Do Hand Surgeons Deal With Shoulders? Unveiling the Scope of Hand Surgery
The answer is nuanced, but generally, hand surgeons do not primarily deal with shoulders. While their expertise lies in the upper extremity, their focus is primarily on the hand, wrist, forearm, and elbow, though there is some overlap.
Understanding the Scope of Hand Surgery
Hand surgery is a specialized field within orthopedics and plastic surgery that focuses on the diagnosis, treatment, and rehabilitation of conditions affecting the hand, wrist, forearm, and elbow. While the shoulder is part of the upper extremity, it typically falls under the purview of orthopedic surgeons specializing in shoulder and elbow surgery, or sometimes sports medicine. This difference lies in the expertise required for the complex biomechanics and conditions specific to each joint.
The Training and Expertise of a Hand Surgeon
To understand why hand surgeons typically don’t deal with shoulders, it’s important to appreciate their rigorous training. Their path involves:
- Medical school graduation
- Residency in orthopedic surgery, plastic surgery, or general surgery
- Fellowship in hand and upper extremity surgery (usually one year)
This intensive fellowship provides specialized knowledge in:
- Microsurgery: Operating on delicate nerves and blood vessels.
- Arthroscopy: Minimally invasive techniques for joint repair.
- Fracture management: Treatment of broken bones in the hand, wrist, forearm, and elbow.
- Tendon and nerve repair: Reconstructing damaged tissues.
- Reconstructive surgery: Addressing congenital differences and traumatic injuries.
While some hand surgeons may have a broad understanding of shoulder anatomy and conditions, they generally lack the dedicated training and experience to effectively manage complex shoulder problems.
When Hand Surgeons Might Address Shoulder Issues
There are limited scenarios where a hand surgeon’s expertise might intersect with shoulder issues. These typically involve conditions that:
- Affect both the hand and shoulder indirectly: For example, thoracic outlet syndrome, which can compress nerves and blood vessels in the shoulder region, leading to hand symptoms. A hand surgeon might be involved in diagnosing and treating the neurological component affecting the hand.
- Involve nerve transfers: In some cases of severe brachial plexus injuries (nerve damage in the shoulder region), nerve transfers may be performed, where a working nerve from the hand is connected to a nerve controlling shoulder function. However, shoulder specialists and neurosurgeons are still integral to this process.
- Are part of a broader upper extremity trauma: In major trauma cases affecting the entire arm, including the shoulder, the hand surgeon might be part of a multidisciplinary team addressing the injury, although a shoulder specialist would likely take the lead on the shoulder aspect.
The Importance of Seeing the Right Specialist
Seeking the appropriate specialist ensures you receive the best possible care. Here’s why seeing a shoulder specialist for a shoulder problem is crucial:
- Accurate Diagnosis: Shoulder specialists have the experience and training to accurately diagnose a wide range of shoulder conditions.
- Targeted Treatment: They can develop a tailored treatment plan based on your specific needs, which might include physical therapy, injections, medication, or surgery.
- Optimized Outcomes: Their expertise in shoulder-specific procedures and rehabilitation protocols can lead to better outcomes and faster recovery.
| Specialist | Primary Focus Area | Common Conditions Treated |
|---|---|---|
| Hand Surgeon | Hand, wrist, forearm, and elbow | Carpal tunnel syndrome, trigger finger, arthritis of the hand and wrist, fractures of the hand and wrist, tendon injuries |
| Shoulder Specialist | Shoulder | Rotator cuff tears, shoulder impingement, frozen shoulder, shoulder dislocations, arthritis of the shoulder |
Factors to Consider When Choosing a Surgeon
When choosing a surgeon for any upper extremity issue, consider the following:
- Board certification: Ensure the surgeon is board-certified in orthopedic surgery or plastic surgery and has completed a fellowship in hand and upper extremity surgery (for hand/wrist/elbow issues) or shoulder surgery (for shoulder issues).
- Experience: Ask about the surgeon’s experience treating your specific condition.
