I. Congenital hand deformity and scar contracture in children 1. When is it better to operate on congenital hand deformity? What kind of anesthesia is used? Surgery for congenital malformations of the hand is generally appropriate at the age of one week, but premature surgery is not well tolerated by children with anesthesia, while late surgery may cause psychological developmental disorders in children who are ashamed to use the affected hand. The surgery is usually performed using intravenous basic anesthesia, which is safe and will not cause adverse effects on the child. 2.What is the disease of infants and children who cannot straighten their thumbs and have obstructed movement and how to treat it? This is a common congenital deformity in children. It is a common congenital deformity in children. The cause is that the tendon responsible for flexing the thumb is compressed by the thickened tendon sheath around it, which causes aseptic inflammation and edema of the tendon, eventually leading to a flexion of the interphalangeal joint and resistance, popping or pain when moving, and eventually making it impossible to extend and flex the thumb. If not treated early, it will affect the function of the joint, which in turn will affect the normal function of the thumb and lead to secondary deformities. In severe cases, surgery is required. Young children can be operated under intravenous general anesthesia, while older children can be operated under local anesthesia, which is simple and effective. 3.Will it affect the development of the left middle ring finger in children? How do I need to treat it? Syndactyly is a common congenital deformity of the hand, and the timing of surgery depends on the degree of the deformity. If the physician determines that the deformity does not affect the development of the fingers, surgery can be performed between the age of 1 week and before school age. 4.What is the disease of a 1-year-old child with hypoplastic left thumb, only the skin is attached, and the other 4 fingers are normal? How to treat it? The medical term for this is “floating thumb”. For this type of deformity, it is better to use index finger transposition to reconstruct the thumb, which is the mainstream treatment measure in China and abroad. Second, upper limb nerve injury and compression 1. Is cervical spondylosis caused by neck and shoulder pain and hand numbness? Cervical spondylosis is a series of clinical manifestations of nerve root irritation or dysfunction due to the lateral protrusion of cervical intervertebral discs, cervical hook joint or synovial joint hyperplasia and hypertrophy of “bone spurs”, which stimulate or compress the nerve roots at the corresponding level. The clinical manifestations can be neck and shoulder back pain, radiating pain, numbness and weakness of the upper limbs and fingers. However, the most common cause of neck and shoulder pain combined with hand numbness is due to the abnormal structure of the brachial plexus nerve being stuck in the neck and shoulder, which is easily misdiagnosed as cervical spondylosis. 2, frequent use of computers can lead to numbness in the fingers, especially the thumb, index finger, middle finger and ring finger, what is the matter? The median nerve, one of the main nerves in the hand, is responsible for innervating the sensation of the thumb, index, middle and ring fingers and the function of the thumb on the opposite finger, and travels in a relatively closed canal on the palmar side of the wrist, called the carpal tunnel. When the wrist is in a working position such as dorsal extension for a long period of time, if there is any reason for increased pressure in the canal, it can trigger a nerve entrapment, which is called carpal tunnel syndrome. The early symptoms of median nerve entrapment are numbness of the indicated middle finger with nocturnal numbness and awakening, and thumb dysfunction at a later stage because of muscle atrophy. Long-term frequent use of the mouse, resulting in carpal tunnel syndrome, is one of the “mouse hand” disease. Therefore, once the numbness of the fingers persists, you should immediately consult a doctor, early treatment. 3.In the past six months, I have felt numbness in the ring finger, little finger and back of the hand, and the strength of the hand has weakened. The diagnosis of elbow canal syndrome is more likely. The ulnar nerve, another major nerve in the hand, is easily compressed by abnormal anatomical tissue at the elbow joint, causing numbness in the ring and little fingers and the ulnar side of the back of the hand, and then developing into irreversible atrophy of the internal muscle groups of the hand. If conservative treatment is ineffective or recurrent, surgery is required as soon as possible. 4.After a fall on a motorcycle, I can’t move my whole arm and I can’t feel my hand. The brachial plexus nerve is an important nerve plexus emanating from the spinal nerve roots that innervates the movement and sensation of the entire upper extremity, and once it is severely injured, it will lead to serious dysfunction of the upper extremity. In principle, treatment should be clearly diagnosed, and conservative treatment can be tried for most patients, but for serious injuries with a clear diagnosis, surgery must be performed as soon as possible. With the advancement of medical theory and technology, this “incurable disease” has become treatable, and most patients can recover useful upper limb function. 