The initial consultation lets you get to know your physician and tell him about your symptoms. The physician will ask detailed questions and help clarify any accompanying symptoms, as well as their effect on your everyday life and your quality of life. You will also discuss your life circumstances (work, which hand you use, previous illnesses, etc.).
The hand contains a variety of functional structures in a tightly restricted space. A detailed clinical examination will clarify the cause of your complaints. Either the tentative diagnosis will be confirmed analytically or a precise diagnosis will require further examination. Following the clinical examination your physician will be in a position to assess whether further diagnostic examinations are necessary.
The different tissue densities of the human body allow X-rays to penetrate to varying degrees. Bones allow significantly fewer X-rays to pass through than does muscle tissue. The conventional X-ray image represents the 3-D object (e. g. of a hand) through a 2-D image. That is why two X-ray images of the same region are often taken from two directions. X-ray diagnostics is a good way to visualise bone fractures and degenerative joint disease. Depending on the tentative diagnosis, the X-ray examination is supplemented by further imaging (CT or MRI).
Ultrasound penetrates body tissue. An image of the internal tissue structures is generated based on reflection patterns of the ultrasound on the tissue surfaces inside the body. This examination is particularly suitable for assessing soft tissue (tendons, nerves, ganglia, soft tissue tumours).
In computed tomography (CT), X-rays are sent into the body from various directions. As with radiography, the rays penetrate the body to varying degrees depending on the type of tissue. A computer can process this information into cross-sectional images on different planes.
Computed tomography generates much more detailed images of a body than X-rays, since each cross-sectional plane is viewed individually and the overlapping of different structures is practically eliminated. Computed tomography is very well suited for assessing complex fractures, for planning therapy, and for evaluating the success of conservative or surgical therapy.
Magnetic resonance imaging (MRI) generates a very strong magnetic field that excites the atoms in the human body. The time it takes atoms to return to their normal state after this excitation varies according to tissue type and can be measured. The spatial points determined in this way are smaller than 1 mm and can be converted into three-dimensional cross-sectional images by computer. This examination thus requires no X-rays at all and is particularly suitable for assessing soft tissue (ligament lesions, cartilage wear, ganglion, soft tissue tumours).
- Specialist examination
Further specialist examinations can contribute to a more precise diagnosis in case of specific symptoms. The neurology specialist, for example, assesses the clinical suspicion of a nerve compression syndrome, while the rheumatology colleagues are consulted if there is a well-founded suspicion of a rheumatological disorder that can, for example, cause joint complaints.
Once the diagnosis has been confirmed using the appropriate diagnostic tools, your physician will explain the nature of your disorder and inform you about its prognosis and associated treatment options. No therapy may be required, depending on the specific disorder (e.g. in case of a symptom-free ganglion). Conservative therapy options are often considered at the start of therapy. Depending on your symptoms, pain or inflammation management medication, special splints, ergotherapy or physiotherapy can be used.
Depending on the diagnosis, there are minimally invasive options such as puncture or cortisone infiltration as well as invasive surgical options such as endoscopic or open surgical procedures. The treatment consultation will give you insight into the advantages and disadvantages of the respective therapy option.
Before each therapeutic intervention, your physician will make sure that you have understood the explanation and that all your questions have been clarified. Once you have given your consent you will receive the appropriate therapy.
Depending on the clinical picture, there are very different treatment options. Therapeutic progress or success is monitored either in a standardised way – such as X-ray check-up of an immobilised fracture – or an optional way (e.g. after puncture of a ganglion). The aim of the check-ups is to reaffirm the healing process or improvement of symptoms, or otherwise to be able to assess or plan a change in therapy.
Surgery is only considered useful if it is very likely to lead to a better functional result than conservative therapy. Surgery is a good option if its probable benefit greatly outweighs the risk involved (e.g. in the case of a severely displaced or open fracture or the severing of a nerve in a healthy patient).
The necessity of the surgical procedure is only relative if a less invasive measure is likely to lead to an equivalent therapy result or the surgical risk is high. You thus have the right to be properly informed before each surgical procedure: Before the operation your doctor will discuss with you in detail the type of procedure, its possible benefits and risks, the expected course of treatment, and possible alternative treatments. Your personal involvement is very important in ensuring that the healing proceeds as desired. As early as the planning stage, you will receive all important instructions, a list of foods rich in Vitamin C (PDF Vitamin C), the prescription of the medications recommended after the operation, and the planned check-up appointments.
