8 Recovering From HAND FRACTURE SURGERY

Transcription

1 8 Recovering From HAND FRACTURE SURGERY Hand fractures are caused by trauma and result in breaking (fracturing) the phalanges or metacarpals. Surgery involves achieving acceptable alignment and providing stable fixation through devices such as pins, screws, and plates. 2) ICE TO REDUCE '[NFLAIVIMATION. 4) BANDAGE/WOUND CARE. Keep the bandage clean and dry and do not change it unless instructed. Do not immerse the hand/wrist in water until the wound is sealed. The splint is removed and patients are transitioned to a removable splint. If pins are used, they are typically removed 6 weeks after surgery. Perform active range of motion of the unaffected fingers every hour. Formal therapy is typically initiated 2-4 weeks after surgery. Residual pain, loss of motion, and strength are related to injury severity. Sometimes hardware removal, tenolysis, and joint release are needed to improve motion 4 months after surgery. Infections can occur with external pins and are treated with antibiotics. Recovery should be expected to take up to 6 months. 10)RETLIRNING TO WORK.

2 * Recoyring From WRIST FRACTURE SURGERY Wrist fractures are caused by falling on an outstretched hand and result in breaking (fracturing) the distal radius. Surgery involves achieving acceptable alignment and providing stable fixation through devices such as pins and plates and screws. Keep the bandage clean and dry and do not change it unless instructed. The splint is removed and patients are transitioned to a removable brace. Follow up visits are typically 6 weeks and 3 months after surgery. Perform active range of motion of the fingers and thumb every hour. Formal therapy is typically initiated 4-6 weeks after surgery. Most patients take approximately 3 months to get the majority of their strength back while patients frequently lose some motion. Recovery should be expected to take at least a year. Numbness, hardware irritation, and swelling can occur after surgery.

3 4 Recovering From CARPAL TUNNEL SURGERY Carpal tunnel syndrome is a very common condition causing hand numbness and pain that results from increased pressure on the median nerve in the carpal tunnel. Releasing the overlying transverse carpal ligament decompresses the tunnel. 4) BANDAGE/WOUND CARE. Keep the splint clean and dry and remove it in 5 days. Once the splint is removed, apply light gauze to the incision if needed. Perform active range of motion of the fingers and thumb every hour. Formal therapy is typically required only if a patient has difficulty regaining range of motion. Most patients have good to excellent relief of their symptoms. The pain can quickly resolve, while the numbness takes longer to resolve, and depending on its severity, may not resolve completely. Some patients have prolonged tenderness or pain in the palm. Recovery of strength and sensation can take up to a year. If symptoms are worse after surgery, please

4 b Recov~ring From DUPUYTREN'S CONTRACTURE RELEASE Dupuytren's disease is a hereditary condition that involves the abnormal thickening of the fascia of the hand into nodules and cords. Surgery is performed to excise the abnormal tissue that forms cords that can draw the fingers into the palm. Swelling may make the bandage tight. If your cast or bandage is too tight, please Keep the bandage clean and dry and remove it in 5 days. The splint can be worn when not performing exercises. The sutures will be removed and the incision will be examined. Perform active range of motion of the fingers and thumb every hour. Formal therapy is used in patients with extensive disease. 8) RECOVERY ARID LONG-TERM OUTCOMES. This is a disease and surgery is not a permanent cure. There can be a recurrence of the contracture at the same site or on other places in the hand.

5 I Recovering From CMC ARTHROPLASTY SURGERY Thumb carpometacarpal (CMC) arthritis is a common arthritic hand condition causing pain and weakness of grip and pinch strength. Surgery involves excision of one of the carpal bones and reconstruction of a ligament of the joint with a tendon graft. 2) ICE TO REDUCE INFLAPIIYATION. 3) PAIIV MANAGEMENT. 4) BANDAGE/WOUND CARE. Keep the bandage clean and dry and do not change it unless instructed. Do not immerse the hand/wrist in water until the wound is sealed. The splint is removed and patients are placed into a thumb spica cast. Follow up visits are typically 6 weeks and 3 months after surgery. Perform active range of motion of the fingers hour. Formal therapy is typically initiated 4-6 weeks after surgery. Immobilization is typically discontinued at 3 months. Pain and pinch strength are typically improved after surgery. It can take 3-6 months for recovery to occur. Residual pain occurs if arthritis has advanced into the surrounding joints. 10) RETURN LNG TO WORK.

6 ' 1 Recovering From SCAPHOID FRACTURE SURGERY Scaphoid fractures are caused by falling on an outstretched hand and result in breaking (fracturing) the bone. Surgical screw fixation for unstable or displaced fractures is performed to stabilize the bone to allow it to heal. 2) ICE TO REDUCE INFLAIVIMATION. Keep the splint clean and dry and do not change it unless instructed. The splint is removed and radiographs are obtained. Depending on healing, a removable thumb spica brace or a cast is applied. Follow up visits occur in four-week intervals until fracture healing is confirmed. Perform active range of motion of the fingers every hour. Formal therapy is typically initiated 6 weeks after surgery. Most fractures take 3 months to completely heal. Michigan Orthopaedic 8 Spine Surgeons

