What exactly is meant by hand surgery?
Hand surgery is a decidedly transversal discipline. It deals not only with bones and joints, but also with tendons, muscles, the nerves that provide sensation and movement, the vascular system—i.e., arteries and veins—and finally the soft tissues, such as the skin and the tissues that protect the deeper structures. In this sense, it is a synthesis of several specialties: orthopedics, reconstructive plastic surgery, vascular surgery, and neurosurgery of the peripheral nervous system. Everything that "exists" outside the brain and spinal cord, so to speak, falls within our scope.
What are the most common pathologies treated?
There are many different conditions. When it comes to bones and joints, we first encounter osteoarthritis, a degenerative disease linked to wear and tear and aging, but also arthritis, which is a true inflammatory disease. Then there's the whole issue of trauma: fractures of the bones of the hand, wrist, and often the elbow, which falls squarely within the scope of hand surgery. In addition to these, we treat tendon injuries, often due to cutting wounds, and nerve injuries, which can cause loss of sensation or movement. One of the most well-known conditions in this area is carpal tunnel syndrome. Finally, there's the plastic and reconstructive surgery component, necessary when the skin or covering tissues are damaged and can no longer protect the deeper structures.
How common are hand and wrist injuries?
Very common. About 20% of all injuries involve the hand and wrist. Wrist fractures, in particular, are one of the most common injuries we see in emergency rooms: from a young person who falls off a bicycle to an elderly person who slips at home, to a worker who falls from scaffolding. Hands and wrists are poorly protected and highly exposed, so a simple fall or a cut from everyday tools can cause significant damage.
When does prosthetic hand surgery come into play?
Prosthetic surgery was historically developed for large joints. The first hip replacements appeared in the 50s and 60s; only later, in the 70s and 80s, were these technologies miniaturized and adapted to smaller joints. Today, we also use prosthetics in the hand, particularly for arthritis at the base of the thumb (also known as rhizarthrosis). The goal is twofold: to relieve pain and preserve movement, because a stiff joint, even if painless, severely reduces the hand's functionality.
How widespread is this solution today?
In Switzerland, approximately 2.000 prostheses are performed each year for thumb rhizarthrosis. These are significant numbers, but still lower than hip or knee replacements, which are 10–15 times more frequent. This is because, despite the thumb being crucial, hand osteoarthritis is often less debilitating in daily life than hip or knee osteoarthritis, which also limits basic activities like walking or getting up from a chair.
There's a lot of talk about stem cells: what role do they play today?
Mesenchymal stem cells represent a fascinating idea: stimulating the body to heal itself, rather than replacing a joint with a metal prosthesis. It's a valid and promising direction of research. That said, we must be very clear today: there is still no definitive scientific evidence demonstrating actual cartilage regeneration. Currently available treatments primarily address pain and, to some extent, joint function. Furthermore, the use of stem cells is strictly regulated and not covered by insurance. We're not yet at the point where they can be considered a consolidated alternative to prosthetic surgery.
How is the Manoelbow Center for Hand Surgery organized?
Taking into account the complexity of the organs and pathologies we are called to deal with, the basic idea of the Elbow center Our goal was to create a multidisciplinary center that fully reflects a modern and efficient vision of medicine. Alongside hand surgeons, we also have occupational therapists—physical therapists specializing in hand rehabilitation—neurologists, rheumatologists, and radiologists for targeted ultrasound diagnostics. We also have complementary professionals such as osteopaths, specialists in acupuncture and traditional Chinese medicine, and naturopaths. We don't turn a blind eye to anyone, as long as the treatment is serious, appropriate, and performed by qualified professionals. I also like to talk about a dynamic organization that places particular emphasis on the continuing education of younger doctors. Furthermore, it's worth highlighting our connection to a solid network of specialists operating in Switzerland and internationally, and our constant participation, very often as speakers, in national and international symposia, which ensures our continuous updating.
A final message for patients?
It's important to clarify that you don't go to a hand surgeon just to have surgery. Most conditions resolve without surgery. Our task is first of all to make a correct diagnosis, propose the most appropriate therapy and support the patient throughout the entire process, from treatment to rehabilitation. Surgery is a fundamental resource, but it remains the last option, not the first.
