidly increasing swelling, signs of infection, fresh and deep burns, or severe trauma, emergency medical care should be sought without waiting for referral or planned consultation.

In short, consulting a hand surgeon does not mean only “having surgery.” The goal is to correctly identify the cause of the problem, preserve hand and upper extremity function, and establish the most appropriate treatment plan for the patient.

Although the hand may appear small in size, bones, joints, tendons, nerves, blood vessels, skin, and soft tissues are located very close to one another within it. For this reason, hand anatomy is highly complex and sensitive.

Injury to one structure in the hand may sometimes affect the function of other structures as well.

Visible curvature or deformity after trauma, inability to bend or straighten the fingers, numbness in the hand or fingers, weakness, color change at the fingertip, as well as progressively increasing swelling, redness, and pain after injury are considered serious signs.

In such cases, regardless of the size of the wound, obtaining a medical opinion is important. Especially if finger movement is lost, sensation is reduced, or the shape of the hand changes after trauma, evaluation from the perspective of hand surgery should not be delayed.

As in all fields of medicine, the diagnostic process in hand surgery first begins with carefully listening to the patient. When the complaint started, whether there was trauma, when the pain increases or decreases, numbness, weakness, limitation of movement, and previous treatments are important information for diagnosis.

Then the hand, wrist, fingers, forearm, and, if necessary, the upper extremity are clinically examined. During this examination, movement, sensation, blood circulation, grip strength, painful points, swelling, deformity, and nerve-tendon functions are evaluated.

When needed, additional examinations such as X-ray, ultrasound, electromyography and nerve conduction studies, computed tomography, or magnetic resonance imaging may be used to clarify the diagnosis and establish the treatment plan. Not every patient needs all examinations; which test is necessary is determined according to the complaint, examination findings, and suspected diagnosis.

For this reason, before the medical appointment, it is helpful for the patient to prepare information about when the complaints started, in which situations they increase or decrease, which treatments were previously received, and any previous examination results if available. For children, elderly patients, or patients who have difficulty expressing themselves, it is recommended that they come with a person who knows them well and provides care.

After the diagnosis is made, the treatment plan is prepared individually for each patient. The goal is not only to determine the name of the disease, but to choose the most appropriate treatment path by taking into account the patient’s complaint, functional need, daily life, and expectations.

Nerves are sensitive and functional structures that exit the spinal cord and continue along the upper and lower extremities to the fingertips and toes. Along this path, there are certain anatomically narrow areas, tunnels, and passage points. When a nerve is compressed in these narrow regions, its normal function may be impaired.

The symptoms of nerve compression vary depending on which nerve is compressed and where the compression is located. In some cases, the main complaint is numbness, tingling, and burning sensation; in other cases, muscle weakness, reduced grip strength, and difficulty with finger movements may occur.

For example, compression of the superficial branch of the radial nerve in the forearm may mostly present with sensory problems. Compression of the ulnar nerve at the elbow level may cause weakness in the hand, difficulty with fine movements, and weakness in the fingers.

On the other hand, not every numbness or weakness in the hand necessarily means nerve compression. Diabetes mellitus, neuropathies related to chronic kidney failure, neck-related nerve problems, and some metabolic diseases may also cause similar complaints. Therefore, the diagnosis of nerve compression should be evaluated together with the patient’s complaints, clinical examination, and, when needed, nerve tests.

No. Nerve compression does not occur only in the hand; it can develop in different regions of the upper extremity starting from the neck. Nerves pass through different anatomical passages at the levels of the neck, shoulder, arm, elbow, forearm, wrist, and hand. When compression occurs at any of these passages, the patient’s complaints may appear in different ways.

Examples of nerve compressions that may be seen in the upper extremity include thoracic outlet syndrome, quadrilateral space syndrome, suprascapular nerve compression, cubital tunnel syndrome, lacertus fibrosus syndrome, pronator syndrome, radial tunnel syndrome, Wartenberg syndrome, carpal tunnel syndrome, and Guyon’s canal syndrome.

