Advice from a Certified Hand Therapist: What to Expect When You’re Expecting Surgery

Surgery generally falls into two categories, elective and emergency.  Outcomes from these two types can vary greatly.  Emergency surgery is usually done to preserve life or function and usually follows some sort of serious incident or injury.  Elective surgery means you may have some choice about the surgery as well as some time to discuss options with your doctor or medical team.

Post-operative expectations following surgery will depend greatly on the type of surgery you have, the amount of damage before and during surgery, your body’s response, and how well you take care of yourself afterward.

How can I prepare myself for my surgery?

The best way to prepare for surgery is to start as early as possible.  Most surgeries come with a set of precautions for after surgery, but what you do before surgery can also make a difference.

Plan to get plenty of rest and plenty of exercise in the weeks BEFORE surgery.  Eat well balanced meals, take vitamin supplements (clear this with your surgeon beforehand) and be well hydrated.  No matter what condition you are in before surgery, you will experience a decline in function.  The better you are before the procedure, the better you will be after.

I just had surgery, but I’m still in a lot of pain!  Why?

Most people head into surgery with the expectation they will be better after surgery, frequently this isn’t the case.  You are not better after surgery, you are better after you RECOVER from surgery.  The time between your surgery and when you recover is an important time.  Pain is a normal response to surgery.  If you feel your pain is not managed and you are following the directions for pain medication, discuss this with your therapist or contact your surgeon.

What can I do to help ensure a successful recovery?

There are lots of things you can do to make your recovery brief and as painless as possible.

• First, expect that you will have pain.  Your body has just experienced an event where it was damaged. (Yes, a surgeon’s knife is still damaging tissue as far as your body is concerned, even if it is to fix a problem. Your body doesn’t know the difference and responds the same as it would with any other injury.)  Luckily, your surgeon is skilled in making as little damage as possible and does your surgery in a safe and sterile manner to decrease the damage and your body’s response to it.
• Second, expect that there will be swelling.  This is a natural body process but one that you have a lot of control over!  Gravity can be your best friend or worst enemy during this time.  If you keep the operative area elevated above the heart constantly, gravity will help to pull that swelling away from the surgery site.  On the other hand, if your hand spends more time below your heart, you can expect gravity to help the swelling INCREASE, usually with more PAIN AND STIFFNESS!  So keep it up!  Massage at this time can also help fluids drain away from the surgery site.  Massage as close to the injured site as possible, you can even do gentle massage over the top of bandages as allowed by your surgeon.  You always want to massage FROM the surgical site TOWARDS your heart.  (So if you have a wrist surgery, you will want to massage from your wrist towards the elbow.)  Moving joints that are further from the surgery site is usually okay and also helps decrease swelling.
• Third, expect that you will have some level of disability and need some more assistance for a period of time.  Depending on the type and location of surgery you may not have any use of your hand for days to weeks.  Have you tried getting dressed with one hand lately? How about putting on your shoes or making breakfast?  Plan ahead! Depending on the type of surgery, pullover shirts may be easier to put on than clothes with buttons, and prepared foods are easier to manage than cutting and chopping veggies.
• Fourth, expect your body to recover.  The pain will lessen, the swelling will decrease, and your ability to do things independently will return.  However, it will take time, the amount of time depends in large part on how you treat yourself after the surgery.  If you respect the pain and keep the swelling down and don’t overexert yourself, you will help your recovery.

Something doesn’t feel right. What do I do?

As with most things, there can be complications.  One of the biggest is infection.  Be aware of increases in PAIN, SWELLING and REDNESS. These three signs mean it’s time to call your surgeon or head to urgent care.  Typically, the body’s response to surgery or injury is relative to the amount of damage from the surgery or injury.  If your body seems to be responding out of proportion to the injury, it may be a signal that your body is over-reacting.  If you feel you have more pain or stiffness than you would expect, take extra steps to address it early, such as ensuring it is elevated all the time and massaging the surrounding tissue.

During your recovery your hand therapist will work closely with you and your surgeon to help ease your symptoms and address your concerns.  You should work with both a surgeon and a therapist who specialize in the treatment of conditions of the hand and arm.  You can find a specialized surgeon at ASSH and a specialized therapist at ASHT.

Adam Holbrook, OTR/L, CHT, is a certified hand therapist and an active member of the American Society of Hand Therapists.