Hand Surgery: Post-Operative Restrictions, Recovery, and Long-Term Care

What can you not do after hand surgery?

Following hand surgery, a period of strict activity restriction is crucial to ensure proper healing and prevent complications. The specific limitations depend on the type of surgery, but generally involve avoiding heavy lifting, gripping, pushing, pulling, and any activities that place undue stress on the healing tissues.

Introduction

Hand surgery is a broad category encompassing procedures to address conditions ranging from carpal tunnel syndrome and trigger finger to complex tendon repairs, fracture fixations, and nerve reconstructions. Regardless of the specific pathology, the overarching goal of post-operative care is to facilitate optimal healing, restore function, and prevent re-injury or complications. Understanding what activities to avoid is paramount to achieving a successful outcome. Adherence to post-operative protocols, guided by your surgeon and hand therapist, is non-negotiable for safeguarding the integrity of the repair.

Immediate Post-Operative Restrictions

In the critical days and weeks following hand surgery, the focus is on protecting the surgical site and minimizing swelling.

• Elevation: Keep the hand elevated above heart level as much as possible, especially for the first 48-72 hours. This helps reduce swelling and throbbing, which can impede circulation and healing.
• Keeping the Wound Dry: The surgical incision must be kept clean and dry to prevent infection. Avoid showering or bathing without proper wound protection (e.g., waterproof covers) until cleared by your surgeon.
• Pain Management: While not an activity restriction, managing post-operative pain is crucial. Take prescribed medications as directed to allow for necessary rest and controlled movement as advised.
• Movement Limitations: Depending on the surgery, specific movements will be severely restricted or entirely prohibited. This often includes:
  • Active Finger/Wrist Flexion/Extension: For tendon repairs, active movement might be restricted to prevent rupture.
  • Weight-Bearing: Absolutely no weight-bearing through the hand or wrist.
  • Lifting: Even light objects can stress healing tissues. Avoid lifting anything, even a cup of coffee, without explicit permission.
  • Gripping/Squeezing: Powerful gripping or squeezing actions are typically forbidden to protect internal repairs.
  • Pushing/Pulling: These actions can strain tendons and muscles around the surgical site.
• Splint or Cast Care: Do not remove, adjust, or get your splint or cast wet unless specifically instructed. It is a critical component of immobilization and protection. Report any issues like tightness, numbness, or skin irritation immediately.

Common Activities to Avoid or Modify (Short-to-Medium Term)

As healing progresses, some restrictions may ease, but many activities will remain off-limits or require significant modification for several weeks to months.

• Heavy Lifting and Carrying: This is perhaps the most common and longest-lasting restriction. Any weight, from groceries to gym weights, can place excessive strain on healing bones, tendons, and ligaments.
• Forceful Gripping and Squeezing: Activities like opening jars, using tools, wringing out cloths, or even forceful handshakes can jeopardize repairs.
• Repetitive Motions: Tasks involving repetitive hand or wrist movements (e.g., extensive typing, knitting, assembly line work) can cause inflammation and stress, hindering recovery.
• Pushing and Pulling Activities: Opening heavy doors, pushing furniture, or pulling weeds can place undue stress on the operated hand.
• Impact Activities and Sports: Any activity that risks impact to the hand (e.g., contact sports, ball sports, cycling without adequate protection) is strictly prohibited until full clearance. This can be a restriction for several months.
• Driving: The ability to safely operate a vehicle, especially in an emergency, requires full use and strength of both hands. Driving is typically restricted for a period, often until the splint is removed and adequate strength and reaction time return.
• Fine Motor Tasks: Initially, intricate tasks like buttoning shirts, writing, or picking up small objects may be challenging or restricted to prevent strain on newly repaired structures.
• Sleeping on the Hand: Avoid sleeping directly on the operated hand, as this can compress tissues, increase swelling, or compromise the surgical site.

Why Are These Restrictions Necessary?

Understanding the physiological and biomechanical reasons behind these limitations can reinforce adherence.

• Protection of Healing Tissues: Surgical repairs (sutures on tendons, plates/screws on bones, nerve grafts) are initially fragile. Any undue stress can cause rupture, displacement, or failure of the repair.
• Prevention of Swelling and Inflammation: Movement and gravity can increase blood flow to the area, leading to excessive swelling, which can compromise circulation, increase pain, and delay healing.
• Optimization of Scar Tissue Formation: Controlled movement, as prescribed by a therapist, is vital for guiding scar tissue formation to be strong and flexible, rather than dense and restrictive. Uncontrolled movement can lead to excessive, problematic scar tissue.
• Allowance for Revascularization and Nerve Regeneration: Tissues need time to re-establish blood supply, and nerves regenerate very slowly. Protecting the area ensures these delicate processes are not disrupted.
• Prevention of Re-Injury or Complications: Non-compliance with restrictions significantly increases the risk of re-injury, infection, chronic pain, stiffness, or the need for revision surgery.

The Role of Hand Therapy and Gradual Progression

Post-operative hand therapy is an integral part of recovery and directly dictates the progression of activity.

• Individualized Protocols: Your hand therapist will provide a specific, phased rehabilitation program tailored to your surgery and individual healing. This program includes specific exercises and clarifies what activities are permissible and when.
• Gradual Reintroduction of Activities: Restrictions are gradually lifted as healing progresses and strength/mobility improve. This is a carefully managed process, not a sudden return to full activity.
• Therapeutic Exercises: Exercises are designed to restore range of motion, improve strength, reduce swelling, and enhance functional use of the hand, but must be performed precisely as instructed to avoid harm.

Long-Term Considerations and Return to Full Activity

The timeline for returning to full, unrestricted activity varies widely, from a few weeks for minor procedures to over a year for complex reconstructions.

• Listen to Your Body: Even after formal therapy concludes, continue to monitor your hand. Any pain, swelling, or discomfort after an activity indicates you may be overdoing it.
• Potential for Permanent Limitations: While most hand surgeries aim for full recovery, some complex cases may result in minor, permanent limitations in strength, dexterity, or range of motion. Your surgeon will discuss these possibilities beforehand.
• Continued Strength and Mobility: Maintaining the strength and flexibility gained through therapy is crucial for long-term function and preventing recurrence of symptoms.

When to Seek Medical Attention

It is vital to be aware of warning signs that may indicate a complication and require immediate medical attention:

• Signs of Infection: Redness, warmth, increased pain, pus, or foul odor from the incision site.
• Increased Pain: Uncontrolled pain despite medication, or sudden, sharp increases in pain.
• Numbness or Tingling: New or worsening numbness, tingling, or weakness in the hand or fingers.
• Loss of Motion: Sudden inability to move fingers or wrist, or a significant decrease in range of motion.
• Fever: Elevated body temperature.
• Excessive Swelling: Swelling that is rapidly increasing or does not respond to elevation.

Conclusion

The period following hand surgery is a critical phase of recovery that demands patience, discipline, and strict adherence to medical advice. Understanding and respecting the "don'ts" of post-operative care is as important as diligently performing the "dos" prescribed by your surgeon and hand therapist. By protecting the healing tissues and gradually reintroducing activity under expert guidance, you significantly enhance your chances of a successful recovery and optimal long-term hand function.