You will also be given the ergotherapy prescription, if this is considered useful in your case. This gives you time to think everything over in peace before proceeding with surgery and prepare yourself in a relaxed manner. It is important that you accept the surgical procedure as a good solution to your problem and have no unaddressed doubts or questions. The surgical procedure itself is performed on an outpatient basis at Clinique Moncor or on an in-patient basis at the Daler Hospital or Clinique Générale.
Check-up appointments / termination
Your physician will evaluate the healing process or the success of treatment or rehabilitation during the check-up appointments following conservative or surgical therapy. This is where the above-mentioned diagnostic options come in:the detailed discussion about the course of therapy with your physician, the clinical examination and, if necessary, further examinations.
Your physician will inform you of his assessment as well as discussing the options for continuing therapy, a change of strategy or termination of therapy.
Therapeutic surgical post-operative care following a complication-free standard procedure, such as splitting the roof of the carpal tunnel (carpal tunnel syndrome), often ends with the removal of the sutures two weeks after surgery.
If you develop severe or painful scarring, please do not hesitate to contact us again in order to benefit from the therapeutic options for scar reduction.
Alongside the brain and its ability to think logically, our hands have contributed the most to human evolution and development. Our dexterity is unique in nature, not least thanks to the capabilities of our thumb.
It is only the sophisticated precision engineering of our hands and our hand-eye coordination that allows us to creatively turn our thoughts into reality. The hand enables the human mind to express itself through writing, music and the visual arts.
While shoulders and elbows perform basic motor functions, the hand and especially the fingers transmit muscular force directly and deploy precise skills. The hand is also a highly sensitive tactile organ and contributes significantly to interpersonal communication.
The importance of the individual functional elements of the hand, bones, joints, tendons, blood vessels and nerves always becomes evident when they are impaired or fail. Depending on the symptoms, the dependability of the entire hand may be compromised.
As a complex multi-joint and multi-system organ, the hand can be affected by acute or chronic symptoms of many different kinds: e.g. bone fractures, dislocations, strains, degenerative joint disease, severed nerves and blood vessels, and joint or tendon sheath infections.
These functional limitations can show up in different forms from early childhood to old age. The general challenge for hand surgery in case of hand injury is to restore movement, strength, sensitivity, good soft tissue coverage, and the best possible aesthetics.
Alongside theoretical knowledge, surgical competence requires a guiding philosophy and a systematic approach. The aim is to reduce the complexity of the problems and break them down into treatable sub-components. This approach is followed by a well conceived and patient-oriented treatment. Optimal treatments are tailored to the individual patient rather than a stereotyped ‘cookbook learning of procedures’ (Robert W. Beasley). The guiding philosophy of William J. Mayo should not be forgotten either: “The interests of the patient are the only interests worthy of consideration.”
History of hand surgery
Historically, the numerous different and dramatic injuries in the Second World War led to the development of regional surgical specialties, especially hand surgery.
US General Norman T. Kirk founded surgical hand centres and prioritised the soft tissue treatment of injuries. Major J. William Littler headed the first specialised hand centre near Boston, and Sterling Bunnell, as a civilian doctor, tirelessly promoted the exchange of ideas among the various hand centres. Bunnell, whose groundbreaking work “Surgery of the Hand” was first published in 1944, is regarded as the founder of hand surgery in America. The “father” of Swiss hand surgery is Claude Verdan, who founded the Longeraie Clinic in Lausanne in 1946 and headed the surgical polyclinic at the University of Lausanne from 1961 to 1980.
The hand in our language
The hand’s uniqueness is also expressed in language: When we have something under control, we say: “We have it firmly in hand”. “Wringing our hands”, we look for a solution. To “let something get out of hand” means we lose control of an situation. “Handpicked” options are presented to us and “with a hand’s turn” or “in one stroke” we find a solution. We can count on “our right-hand man/woman” to assist us with important business and work best “hand in hand” – or make no effort at all when we “sit on our hands” . There are many more such aphorisms and metaphors.