The care of the hand in the post-operative period is very important in helping to ensure a good result. Initially the aims are comfort and elevation. These are met by keeping the hand up (elevated) especially in the first few days and by use of a long acting local anaesthetic (Bupivicaine). The local anaesthetic lasts at least 12 hours and sometimes 48 hours. Patients should start taking painkillers before the pain starts . on return home or whilst still in hospital and for at least 24 hours from there. This way most of our patients report little or any pain.
The patient is reviewed in clinic after within 2 weeks of the operation. Typically dissolvable stitches are used so they should not require to be removed. A splint may be provided by the physiotherapists particularly following joint replacement. Careful follow up is required to ensure a successful result with good relief of pain and a good range of movement.
The hand can be used for normal activity after the first few days. Wrist movement will depend upon the scale of the operation. Typically most of the movement gained following surgery occurs in the first 6 weeks but the wrist seems to be more forgiving and will regain movement quite late (even after several months) nonetheless early movement is encouraged where appropriate. The key is regular long gentle stretches both into straightening and into bending. Ideally these should be performed for 5 mins in each direction (feeling the stretch but without pain) once an hour. In practical terms most people mange 5-6 times a day. Elevation and icing the elbow also help reduce swelling and thus pain and improve movement.
Most patients can drive after a 1-2 weeks following arthroscopy or denervation, and 6-8 weeks following the larger operations. Most patients return to work following arthroscopy or denervation in 2-3 weeks, but this varies with occupation; heavy manual work usually takes about 6 weeks. Following the larger operations patients return to light work in 6-8 weeks and heavy work not before 3 months if ever.
The scars should be massaged by the patient 3 times a day with a bland soft cream for 3 months once the wound is well healed (typically after 2 weeks). This reduces the scar sensitivity which can be a nuisance.
The patient should remain in the supine position for several minutes after the injection. To ascertain whether the pharmaceuticals have been injected into the appropriate location, move the joint through passive range of motion. For tenosynovitis, stress the finger flexors to ascertain the same. A compression dressing should be applied after aspirating a ganglion cyst. To monitor for any adverse reactions, the patient should remain in the office for 30 minutes after the injection. In general, patients should avoid strenuous activity involving the injected region for 48 hours. Patients should be cautioned that they may experience worsening symptoms during the first 24 to 48 hours related to a possible steroid flare, which can be treated with ice and NSAIDs. A follow-up appointment should be arranged within three weeks.