7 + 4 Recoqring From TRIGGER DIGIT SURGERY Trigger digits occur in any finger or thumb caused by inflammation at the tendon sheath that can result in finger catching, pain, and decreased range of motion. Surgery involves release of the tendon sheath at the area of inflammation. Swelling may make the bandage tight. If your cast or bandage is too tight, please 3) PAIN IYAIVAGEPIENT. Keep the bandage clean and dry and remove it in 5 days. 5) BRUISIIVG OR BLEEDING is common after surgery. Perform active range of motion of the fingers and thumb every hour. Formal therapy is typically required only if a patient has difficulty regaining range of motion. 8) RECOVERY AND LONG-TERM OUTCOPIES. Surgical release of trigger digits has a high success rate and low recurrence rate. If symptoms persist, please

8 * 4 Recove~ing From CUBITAL TUNNEL SURGERY Cubital tunnel syndrome is a common condition causing hand numbness and weakness resulting from increased pressure on the ulnar nerve at the elbow. Surgical treatments include decompressing the nerve or moving it out of its tunnel. 1) KEEP YOUR ARM ELEVATED. 2) ICE TO REDUCE INFLAIY MATION. Keep the bandage or splint clean and dry and remove it in 5 days. Once the splint is removed, apply light gauze to the incision if needed. Do not immerse the hand/wrist in water until the wound is sealed. 7) THERAPY. Perform active range of motion of the hand and wrist every hour. Maintaining shoulder range of motion is very important. Formal therapy is typically required if a patient has difficulty regaining range of motion. Surgery has a high success rate while the success rate decreases with disease severity. Patients with severe disease and muscle wasting are less likely to completely recover. 10)RETURNING TO WORK.

9 * 4 Recovering From DEQUERVAIN'S TENDINOSIS SURGERY DeQuervain 's tendinosis causes radial-sided (thumb side) wrist pain resulting from compression of two thumb tendons passing through a narrow tunnel at the wrist. Surgery is performed to release the tight tunnel that the tendons travel through. Keep the splint clean and dry and remove it in 5 days. Once the splint is removed, apply light gauze to the incision if needed. 6) FOLLOW UP TWO WEEKS AFrER SURGERY. Perform active range of motion of the fingers every hour. Formal therapy is typically required only if a patient has difficulty regaining range of motion. The majority of patients obtain relief of their symptoms after surgery. Numbness on the back of thumb and hand can occur after surgery and can take months to resolve. If a snapping sensation over the thumb side of the wrist occurs, please tell the doctor.

10 . 4 Recoveling From DIP JOINT FUSION Arthritis of the distal interphalangeal (DIP) joint at the fingertip is a common location of hand arthritis that can cause pain and deformity. Joint fusion (arthrodesis) is a reliable way to manage pain and instability with minimal functional impairment. Swelling may make the bandage tight. If your cast or bandage is too tight, please Keep the bandage and splint clean and dry and do not remove it. The bandage and splint and sutures will be removed. If pins were used for the fusion, the splint will be used for 4 more weeks. Perform active range of motion of the proximal interphalangeal (PIP) joint (the first finger joint) every hour. Formal therapy is typically required only if a patient has difficulty regaining range of motion. There is a high rate of DIP joint fusion at 6 weeks.

11 . C Recowring From PROXIMAL ROW CARPECTOMY A number of wrist degenerative conditions can lead to pain and decreased range of motion. A proximal row carpectomy is a procedure that involves the removal of three bones (scaphoid, lunate, and triquetrum) to help alleviate these symptoms. Keep the bandage clean and dry and do not change it unless instructed. The splint is removed and patients are transitioned to a removable brace. Follow up visits are typically 6 weeks and 3 months after surgery. Perform active range of motion of the fingers and thumb every hour. Formal therapy is initiated 6 weeks after surgery depending on difficulty regaining wrist and finger range of motion. Full activities are encouraged at 3 months. Patients can be expected to have decreased range of motion and strength. Despite surgery, progressive arthritis may occur.

12 r b Recom~ing From LATERAL EPICONDYLITIS SURGERY Lateral epicondylitis (tennis elbow) is a tendinosis at the common extensor tendon origin causing pain along the lateral (outside) of the elbow. Surgical removal of the damaged tissue is performed for those with chronic pain unresponsive to treatment. Swelling may make the bandage tight. If your bandage is too tight, please lvlany patients find that using ice, elevation, and simple, non-prescription Keep the elbow bandage clean ad dry and remove it in 5 days. Do not immerse the elbow in water until the wound is sealed. Use the removable wrist splint. 7) OCCUPATIONAL THERAPY. Perform active range of motion of the fingers every hour. Strengthening program is started at 6 weeks. Restrictions are removed at 3 months. IVo impact activities for 4-6 months. The majority of patients obtain relief of their symptoms after surgery. Pain-free full range of motion may require 6-12 months. Some patients may experience decreased strength.

13 . * Recovqing From DISTAL BICEPS TENDON REPAIR Distal biceps tendon ruptures are typically caused by an eccentric muscle contraction and can result in decreased elbow flexion and supination strength if left untreated. Surgery is performed to reinsert and fixate the tendon back into the bone. Use the sling for comfort. 4) BANDAGE/WOUND CARE. Keep the elbow splint clean, dry, and intact until the follow-up visit. When bathing, protect your splint in a plastic bag. Once the splint is removed, apply light gauze to the incision if needed. Do not immerse the elbow in water until the wound is sealed. 7) THERAPY. After the splint is removed, active and passive elbow range of motion should be performed but no lifting greater than a coffee cup for 6 weeks. Maintaining finger and shoulder range of motion is very important. Formal physical therapy is typically not necessary. -the majority of patients obtain good results after surgery especially with supination strength. There may be transient forearm numbness after surgery. Tendon re-ruptures are rare but can occur.