- Patient reviews: Read online reviews to get a sense of other patients’ experiences.
- Comfort level: Choose a surgeon with whom you feel comfortable communicating and who takes the time to answer your questions.
Frequently Asked Questions (FAQs)
Is it ever appropriate to see a hand surgeon for shoulder pain?
While Do Hand Surgeons Deal With Shoulders? is primarily “no,” if the shoulder pain is directly related to a nerve compression issue affecting the entire arm, such as thoracic outlet syndrome with pronounced hand symptoms, a consultation might be beneficial to evaluate the nerve involvement in the hand. However, a shoulder specialist will likely still be needed for a complete evaluation.
What is the difference between a hand surgeon and an orthopedic surgeon?
An orthopedic surgeon deals with the entire musculoskeletal system. A hand surgeon is an orthopedic or plastic surgeon who has completed a fellowship specializing in the hand, wrist, forearm, and elbow. They have specialized expertise in these specific regions of the body.
Can a hand surgeon diagnose shoulder impingement?
Potentially, a hand surgeon might be able to recognize shoulder impingement as a possible cause of referred pain down the arm. However, a diagnosis of shoulder impingement, or any shoulder issue, is best made by a surgeon or physician specializing in shoulder injuries.
What should I do if my primary care physician refers me to a hand surgeon for shoulder pain?
It’s important to clarify the reason for the referral. If your primary complaint is shoulder pain, and there are no hand or wrist symptoms, it may be prudent to request a referral to an orthopedic surgeon specializing in shoulder and elbow problems.
Do hand surgeons perform shoulder arthroscopy?
Generally, hand surgeons do not routinely perform shoulder arthroscopy. This procedure is typically performed by orthopedic surgeons with specialized training in shoulder arthroscopy.
Can carpal tunnel syndrome cause shoulder pain?
While carpal tunnel syndrome primarily affects the hand and wrist, the discomfort can sometimes radiate up the arm. However, carpal tunnel itself doesn’t typically cause true shoulder pain. Shoulder pain with hand symptoms should be investigated for issues in the neck, shoulder, or thoracic outlet.
Are there any non-surgical treatments a hand surgeon might recommend for shoulder pain?
A hand surgeon might recommend some general conservative measures, such as rest, ice, and over-the-counter pain relievers. However, the vast majority of nonsurgical treatment strategies are provided by specialists with greater familiarity with shoulder problems.
What is the difference between a rotator cuff tear and carpal tunnel syndrome?
A rotator cuff tear involves damage to the tendons surrounding the shoulder joint, causing pain and weakness in the shoulder. Carpal tunnel syndrome is a nerve compression issue in the wrist, causing numbness, tingling, and pain in the hand. They are completely separate conditions affecting different parts of the upper extremity.
If I have both shoulder and hand pain, who should I see first?
The best approach is to start with the area of primary discomfort. If your shoulder pain is more significant, see a shoulder specialist first. They can evaluate your shoulder and determine if further evaluation of your hand is necessary. If the hand pain is more pronounced, then start there.
What are the common symptoms of shoulder impingement?
Common symptoms include: pain when lifting your arm, pain at night, weakness in the arm, and limited range of motion. This requires evaluation and treatment by a shoulder specialist.
Is it possible to have a hand condition that is referred pain from the shoulder?
Yes, it is possible. Cervical radiculopathy or a shoulder issue causing nerve compression can cause pain, numbness, and tingling that travels down to the hand. A shoulder specialist or neurologist can help differentiate.
What is thoracic outlet syndrome (TOS), and how does it relate to both hand and shoulder pain?
Thoracic outlet syndrome (TOS) involves compression of nerves and/or blood vessels in the space between the collarbone and the first rib. This can lead to pain, numbness, tingling, and weakness in the shoulder, arm, and hand. While hand surgeons may treat certain aspects of TOS affecting the hand, shoulder specialists and vascular surgeons are also frequently involved in managing this complex condition.