Some of these problems may present with numbness and pain in the hand, while others may present with weakness in finger movements, reduced grip strength, difficulty with fine hand tasks, and muscle wasting. The same patient may also have nerve compression at more than one level; this is called the “double crush” phenomenon. In such cases, a problem at the neck level and a nerve compression at a lower level may together increase the symptoms.

Anatomical variations, meaning individual differences in nerve and muscle structure, may also make diagnosis more difficult. For this reason, in upper extremity nerve compressions, experience in hand surgery and peripheral nerve surgery has special importance in establishing the diagnosis and treatment plan.

No. Nerve compression may occur not only in the upper extremity, but also in the lower extremity. Nerves that exit the spinal cord pass through various anatomical passages along the thigh, knee, leg, ankle, and foot. Compression of the nerve in these regions may cause pain, numbness, burning, tingling, weakness, and difficulty walking.

Examples of lower extremity nerve compression include piriformis syndrome, peroneal nerve compression, tarsal tunnel syndrome, and Baxter’s neuropathy. Although these problems are not part of the classic field of hand surgery, hand surgeons with experience in peripheral nerve anatomy, nerve repair, and microsurgical techniques may participate in the evaluation of these patients in selected cases as part of a multidisciplinary team.

Yes, peripheral nerve tissue has a certain capacity for regeneration and healing. However, this healing depends on the type and severity of the injury.

In mild compression and traction-type injuries, improvement may occur over time. However, in cases of complete nerve transection, severe crush injury, or persistent numbness and weakness after trauma, medical evaluation should not be delayed.

In nerve injuries, timely diagnosis and an appropriate treatment plan have special importance in preserving hand function.

Tendons are important tissues that transmit the force of muscles to bone and enable movement of the fingers and wrist. Tendons may be injured in cases involving sharp object wounds, blunt trauma, sudden and forceful movements, or injuries resulting in rupture.

One of the main signs of tendon injury is loss of voluntary, active movement in the finger or wrist. For example, if the patient cannot bend or straighten the finger, this may indicate a tendon injury. Sometimes the wound may appear small, but there may be a serious tendon laceration underneath.

Complete tendon lacerations and ruptures often do not heal functionally on their own and require timely evaluation. Treatment is planned according to the location, type, and severity of the injury; in some cases, surgical repair may be needed, followed by splinting and a rehabilitation protocol.

For this reason, if after a hand injury the patient cannot actively move the finger, has weakness during movement, or has a change in finger function, evaluation from the perspective of hand surgery should not be delayed.

Yes, tendons may have various non-traumatic pathologies in addition to injuries related to cuts, ruptures, and trauma. The flexor and extensor tendons of the hand may develop their own specific diseases and functional problems.

Among these problems, the most well-known are trigger finger and de Quervain tenosynovitis. In addition, repetitive movements, long-term loading, occupational activity, and tasks requiring fine motor skills may also cause tendon problems. For example, musicians, people doing manual work, and those who use computers and tools may develop different tendon and soft tissue problems.

Unlike traumatic tendon lacerations, many of these tendon pathologies are initially treated with conservative approaches. Activity modification, splint use, medication, injection, physiotherapy, and rehabilitation programs may help reduce complaints and restore function in many patients.

Hand surgery is a specialized field that deals with the diagnosis and treatment of many functional problems related to the hand, wrist, forearm, upper extremity, and peripheral nervous system. In a large proportion of these problems, rehabilitation is an inseparable stage of the treatment process.

Hand physiotherapy and hand rehabilitation, like hand surgery, require special attention and specialization. Rehabilitation plays an important role in many stages, such as sensory rehabilitation after nerve surgery, relearning movements after tendon transfers, protective motion protocols after tendon repair, reduction of contractures after joint surgery, and management of scar tissue after burns and trauma.

The preparation and proper application of orthoses also have special importance in this process. Orthoses may be used to protect injured or operated tissues, keep joints in an appropriate position, guide movement safely after tendon repairs, provide functional support in nerve palsies, and prevent contractures. Each orthosis should be planned individually according to the patient’s diagnosis, type of surgery, stage of tissue healing, and rehabilitation protocol.

