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Hand injuries provide a distinct set of problems. Hand injuries may be highly inconvenient, in addition to the discomfort they cause. There are easy actions you may do to hasten your recovery while minimizing pain.

Exercises for the Hands

First it is extremely important to ensure that there is no underlying fracture (broken bone), joint dislocations, nerve or tendon injury before commencing any exercises. Early identification and correct treatment at the right time be it splinting, guided hand therapy or surgery if necessary can ensure optimal outcomes.

Speaking with your hand surgeon or hand therapist to identify the best physical therapy program is critical for people with unique hand problems. Depending on your specific injury, one or more of these hand exercises may be required for a speedy recovery.

Delayed identification of more serious problems in these seemingly minor injuries can often lead to adverse outcomes that may significantly affect the function of your hand.

Whether you’re a student-athlete, an office worker with carpal tunnel syndrome, or someone who has recently been diagnosed with arthritis, one of these exercises might help you get back on your feet. The workouts mentioned below are some of the most often suggested. These are also excellent exercises for anyone wanting to increase their hand mobility in general.

Again if you are in pain or have a swollen, or recently injured hand please consult a hand specialist before commencing any of the exercises below.

• It’s as easy as it sounds to make a fist. Begin with your hand spread out in front of you, then create a fist.
• Stretch your fingers by starting with your hand in a natural posture on a flat surface and gradually straightening them. Hold this stance for roughly a minute before switching hands.
• Place your palm flat on the table and slowly raise each individual finger to increase your flexibility. For each hand, repeat this exercise 8-12 times.
• Stretch each of your fingers to contact your thumb while holding your hand in an upright posture.
• For 30-60 seconds, move your fingers into a claw-like stance with your palm facing out.
• With each hand, squeeze a grip-strengthening ball as tightly as possible 10-15 times.
• Pinch a soft foam ball between the tips of one of your fingers and your thumb to strengthen your grip. Do this for approximately a minute, then do it again for a total of 10-15 times.
• Elevate your wrist by draping it over the edge of a folded towel or other similar-sized items. Move your hand up and down completely, starting with your palm facing down and ending with your palm facing up.
• Place your wrist/forearm on a folded-up towel, this time with your hand sideways and your thumb pointing up, like in the last exercise. Then, in a complete range of motion, wave your hand up and down.
• Rotate your arms by placing your palms up, then down, and so on while standing or sitting with your elbows bent at a 90-degree angle.
• Extend your thumb from its natural position to the palm’s center and back.
• Tendon Gliding is an activity that involves placing your hand in various postures and then returning it to a flat position. Make a hook fist first, then a full fist, and finally a straight fist.

Speak with a fellowship-trained Hand Surgeon who specializes in this area right now.

You can traverse the healing phase of your hand injury with relative ease if you follow the advice of a hand surgeon. He/She can assist you in overcoming these obstacles and moving toward long-term recovery. For additional information on how we can help you recover, please contact us.

If you are recovering from a hand/wrist injury, or having surgery to your hand/wrist, you may need to rest it for a period of time.
This leaflet is designed to give you advice on managing “onehanded”.

BEFORE YOUR SURGERY

Ask for help

After your surgery, you are likely to need help with activities such as childcare, housework, meals and trips to hospitals.
Try to plan and make arrangements beforehand with others (friends, relatives, careers) to get the help you might need.

Driving

You are advised not to drive until stitches and casts/splints have been removed.
Your car insurance may not be valid if your hand/wrist is in a dressing or plaster cast.
Try to plan by checking bus/public transport routes and timetables.

Practice makes perfect

Before your surgery, practice doing everyday activities such as dressing, showering and eating using only one hand.

Prepare

Start preparing before your surgery you to make managing easier:
Food
• Stock up on food before your operation, especially ready/easy to cook meals
• Soups, sandwiches, ground meats are often easier to manage
Medication
• Consider using a tablet box or open medication container to make them easier to access. Keep them out of reach of children. Alternatively, your pharmacist can provide easy to open containers.
Mobility
• If you have problems with your mobility, or require mobility aids such as walking sticks/Zimmer frames, speak to the therapy department for advice.
•You may require additional or alternative mobility aids whilst you are onehanded.
•Practice using the new or additional aids before your surgery to familiarise yourself.
Money
•Use a wallet/purse that opens easily

AFTER YOUR SURGERY

After your surgery, it is important to follow these postoperative care instructions:

General Care

• Keep dressings/plaster dry until review.
• Elevate your hand/wrist at or above the level of your heart to reduce swelling and pain (see Fig 1)
• Carry a shoulder bag/backpack to free up your good hand for use
• Wear your sling when leaving the house, so other people are aware you have a hand/arm problem and will avoid bumping into you. Otherwise walk with your hand on your opposite shoulder, to keep it protected from others (see Fig 2)

Elevation

• Elevation helps reduce swelling and pain. It is very important after your surgery
• Elevation should continue for as long as it takes for all the swelling to go down
• Every 2-3 hours, stretch your arm above your head and move all the other joints you are allowed to move to avoid stiffness
• When resting at home or in bed, keep your hand/wrist up on some extra pillows beside you or across your chest (see Fig 3 & 4)

