Hand Surgery has developed into an independent specialty over the last decade and there are not many trained Hand Surgeons in Pakistan while the number of Hand Surgeons in Lahore is really small. Hand Surgery mainly deals with upper limb which starts from neck and shoulder and extends all the way to the tip of fingers. Hand is probably the most important non vital organ of the body. We need hands for every little activity of daily life. Hand also is the finest master piece of biomecahanics possible. The intricate anatomy and functional harmony of so many bones, muscles, tendons, nerves and blood vessels makes it literally impossible to duplicate or recreate. This is the reason that a Hand Surgeons needs to have an extremely detailed command on anatomy and physiology of hand and its function. A hand surgeon must have a keen observation and knowledge to pick up the minutest of pathologies in the hand structure and function.

Bones of Hand:

               Upper Limb comprises of a shoulder joint that is made up of mainly 3 bones namely Scapula, Clavicle and Humerus. Scapula is the flat bone that suspends the arm to the side of body. And helps to keep the shoulder joint stable. Clavicle is a narrow bone also called as Collar bone and it also helps in providing stability to the shoulder joint. Humerus is the longest bone in the arm which helps to move the hand and arm away from the body to perform all sorts of functions. A Hand Surgeon must be very well acquainted of this joint as any pain or trauma or other problems in this joint can make the whole limb useless or difficult to use.

The bones of the forearm are Radius and Ulna. They are not as thick as Humerus but they are extremely important as theynote only provide length to upper limb but provide attachments to a large number of muscles each one of which performs a specific function in hand mechanics. They also help in forming the Elbow and Wrist joints. These bones are often fractured or involved in other pathologies. So a Hand Surgeons should be well trained in managing any pathologies related to these bones and general conditions of forearm.

Hand itself comprises of rows of small bones that make Carpal bones, Metacarpal bones and Phalanges. This arrangement should be very clear to a Hand Surgeon and function and pathologies of each one of these very small bones should be very clear to a Hand Surgeon. A good Hand Surgeon is able to pick the smallest of changes in structure and function of every bone in upper limb, arm and hand.

Muscles of Hand:

There is a whole array of muscles in the upper limb making it suitable for the wide variety of functions that the hand has to perform in every day living and in specialized fields of life. Therefore a Hand Surgeon should be familiar with the anatomy and physiology of each muscle including origin, insertion, action and nerve supply.

The muscles in shoulders are often thought of comprising of only the Deltoid muscle as a body builder might tell you but all the muscles that attach the arm to chest wall are vital for the shoulder movements. These include Pectoralis muscles and Latissimus Dorsi muscle among other wing muscles on the back.

The muscles which move the elbow are bulky biceps, triceps and brachialis muscles which themselves rarely have a pathology but are important for their prime function of moving the elbow and also for various reconstructions.

The muscles of forearm and hand and their tendons are most important in whole of upper limb as they are responsible for the most delicate and refined movements to accomplish different tasks. A Hand Surgeon needs to have a very extensive and complete knowledge of these muscles their tendons, routes of these tendons and excursion in addition to the interplay of different muscle and tendon groups. Often these muscles and tendons are so badly damaged that  a different tendon or muscle may be required to be used in its place therefore only a highly trained Hand Surgeon should embark on a journey of treating such hand injuries.

Blood Vessels:

The blood vessels supplying the bones, muscles and even nerves are continuation of major vessels starting in the neck. The main artery is Brachial artery and in forearm it divides into Radial and Ulnar arteries which in turn end up in small arteries supplying all the way to the tips of fingers.

A Hand Surgeon is the one who is well versed and trained in Micro and Macro-Vascular surgery. He should be able handle all sorts of vascular trauma. This is Important for the fact that if the Hand Surgeon has no training in vascular surgery, he cannot handle the whole condition and will be dependent on Vascular Surgeon and Orthopedic Surgeon for managing vascular injury and bone injury, respectively.

Nerves:

Nerves are the most important structure in the upper limb and most General and Orthopedic Surgeons are not trained in assessment and management of nerve injuries and other conditions of the upper limb. This makes the job of a trained Hand Surgeon even more important.

Nerves in the upper limb and hand make the most extensive network which starts from from nerve roots that arise from spinal cord in the neck and then pass through axilla into the arm and then onwards into the forearm and hand. This plexus is known as Brachial plexus and these nerves are responsible for contraction of muscles, movements of joints and sensation of all the skin in the region. The injuries to the brachial plexus from the start in neck or in arm, forearm or hand have very grave implications on the function not only of the hand but the whole body. Therefore a Hand Surgeon should be trained in and must have a detailed knowledge of anatomy and physiology of nerves in upper limb.

Hand Surgeon in Lahore:

Unfortunately there are not many trained Hand Surgeons in Lahore. Quite a few surgeons are practicing as hand surgeon but they are either not trained or are trained in one of the aspects of Hand Surgery e.g orthopedic surgeons are trained in managing the bony fractures while vascular surgeons are trained in managing vascular conditions of the hand. Some neurosurgeons are managing nerve injuries and tumors butthere’re training and knowledge is much limited in that regards.

Not only in Lahore but all over Pakistan there are only a counted number of trained Hand Surgeons. Dr. Muhammad Sheraz Raza is a celebrated name among these Hand Surgeons. After his training in Surgery from Royal College of Surgeons of Edinburgh and training in Plastic Surgery from College of Physicians and Surgeons of Pakistan, he persued Hand Surgery as a superspeciality and trained in Hand and Microsurgery from the top institutes in world like National University Hospital, Singapore and Kleinert Institute Louisville Kentucky, USA. He is invited as a speaker in major local as well as international conferences and meetings of Hand Surgery and he makes special effort to stay up to date with all the latest knowledge and innovations in the field of Hand Surgery. He is author of many internationally published articles. He has successfully treated hundreds of patients with hand trauma, upper limb Tumours, Brachial plexus injuries and Congenital ( by birth ) hand disorders.

He is heading the Hand Surgery team in Jinnah Burn and Reconstructive Surgery Center, which is the only government institute in Punjab to have a dedicated Hand Surgery Team and provides 24hr Emergency service to Hand Trauma patients including hand amputations in which hand or any level of upper limb is totally cut off.