Turning a doorknob, opening a can or lifting a mug of tea – these daily actions are so common you may not even take note of performing them. Yet, for orthopaedic surgeon Dr Phumza Mshuqwana, nothing is more fascinating than the intricate physical anatomy that makes such tasks possible.
“I think of the hand as a second brain,” says Mshuqwana, who practices as a hand, wrist, and upper limb orthopaedic surgeon in Springs.
“[The hand] it is a deeply complex structure that we require to function properly to complete many of even the simplest activities.”
Mshuqwana specialises in the treatment of a broad spectrum of conditions affecting the hand, wrist, elbow, and upper limb specifically, including arthritis, congenital abnormalities, burn contractures, peripheral nerve injuries and trauma injuries, among others.
Inside the human hand
“The anatomy of the hand comprises 27 bones and joints, 34 muscles, more than 100 ligaments and tendons, and countless nerves and blood vessels all surrounded by soft tissue. Any surgery to this area – and to the connecting wrist, arm and shoulder – is incredibly detailed and needs to be as precise as possible if hand and limb function is to be maintained or improved,” explains Mshuqwana.
“The interconnectedness in this part of the body extends far beyond what the eye can see, with tiny nerves working together much like an electrical circuit. If a nerve fails to work due to an injury, and the patient cannot lift their wrist or fingers, then a tendon transfer or nerve transfer might be performed. This entails taking a tendon or a nerve from one side of the body and reattaching it in the affected area to stimulate movement, a little like jump-starting a car.
“Sometimes it may be a case of trying to reconnect severed nerves. For example, a patient may experience damage to the brachial plexus, a complex network of nerves located in the neck and shoulder area that carries movement signals from the brain down the length of the limb. If any of these nerves are damaged, it can result in paralysis in the arm or the hand.”
Race against time
“Nerves in this area grow at a very slow rate of just 1mm per day and if the impairment has occurred as a result of severe trauma to the area rather than a clean cut, the prognosis may not be very good. The sooner the nerve damage can be attended to, the greater the chances of recovery.
“Surgeries to the hand and upper limb vary in complexity. Certain conditions are more common than others, such as arthritis, which tends to be associated with ageing. Arthritis affects the joints and can therefore make it painful or difficult to use your hand as you normally would.
“There are several non-surgical interventions for arthritis in the hand but when these are no longer effective, surgery can prove highly beneficial, such as when the arthritis is at the base of the thumb.
“In such a case, removing a part of the bone can improve mobility and dramatically reduce pain, improving the patient’s overall quality of life,” she explains.
Finding passion in the intricacy
Mshuqwana notes that not only is there a broad spectrum of pathologies that can affect the hands and upper limbs, but anatomy is not always the same, as in paediatric patients with congenital abnormalities.
“As it is, babies and young children do not have the same anatomical structure as an adult, as they are still growing and their bones are not yet fully developed. You then have further differences in paediatric patients who were born with an abnormality, such as webbed fingers or an extra digit (finger).
“Children can only be operated on at a certain age when it is safe to put them under general anaesthetic – usually between the ages of 12 to 18 months. Once they are old enough, surgery can be quite straightforward, depending on what is involved.”
“This may simply involve taking off a little lump of skin. However, it could be that a full extra finger needs to be removed, which requires considerable planning as to which fingers should stay and which one should go to correct the digits,” she explains.
According to Mshuqwana, the highly detailed nature of orthopaedic surgery in the hand, wrist and upper limb is precisely what drew her to the field, along with the deeply rewarding nature of her work.
“When you improve the functioning of a hand, you improve the quality of a person’s daily life, and it is most rewarding to be able to see such outcomes in patients. At the same time, I find the intricacies of this area of anatomy fascinating – it requires a particular level of patience and focus, and once I had experienced it, I felt as though a switch had been flicked in my brain. I knew this was what I wanted to do,” she says.
Answering her calling
Growing up in the Eastern Cape as the only daughter in a busy family of five children, Mshuqwana says that from the age of six, she knew that her calling was to one day be a doctor.
“All through my school career and years at university, I worked with one goal in my mind – to qualify as a medical doctor. However, it was during my internship in orthopaedics that I was exposed to hand surgery, which triggered my passion for this discipline,” she recalls.
“To this day I still take an active interest in the academic world of medicine, acting as a facilitator in the Graduate Entry Medical Programme at the University of the Witwatersrand (Wits) Medical School. There I assist with the case assessments and the coordination of the programme, which seeks to increase the number of highly skilled medical graduates and address the shortage of doctors in our country.
“There are many young women out there who have a dream to become a doctor, just as I did, and once you have found your niche, there is little that can compare to the sense of fulfilment in doing what you love and making a difference in the life of another,” says Mshuqwana.
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