5.The car accident caused my humerus fracture and radial nerve rupture 10 months ago, and the fracture was fixed and the nerve was sutured during the initial surgery. Now it has been more than 1 year after surgery, but I still cannot extend my wrist, thumb and fingers. The recovery time of the nerve injury is slow, with a maximum of 1mm growth per day, so it is important to check whether the muscle strength is recovering through physical examination and electromyography. If there is recovery, medication and physical therapy can be given; if there is no sign of recovery at all, the dorsal extension of the hand can still be restored by muscle transposition. Common diseases of the hand 1.What happened to the pain in the right lateral elbow joint for six months and the difficulty in lifting heavy objects? The most likely diagnosis is “tennis elbow”, which is also known as humeral epicondylitis. This is an aseptic inflammatory disease, because the forearm extensor muscle group from the lateral elbow, such as the existence of certain anatomical abnormalities, coupled with long-term, repeated force concentrated on the local and pulling muscle, can make the muscle starting point of acute or chronic accumulative injury and cause “tennis elbow”. After the disease, the affected arm should be properly rested, avoid excessive activities, local painful point closure is the most common treatment method, only a few need surgery. 2, the finger was hit by a basketball thrown at speed, the injured finger end flexion, can not straighten, and pain and swelling, what is the injury? How should I treat it? This injury may be a “hammer finger”, which is caused by the tendon of the extensor of the finger tearing off at the end of the phalanx. You should go to the hospital immediately for an examination and x-ray. Most of these injuries can be treated with splints and braces, but for fingers with avulsed bones or old injuries, surgery is often required. 3.What should I do for the redness, swelling and throbbing pain of my finger that has been increasing for three days after it was not treated at the hospital after being pricked by wood chips a week ago? The diagnosis is purulent dactylitis. Purulent dactylitis is a purulent infection of the subcutaneous tissue in the abdomen of the terminal phalanx of the finger. It is often caused by bacterial infection secondary to minor injury or foreign body. Antibiotic anti-infective treatment is preferred, and immediate incision and drainage is required once throbbing pain or abscess formation occurs. 4, no history of trauma to the hand, 2 years gradually occurring ring finger can not straighten, palm subcutaneous see obvious “nodules”, although there is no pain, but the finger is increasingly curved, what is the disease? According to the description, the diagnosis is “palmar tendon contracture”. If the flexion contracture is mild and there is no obvious dysfunction, you can wear a brace to prevent further contracture; if the flexion contracture is obvious and has caused dysfunction of the finger and has a tendency to increase gradually, you should have early surgery to restore the function of the finger. Bone and Joint Diseases 1.A 60-year-old woman who fell and held her right hand on the ground caused pain in her wrist, and was diagnosed with “distal radius fracture” after a hospital film. The treatment of distal radius fracture depends on the type of fracture. Most of the fractures can be treated with a cast after a manual repositioning. For those types of fractures that do not achieve ideal repositioning, poor intra-articular fracture alignment, fracture collapse and instability after repositioning, surgical treatment is usually required. In addition, a significant proportion of distal radius fractures are accompanied by wrist ligament injury, which may lead to joint instability and other complications if not detected early, so special attention is needed. The doctor said that the fracture may need to be fixed in a cast for more than three months, but is there any way to reduce the time of fixation in a cast? The blood supply to the navicular bone of the wrist is poor, and once the fracture occurs, especially the lumbar fracture, osteonecrosis and osteonecrosis are likely to occur, so the traditional treatment method must maintain a long time of cast fixation, and the fracture with poor repositioning must also be fixed for a long time after surgery. In order to shorten the time of cast fixation, the first thing is to choose the appropriate treatment method. Nowadays, the minimally invasive internal fixation can play the effect of shortening the course of disease, reducing the cast fixation and promoting the functional recovery. 3.A 62-year-old female presented with a year-long coxa bulge of the distal finger joint, pain at the proximal basal joint of the thumb in the last 4 months, and significant loss of grip strength in the hand, what is the cause? The possible diagnosis is osteoarthritis of the hand. Osteoarthritis of the hand in the elderly often occurs in the distal finger joints, and the first carpometacarpal joint of the proximal thumb is one of the most common sites. Osteoarthritis can be treated conservatively in its early stages, but first carpometacarpal joint arthritis of the thumb requires special attention because progressive development can lead to severe impairment of hand function. This disease should be understood through X-rays of the disease progression, and a standardized treatment plan should be developed by a specialist. 4.Serious hand deformity and dysfunction after hand trauma can be further treated? Severe trauma to the hand often results in fracture deformity and joint stiffness, soft tissue adhesions, scar contracture and other complications. In most of these cases, the appearance and function of the hand can be significantly improved with systematic treatment.