 I am Dr. Bharath K. Kadhari, consultant hand and brachial cancer surgeon, Manipal Hospital, Malaysia and 12 group of hospitals. I have run the hand clinic. Hand injuries are so common that it is so difficult to use the hand for day to day activities You can apply the function of the whole hand. Hand is economically and functionally the most productive unit of the body. So, you see injuries can be of different varieties. For example, industrial accidents. You see in this paper cutting machine, wood cutting machine, press cutting machine where the accidentally hand pulls inside the machine and then they can sustain injury. So, these needs immediate attention. Many times fingers are cut off from their parts. The part is cut off from the body part and then we have to reattach it as early as within 6 hours. So, they have to do the part covered with the plastic cover and in a ice container. But they should know direct contact between the part and the ice to be separated with the thin layer of plastic cover. So, once in any part then it is emergency. So, within 6 hours we take them up for operation data and repair all the parts which are injured. For example, injury can involve the skin, the tendon, the nerves, the blood vessels and the bone. So, we repair each and every one component of the body part and then reattach it. This is a technique called replantation. And to do this process we use a special equipment called microscope. In addition to that you can also sustain injuries after road traffic accident, fall from a bike or even a, you know, suddenly you keep your door and they will come and be close to the car. So, it is a question of the creativity. These are also similar fashion. Whatever injured parts are there, always all open wounds are in emergency. They should be reaching the hospital within 6 hours. And then we take them up to operation data and then subject them to surgery and then repair the parts. And then we immobilize for, depending on 3 to 6 weeks of the healing time, the bone is different, the healing time of the tendon is now different. Then we keep it for around 3 to 6 weeks and then we taught, we teach them what you call physiotherapies. Very, very crucial to do physiotherapy, hand therapies. The most important part of their hand re-repletation in order to put the patient back to his previous profession, the most important of the hand is function. No function, no hand, no hand, no function. So, the whole aim is to get back the hand into normal function, day to day activities. For it may be a person who is in the software, engineer on the computer, 10 to 12 hours a day, or it could be a homemaker who can now, all the time she is working during all the hours or 2 hours, or it could be a heavy laborer who is doing an industrial working with the industrial machinery, or it could be a difficult rest with a heavy labor work, lifting weights. So, all the whole idea is to get back the hand into normal or near normal, so that they can get back to their previous functions called occupating therapy or hand therapy. There will be a process of re-repletation of the injury so that they can get back to normal. In addition to that, many patients do not realize that, you know, there is treatment can be done, so they tend to neglect, because lack of awareness they tend to wait for a couple of weeks, or maybe even 3 weeks, 4 weeks, 6 weeks, they say. Some people have a closed injury, where there is no open injury skin. So, inside there is a fracture over near the joint which affects the function of the movement, the joint function is affected. So, a single joint which is stiff can affect the whole function of the hand, because you cannot hold a glass of water and drink water. You cannot hold a bottle of water. You cannot do your day-to-day shots. So, learn what we do, we can do an x-ray, investigate them, and then see what the nature of the injury is. Even if they come 6 weeks or 12 weeks later, you can always correct the deformity. Suppose there is a nerve injury called midi-navigation, which is involving the function of the hand, which is not recognized initially. So, even if they come 2-3 months, we can explore again, and repair the nerves under the microscope, with the fine suture, with the 8-0, 9-0 ethylone. Once we repair the nerves and then the sensation starts improving, the innervation of the bone will start improving, and then they put them on a course of ant therapy, opiative therapy, and then get back to normal. And even bone-deformed corrections, whichever it is, cross-union or a mall-union, you can cut the bone again, re-correct it, and then get them back to a normal function. It's something called a cascade, you remember in the hand. You see there is a special technique that index, middle, ring, little finger. There is a method. They follow a cascade, and when you close the fish, they all come back to a point called the vertebral. So, that's very important. And it's important to have a thumb also, which is going 90 degrees opposite to the index, middle, and middle fingers. So, the function of thumb is as 50 percent of the function the thumb is in the hand is in the thumb. So, it's very important to oppose the fingers to hold an object. It's very important to have a normally moving thumb, because you have a CMC joint, the MCP joint, and IP joint of the thumb, so that the holding objects, doing a regular activity. The finest work also is very important to have, and suppose you have a pinch, you want to pinch an object, or picking up a needle from the table, picking up a button, it's called a tripod pinch, or holding a racket and playing tennis, you know the importance of sports after the recent Olympics. So, the holding a racket and playing, they are all called bridge strength, cylinder grasp, the hook strength, the spine grasp. So, they are all various functions of the hand, even what I am doing to you, what you call a gesture, it's also a part of the function of the hand. In addition to all these, we also, when the patient comes late, when there is lack of function, or not to connect early, we do what you call a nerve transfer, or a tendon transfer to improve the function of the hand. We also specialized in what you call a wrist arthroscopy. It's a part of the sports medicine where people can sustain injury while playing sports like tennis, cricket ball injuries, and so on. So, we have a special technique called small joint arthroscopy where you put a camera inside the wrist joint, you suspend the wrist into attraction, you put a camera inside the wrist joint, and have a look at where exactly they tear the ligament is to arm without