Planning, Expecting, and Preparing for Elective Hand Surgery

Planning, Expecting, and Preparing for Elective Hand Surgery
What is an elective procedure? This procedure can be scheduled in advance, unlike treatment of a fracture or an infection. An elective procedure is one you have decided to have done to improve the function of your hand or arm.

Can the procedure wait? Yes. You and your physician have determined that the procedure will be beneficial but can wait. Your surgeon will discuss a comfortable time frame during which you might want to have your surgery. Write out a list of questions you have for your surgical team about the procedure and address those during a face-to-face visit. Here are some examples:
  • Which symptom(s) will the procedure help the most (numbness, tingling, pain, appearance, etc.)?
  • How important are these things for you, and how will the surgery address them?
  • Why has your surgeon suggested the procedure for you?

What are alternatives to the surgical procedure? Ask about injections, physical or occupational therapy, medications, or consultations with a non-surgical specialist.

What will the recovery from the surgery be like? How long will you be off work? Will you need occupational or hand therapy? Which activities can you do soon after the procedure?

Many elective surgeries of the hand, wrist, or elbow will allow you to resume the use of your arm within a day or two after your procedure. Your hand therapist will give you some suggestions about resuming important hand functions after surgery. Your job may require you to provide documentation of the use of your hand afterwards.

Many things are often possible soon after your surgery, for example “light use,” which includes clerical work, typing, writing, answering a telephone, driving a car, or taking care of yourself without extra help. If you play a musical instrument, it may help your recovery.

Pain is different from person to person. Since there will be a skin incision, some discomfort is expected, but it should diminish as soon as you resume some function of your hand. Full recovery may take several months, but most patients are able to work with their hands within just a few days. Your surgeon can give you an estimate of your “downtime.”

Often, splints are used after surgery. Your surgeon and his/her team will instruct you on dressings and splints. You will receive instructions on how to care for your incisions.

How should you prepare for the surgery? Think about how the procedure, the post-operative visits, occupational therapy, or any temporary adjustments will affect you. Your surgeon will help prepare you for your procedure, and your surgeon’s office will assist you with maps, telephone numbers for the surgery center, and arrival times. The office also arranges for a post-operative visit.

The procedure may require you to make temporary adjustments to your home life or your work. Many of these circumstances vary from patient to patient. Your surgeon can help you assess some restrictions and limitations and how long they last. Prepare yourself and a family member for the time after your procedure. If you have any form of regional or general anesthesia, you will need to have someone help you for 24 hours after the procedure, during which you cannot drive a car or make critical decisions. This is also true if you take narcotic pain pills following the procedure.

What kind of pain should you expect during and after the procedure? Most patients are concerned about pain after elective surgical procedures. Surgeons now use a combination of many treatments. Local anesthesia can be used for many hand surgery procedures. Your surgeon can administer local anesthesia a few minutes before your surgery, similar to a dental procedure. If you prefer, the anesthesia team can administer medication to keep you comfortable during the injection. It is called “local anesthesia with sedation.” You may not remember much of the procedure although you are awake. The medicine for the sedation stays in your body for about 24 hours. You should not drive a car, operate heavy machinery, or make critical decisions during that time.

Additional pain management options are available. The surgical team can anesthetize your arm prior to the procedure. This is called a “block,” and it helps with pain management so that narcotics are rarely necessary. The block lasts for eight to 14 hours. You may feel that your arm is not part of you, and there is much less pain. A sling will keep you protected during that time.

Many procedures are performed under “general anesthesia.” The anesthesiologist will put you to sleep. Your surgeon will often inject the surgical area with additional anesthesia medication. This gives you additional pain relief for several hours. Most elective procedures will enable you to manage discomfort without narcotic pain pills. Your surgeon or another member of the team may contact you to see how you are doing after the procedure, and you should use that time to address additional concerns if you have them.

Can you have a procedure on both upper extremities? Many conditions affect both of your hands or wrists. For example, carpal tunnel syndrome often occurs on both sides. Surgery can be performed on both hands in the same setting. Alternatively, you may want to see how the surgery turns out on one side. When you have recovered enough, you can schedule the surgery on your other side. Sometimes, recovery of the second side is a bit slower. After about two weeks, your recovery is very similar.

What must be done before you finalize your procedure? Your health insurance plan will cover most elective procedures recommended by your surgeon. There is often a portion of a deductible fee and co-pay for which you are responsible. So that you are comfortable with the cost of the surgery, it is best to discuss these details with your surgeon’s billing manager when you schedule your procedure.

Should I get a second opinion? You should select a surgeon for your procedure with whom you are most comfortable. Personal experiences from friends or family can help you decide. Another opinion by a qualified expert may help you make a decision about the procedure, as well.
Dr. Ekkehard Bonatz is an orthopedic upper extremity and hand surgeon in Birmingham, Alabama, where he trained and completed his hand fellowship. He is an active member of the American Society for Surgery of the Hand (ASSH) and the American Academy of Orthopaedic Surgeons (AAOS).

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