Hand surgeon

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Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [1]; Michel C. Samson, M.D., FRCSC, FACS [2]

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Overview

Hand surgeons are a surgeons specializing in the care and treatment of problems relating to the hand, wrist, and forearm including trauma and hand infection. Many hand surgeons also treat the elbow, arm and shoulder. Hand surgeons do not just engage in surgery - they are the primary medical doctors to deal with these issues, and often use non-surgical approaches.

In the US, hand surgery is a subspecialty of surgery. A hand surgeon must first qualify as a general surgeon, plastic surgeon, or orthopedic surgeon, and then must do a one year long fellowship in hand practice. Board certified general, plastic, or orthopedics surgeons who have completed approved fellowship training in hand surgery and have met a number of other practice requirements are qualified to take the "Certificate of Added Qualifications in Surgery of the Hand" examination, commonly referred to as the "CAQSH."

The historical context for the three qualifying fields is that both plastic surgery and orthopedic surgery are more recent branches off the general surgery main trunk. Modern hand surgery began in World War II as a military planning decision. US Army Surgeon General, Major General Norman T. Kirk, knew that hand injuries in World War I had poor outcomes in part because there was no formal system to deal with them. Kirk also knew that his civilian general surgical colleague Dr. Sterling Bunnell had a special interest and experience in hand reconstruction. Kirk tapped Bunnell to train military surgeons in the management of hand injuries to treat the war casualties, and at that time hand surgery became a formal specialty. Orthopedic surgeons continued to develop special techniques to manage small bones, as found in the wrist and hand. Pioneering plastic surgeons developed microsurgical techniques for repairing the small nerves and arteries of the hand. Surgeons from all three specialties have contributed to the development of techniques for repairing tendons and managing a broad range of acute and chronic hand injuries. Hand surgery incorporates techniques from orthopaedics, plastic surgery, general surgery, neurosurgery, vascular and microvascular surgery and psychiatry and is a complex, fascinating specialty.

Two medical societies exist in the United States to provide continuing medical education to hand surgeons: the American Society for Surgery of the Hand and the American Association for Hand Surgery.