The establishment of the journal, Techniques in Hand and Upper Extremity Surgery, can now be viewed as a testimony to the foresight of its original editor, Dr Andrew Weiland, on his editorial staff as they perceived the domain of the "Hand Surgeon" to be that of the entire upper limb. This very edition of this journal reflects this clearly as we present articles extending from the thoracic outlet to the glenoid to the trigger finger!
Although there will remain a substantial discourse as to "who should do what" in the upper limb, it is becoming evident that the boundaries for the subspecialties involved in the upper limb surgery are truly artificial. Advances in technology such as arthroscopic surgery are finding equal application in the shoulder, wrist, and elbow; the training for such procedures has become standard in most orthopaedic programs and an ever-increasing number of hand surgery fellowships.
Yet, it is also evident that subspecialization in the upper limb adds much to both advancing our understanding of problems in a specific region and improving patient care.
These realities present some challenges to our established surgical societies in addition to those involved in determining requirements for curricula for specialty fellowship training. In addition, regarding those entering hand surgery programs from plastic surgical training, how best to include and/or train these individuals will challenge all of us.
What the future may bring is the possibility of some dedicated "Upper Limb" fellowships extending from 18 months to 2 years and encompassing faculty from several subspecialties to train the "complete" upper limb surgeon!
Jesse B. Jupiter, MD
Massachusetts General Hospital
Harvard Medical School