Hand & Wrist Surgery: Post-Operative Instructions

These instructions apply to common hand and wrist procedures, including carpal tunnel release, trigger finger release, and wrist fracture (distal radius) repair. Where instructions differ between procedures, each is listed separately. Your surgeon’s team will tell you if anything is different for you.

Medications

Take all medications exactly as prescribed and follow the instructions on your pharmacy labels. Your prescriptions may include:

• Narcotic pain medication (such as oxycodone): take as prescribed, as needed for pain. Try to taper your use as soon as you feel comfortable. You may take Extra Strength Tylenol in place of the narcotic. Do not take additional Tylenol if you are taking Percocet, Norco, or Vicodin, which already contain it.
• Tylenol (acetaminophen): take as prescribed. You can take it along with your narcotic or in between doses to help manage pain.
• Anti-inflammatory (such as naproxen): take as prescribed.
• Stool softener (such as Colace): pain medicines can be very constipating. Take as directed unless you develop loose stools or diarrhea.

If You Had a Nerve Block

A nerve block can leave your hand and arm numb for up to 24 hours. While it is numb, protect it: keep it supported, and keep it away from heat, ice packs placed directly on the skin, and sharp objects. Start your Tylenol as prescribed before the block wears off, so pain medication is already working when feeling returns.

Diet

Resume a regular diet as soon as possible. It is advisable to start with clear liquids until any nausea is gone.

Elevation and Swelling

• Keep your hand elevated above the level of your heart as much as possible, especially for the first 3–5 days. Prop it on pillows when sitting or lying down. This is the most important thing you can do to reduce pain and swelling.
• Some swelling and bruising of the hand and fingers is normal after surgery.
• Ice can help with pain and swelling. Place a bag of ice or frozen vegetables, sealed in a plastic bag, over the dressing or splint for 20 minutes at a time, several times a day. Keep the dressing or splint dry.

Keep Your Fingers Moving

Moving your fingers helps reduce swelling and prevents stiffness. Start right away, unless you were told otherwise:

• Make a full fist, then straighten your fingers all the way. Repeat 10 times, every hour while awake.
• Touch your thumb to the tip of each finger.
• Move your elbow and shoulder through their full range of motion several times a day so they do not become stiff.

Dressing and Splint Care

• Keep your dressing or splint clean and dry. You may shower with it covered in a plastic bag and kept out of the stream of water.
• Do not remove your dressing or splint until you are told to.
• Carpal tunnel or trigger finger release: keep the bulky dressing in place for the first 2–3 days, then remove it. After that, you may let water run over the incision without scrubbing, pat it dry, and cover it with a light bandage. Do not soak your hand (no bath, hot tub, pool, or dishwater) until your surgeon says it is OK.
• Wrist fracture repair: your splint stays on until your first post-op visit. It is usually then replaced with a removable brace.
• Your stitches are usually removed at your first post-op visit, about 10–14 days after surgery.

Activity

After carpal tunnel or trigger finger release

• You may use your hand for light daily activities, such as eating, dressing, and typing, as comfort allows.
• Carpal tunnel release: no heavy lifting, gripping, pushing, or pulling with the operative hand for 6 weeks after surgery.
• Trigger finger release: you may begin lifting once your incision has healed and your pain is improving, usually within the first 2 weeks.
• Tenderness around the scar in the palm is common and can last for several weeks to months. Once the incision is fully healed, gently massaging the scar for 2–3 minutes several times a day can help.
• After carpal tunnel release, night pain and tingling often improve early. Numbness may take weeks to months to improve, and in long-standing or severe cases it may not resolve completely.

After wrist fracture repair

• Do not lift, push, pull, or bear weight through the operative hand. Lift nothing heavier than a cup of coffee until your surgeon clears you.
• Hand therapy usually begins after your first post-op visit, to regain wrist and forearm motion.
• Strengthening and a gradual return to lifting typically begin around 6–8 weeks after surgery, once your surgeon confirms the fracture is healing. Heavy lifting and strenuous work require your surgeon’s clearance.

Driving

Do not drive while you are wearing a splint or taking narcotic pain medication. You may drive once you can grip and steer safely and have been approved by your surgeon.

Follow-Up

Your first post-op visit should already be scheduled, generally 10–14 days after surgery. If it is not, contact our office.

Call the Office If You Have Any of the Following

• Fever over 101.5°F (38.5°C), or chills
• Excessive blood on your dressing, or drainage from the incision lasting longer than 5 days
• Increasing redness, warmth, or swelling around the incision
• Numbness or tingling in your hand that was not present before surgery, or that returns or worsens after the nerve block has worn off
• Pain that is not controlled by your medication
• Any other worrisome condition

Contact our office right away if your splint or dressing feels too tight, or if your fingers become very swollen, cold, pale, or blue, or you have severe pain when your fingers are moved, even after elevating your hand for 30 minutes. After hours, go to the nearest emergency department.