On the other hand, the patient’s adherence to rehabilitation requirements, orthosis use instructions, and the prescribed protocol is also very important for a satisfactory result. This is because a successful result in hand surgery is shaped not only by the surgeon’s operation, but also by the patient’s active participation in treatment and the proper conduct of physiotherapy and rehabilitation.

In short, a good result in hand surgery often depends on the harmonious cooperation of three key components: the physician, the patient, and the hand rehabilitation team.

The nail is not only an aesthetic structure; together with the nail matrix - the nail root, the nail bed, and the surrounding soft tissues, it is a functional and aesthetic part of the fingertip. The nail protects the fingertip and contributes to fine touch sensation and daily hand function.

After fingertip injuries, nail bed injuries, crush injuries, cuts, burns, infections, or previous trauma, nail curvature, thickening, splitting, ingrowth, and shape deformities may occur. In some cases, the problem may not be only in the nail, but also in the nail bed, nail root, fingertip bone, or soft tissues.

The treatment decision is made after careful examination. The cause of the nail deformity, whether the injury is old or recent, the condition of the nail bed, the fingertip bone, and the soft tissues should be evaluated together. In selected cases, nail bed reconstruction, correction of scar tissue, soft tissue repair, or correction of bone deformity may be required.

In short, treatment is possible in nail curvatures and deformities, but the result depends on the cause of the problem, the duration of the injury, the condition of the nail bed, and tissue quality. Therefore, evaluation of nail deformities from the perspective of hand surgery may be beneficial.

Congenital hand anomalies in children may occur in various forms: extra or multiple fingers, fused fingers, absence or underdevelopment of the thumb, finger curvatures, structural differences of the wrist and forearm, and other congenital problems.

Some hand anomalies are limited only to the hand, while others may be part of a broader syndromic condition. For this reason, the hand surgeon evaluates the child not only from the perspective of the hand problem, but also in terms of general development, other limbs, and, when necessary, the need for evaluation by additional specialists.

In children, the treatment decision is made individually according to the type of anomaly, its functional impact, the child’s age, growth potential, and the family’s expectations. In some cases, observation alone may be sufficient, while in others surgical treatment may be planned.

As a general principle, it is useful to evaluate anomalies that may affect the child’s hand function, social adaptation, and daily activities before school age; however, the timing of treatment is determined individually according to each anomaly.

In these pathologies, differences in appearance, limitation of hand function, and difficulties experienced in the social environment may affect the child’s and family’s psychosocial condition and should therefore be considered in the treatment plan.

In short, many congenital hand problems in children can be evaluated and treated in selected cases. The goal is not only to correct appearance, but also to support the child’s hand function, development, and daily quality of life as much as possible.

We live in a digital era. It is now easier than in previous periods to prepare and share high-quality photos, videos, and medical images with a physician. These possibilities have made medical evaluation, initial guidance, and second-opinion processes more accessible.

Online consultation does not fully replace physical examination. This is because in hand surgery, movement, sensation, blood circulation, grip strength, painful points, and nerve-tendon functions are evaluated more accurately through direct examination.

Nevertheless, online consultation may be an important guide for initial evaluation, review of documents, second opinion, understanding which specialist it would be more appropriate to consult, and preparation for planned treatment.

During online consultation, the patient’s complaints, previous examination results, photos and videos, X-rays, MRI, EMG, and other medical documents may be evaluated together. Clear video images showing hand and finger movements, photos of wounds and deformities, as well as available imaging results may help make the consultation more effective.

In emergency situations, open wounds, serious bleeding, amputation, infection, suspected vessel injury, color change in the finger, or newly developed serious loss of movement and sensation, emergency medical care should be sought without waiting for online consultation.

In short, online consultation does not fully replace physical examination, but when supported by proper photos, videos, and medical documents, it may be useful for initial guidance, second opinion, and preparation for planned treatment.