opening, it's got a minimally invasive surgery where there is no scar, you just put a small 2 millimeter incision, go to the inside of the wrist joint, look at the wrist joint 360 degree, look at what is injured, and then we tackle at the same time. They know it for a second for the same time you can tackle the issue. Suppose there is ligament injury, you can repair the ligament. There is something called a TFCC ligament, Triangular Fever Cartilage Complex ligament, which is very important for racket holders. This takes the shock on all aspects. So, we can go and repair that. There could be an inter ligament injury in the scampoid, so many of the procedures in the wrist joint can be done with a technique called wrist arthroscopy. We also advance to the next level, where we can do a small end arthroscopy, where we put a small camera, so 1.9 millimeter scope in the joints, and then read this MCP and PAP joint with the help of this small scope, called small end arthroscopy, or a minimally invasive technique, where we do the surgery without opening. So, that's advancement. And in addition to what I already told you, we treat what you call a birth-related brachial clusis injuries, and that's been my passion for a couple of decades now, where children born with a paralyzed hand, either because of increased weight of the baby, that is, big babies, you call, more than 3.54 kilos. So, at the time of process of birth, big babies can have a trouble because they can have a shoulder presentation first, or the hand in between the neck, and the shoulder can increase, and then suddenly they can get stuck, and the nerves can get injured. So, these children should be organized as early as possible. The obstetrician all gives them idea, and the pediatrician also tells them, and then they come to us, the hand surgeon. Once we see there is no movement, you can always compare the best part of children, you can always compare their birthright is to move the hands and limb after birth. That's their birthright to keep and move the hands, both the hands, both the upper limbs and lower limbs at birth. And once you notice that there is some asymmetry, that one limb is not moving well, one limb is paralyzed just holding a band. So, now then you know that there is something wrong, something not normal. So, then you advise the mother to do regular exercises. Many a times it improves in one month, two months, three months time, but at the end of three months, if it does not improve, then we do a scan, MRS scan, you see where it gradually is the nerve injury, and then we prepare the nerves with a technique called micro-surgery where we do a nerve repair with the nerve grafting, you take the graft from the limb, place it to the limb, repair it, it finds which are like nine-hundred long or even supplemented with a glue. And they take out in one to two years to recover and they are also subjected to physiotherapy after the softage we arrange, that is a one-month time, and it goes on for six months, one year, two years. You can see improvement in children after three to four years, that's called a birth-related brick and blisters injury, specialized in this treatment of this. A very emotional issue, for any parent, a child which is born who does not move again, it can be a serious issue because they are really worried because they have high hopes in the child, the child wants to, when the child comes into this competitive world, so you know that the child has to get back to so many activities, compete with the peers in terms of playing sports, the variety of sports you know, and then compete with the academics, study, and then they have to get back. So, once you know that the limb is not moving, it's weak, so we take attention and come back to the handy-naked, and then we assess the child, and then they will be required treatment, either physiotherapy or surgery, followed by physiotherapy, depending on the severity of the injury. Many times you must have noticed that softer professionals working computer for long hours have been having this pain called a RSX called a repetitive stress injury or they can also have compress in neuropathy where they can complain of tingling numbness in the fingers, tingling and numbness in the fingers, particularly in the night it's very painful. So, what we do is nerve conduction studies and see if there is nervous compress, they have excruciating pain in the night, they cannot sleep, it's called a carpal tada syndrome, now getting compressed here, because of tingling, numbness and thumb, it takes very finger. So, what we do is, we just give them a splint and physiotherapy, many times it helps. If it doesn't, we just do a small release, minor procedure, it's a release of the nerve, where the nerve will recover and many a times you see a patient telling you that, doctor, I had the best sleep in last so many years, that's the kind of release they can expect with the release of the compress in neuropathies and this nerve can happen either here in the palm with the compression of the median of carpal tada syndrome or in the elbow, cubatal tada syndrome or in the radial aspect that's called the radial tada syndrome. So, one of the three nerves, the three important major nerves supplying the hand can be compressed and then we can identify it, do some investigations, recognize it and then release it if there is no relief from medicines or physiotherapy. So, we also specialize in treatment of replacement, you might have heard of major joint replacements like the hip replacement, the knee replacement. Similarly, we specialize in what you call the small joint replacements, particularly in patients with rheumatoid arthritis, unfortunately it affects young people, young ladies we have seen 20, 20 to 24 having severely affected hands with a deformity and pain, they cannot use the hand for that if they have pain and they go on with, of course anti rheumatoid, this is modifying the rheumatoid treatment, some of them improve but some of them it's too late because they already develop deformity, they are neglected for 4 to 5 years and then they come with the deformity and then what we do already well is small joint replacement, just like we do a hip and knee replacement, we can replace the small joints of the hand that the MCB replacement, the PEP replacement that replace that and then get them back to normal activity. So, always remember the hand very functional, the most functional in the economically productive unit of the body. So, keep your hands safe, keep them productive, if at all there is any issue or trouble make sure that you get the right treatment at the right time.