Post-Operative Instructions

For the Hand, Wrist, and Elbow

Read these instructions very carefully and keep them handy. Everything you need to know is here. Reading carefully will save you time on the phone with our office to ask these same questions. After hours, the only calls the answering service will forward to your doctor will be those listed under item #1 below.

Call your surgeon at any time (off hours included) – for the following events:

a. Circulation Problems = the fingers present color changes to blue or white with no pink

b. Excessive bleeding = bright red blood keeps coming out of the dressing

c. Loss of feeling in your hand or finger tips

d. Tight Dressing = Dressings can become tight from swelling underneath. If this happens, elevate the limb for 30 minutes. If no relief, call our office immediately

e. Problems with your surgery

Call this office during office hours – for the following: Questions about your medications, your next appointment, your post-operative restrictions, other general questions

Call your regular internal medicine doctor – if any other medical condition you have such as heart or lung problems seem to get worse in the period after your surgery

Call 911 – if you have a sudden crisis that has to do with anything other than your arm during the period after your surgery such as symptoms of a heart attack or other serious event

Medication – You have been given enough pain pills including the refill to cover you beyond the next office visit. To control various symptoms do the following:

e. Nauseadrink light liquids and try soft foods. If the nausea or vomiting persists, call your doctor to have an anti-nausea medication prescribed

f. Itching – Itching is a common side effect from pain medications and over the counter Benadryl is still the best medication you can take for this

Controlling Your Pain - You are going to have pain, you can count on it

Here’s what you can do to minimize it:

g. Keep the operated area higher than your heart at all times

h. Take your pain pills every four hours (do not get behind)

i. Ice bags can be applied to the outside of the dressing for 20 minutes at a time for the first few days

j. Rest and take it easy, if you are running all around, you will create a lot more pain for yourself

Taking care of your dressing – Don’t mess with your dressing unless you were specifically told to do something by your doctor. Keep it dry. During bathing enclose it in a plastic bag, seal the bag to your skin above the dressing and place a small towel inside the seal to catch any water that breaks through

Moving your arm and hand – you will be told what joints or tendons not to move. If there is a splint, then the ones not to move are covered by the splint. All other joints not involved in the surgery should be moved to their full capacity every single day to prevent them from getting stiff. If your fingers are free, they are the most important ones to move (see the diagram on the back of this packet and do each of those six positions multiple times every day).

Eating after surgery – Start slowly and eat lightly. Anesthetics and pain medications change the way your digestive system works. If you had an anesthesia tube in the throat, you may be hoarse, have a sore throat, and even spit up small amounts of blood.

What To Expect With Surgery

Will my hand be NORMAL after surgery?

Surgery is not a normal event for the human body to go through. Wherever surgery is performed scar tissue forms. Scar is not normal tissue. We try to minimize scar formation by using sound surgical techniques and appropriate post-surgery therapy. The goal of surgery is to give your hand as normal function as possible.
  

When will I be all better?

The length of time to recover from surgery will depend on the surgery performed. Most surgeries have a 2-4 month healing period. Additional changes keep taking place for up to 2 years.

Is surgery guaranteed to solve the problem?

NO! No surgery in the world has 100% good results. The very best procedures are about 95%. Most surgeries are between 70-90%. Some surgeries are even as low as 50/50. Why do we operate if the results can not be predicted any better than that? Surgery is done to improve the overall situation. Sometimes partially solving the problem makes life much more livable. Deciding when surgery should be done and what procedure should be chosen is very difficult and requires a lot of judgment.

What can I do to improve my results?

Everything! You have more opportunity to make a good or a bad result for yourself than even your surgeon. What happens after surgery really counts. You will be doing therapy on a daily basis. Some of you will work with hand therapists. Some of you will work on your own. Study the Hand Therapy Basics part of this packet to learn how to do proper therapy.

Can serious problems arise during or after surgery?

Yes. Although rare, a problem (also called complication) can occur after surgery. Some complications are more serious than others. All of them have to be treated. The patient who admits a complication is happening and does what is necessary to get over it will usually be OK. The patient who denies that a complication is happening or dwells on asking "why me?’ will usually develop a difficult problem. Some complications can not be prevented. Fortunately, this type of complication is very rare. Luckily most complications can be prevented by carefully following instructions. Let’s go over the most common ones ahead of time.

Swelling: Occurs 100% of the time. Combat swelling by keeping the hand as high as possible the week after surgery. Pump swelling out of the hand by using the muscles and doing exercises like the "six-pack" exercises shown in the diagram included with Hand Therapy Basics. Do not try to move any part that has a splint on it.

Stiffness: Occurs 100% of the time. This will be the hardest part about having hand surgery. You will not believe your hand could ever be this stiff. The earlier you can get back motion the better. Once stiffness sets in, it is very difficult to get rid of.

Numbness: Every incision cuts through small nerves in the skin. This may leave a patch of numb skin near the incision. The size of this patch usually gets smaller with time.

Hypersensitivity: Hypersensitivity after surgery can become a problem if it gets out of control. Fortunately this is very rare. After surgery your nerves can become very sensitive. Massage and early motion are best at preventing this problem with direction from your therapist or doctor.

Infection: this is the most feared complication. You can diminish the chance for infection by following your instructions on dressing and wound care. Do not let your dressing get wet. If you think you are developing an infection, call the office immediately. Fortunately, infections are very rare but they still can happen.

Failure to heal: No matter how well they're put together, not all injured or repaired structures will heal in a timely matter.

SMOKING!!!!!!!!!!!!!!!!!!! Smoking increases the risk of all these complications. You must really stop smoking before your surgery. So, I congratulate you on the decision you have just made to quit smoking. If you can’t, you should seriously consider not having your surgery. It is that dangerous!

Other complications: There are many more possibilities that are fortunately uncommon. If these problems arise, the best thing to do is meet them head on. A motivated patient can overcome most problems with enough time and effort.