USEFUL ITEMS TO HELP YOU AFTER YOUR SURGERY

In the shower

• Use commercially available waterproof cast covers. Ask our plaster room staff for more information about waterproof covers for your cast.
• Avoid using plastic bags, cling film or rubber bandages to cover your dressings.
• A soft sponge on a long stick (Bottle sponge) for washing the armpit of your ‘good’ hand and back
• A hairbrush in the shower to help rub shampoo in your hair
• A cotton terry cloth bathrobe to dry your back
• A rubber mat in the shower/bath to avoid slipping

In the bathroom

• Use toothpaste, shampoo, soaps in fliptops or pump action dispensers. Avoid screw tops
• Consider an electric razor or toothbrush

In the kitchen

• A rubber mat can help keep things from slipping around and be used to open jars.
• An electric can opener, with a lid magnet to hold the can, can be used one-handed.
• Vegetable baskets can be used to lift vegetables out from the saucepan.
• One-handed cutlery e.g. Dyna fork or Nelson knife

In the bedroom

• Wear large sleeved shirts and tops to allow easier dressing.
• Slip on shoes.
• Trousers/skirts with elasticated waistbands.
• Consider a stretch crop bra top or vest.
• Avoid clothing that has buttons, fastens at the back or uses drawstrings

USING YOUR HAND AFTER SURGERY

You may be allowed to use your hand lightly after your surgery, especially if you are wearing a cast or splint.
Your doctor or therapist will explain to you how you should use your hand.
If allowed light movements, keep moving your fingers several times per hour (see Fig 5 & 6)

DO YOU NEED HAND THERAPY AFTER YOUR SURGERY?

After your surgery a hand therapist will assesses your hand and treat your pain, inflammation, scaring and maximize your independence using tailored exercise programs.If you have had surgery on your wrist or hand, you should have been referred to hand therapy. If you haven’t been contacted two weeks after your operation, please contact the Hand Therapy services.

Hand Therapy Team

They can be contacted directly through the hospital switch board.

Plaster Cast:

If you feel the plaster is tight or you are not able to move your fingers and thumb fully, please contact the hospital directly or if out of hours contact your nearest A&E dept and let Mr Mathew’s sect. know the next day.

This leaflet will help answer some of the questions you may have about trigger finger or thumb and possible surgical release. It explains the benefits, risks and alternative to the procedure. If you have any further questions or concerns, please do not hesitate to speak to a doctor, therapist or nurse caring for you.

What is trigger finger ?

Trigger finger is the term used to describe the catching of a finger or thumb as you bend and straighten it. Trigger finger is caused by a thickening around the tendon which bends your finger or thumb. It is more common in women than men and may be linked to diabetes.

What are the symptoms of trigger finger ?

It may feel like your finger or thumb is clicking or it may catch and stay bent. Sometimes the only way to straighten your finger is by straightening it with your other hand. Sometimes it can be sore and painful when direct pressure is placed over the thickening in the palm of your hand.

Why should I have trigger finger released?

Treatment is needed if the triggering of your finger is causing discomfort or stopping you from being able to perform normal daily activities.

What happens during the surgery?

Come prepared with a book or some music to listen to whilst you wait for your turn. You should take all your medications as normal unless otherwise instructed. Please inform the doctor of any blood thinning medication you take and about any allergies you may have. You do not need to starve for this procedure unless you are having this under a general anaesthetic. Surgery for trigger finger aims to remove the fibrous tissue which is affecting the movement. You will routinely have the procedure done under wide awake local anaesthetic no tourniquet (WALANT) technique. The local anaesthetic injection ( the only painful bit of the operation) will numb your finger and allow the surgeon to make a small cut over the area of your palm, and then release the thickening in the tissue that catches the tendon as it glides. The surgeon will then check that the tendon and your finger move smoothly ( you will feel some pushing and pulling but this will not hurt). The wound will then be sutured and then dressings will be applied over the wound.

What are the risks?
Infection: any operation can be followed by infection which can be treated with antibiotics.
Scar: you will have a scar that will be somewhat firm to touch and tender for six to eightweeks.
Stiffness: can occur if the hand is not used and exercised after the operation. This is usually very temporary and can be treated with exercise given by the hand therapist.
Nerve damage: can occur during your surgery which results in either a painful spot in the scar or some loss of feeling in the hand. This complication is very rare but may require a further operation to correct.
Blood vessel injury: damage to the blood vessel can occur during surgery as the blood vessel lies close to the thickened ligament. Damage to the vessel is very rare and can be immediately repaired.
Pain: ongoing discomfort is rare, but possible, following any surgery in the hand.
Loss of function: you will have a temporary loss of function and things will be a little more difficult to do following surgery while the dressings are in place. In rare cases there may be a permanent loss of function.

Are there any alternatives to surgery?

A steroid injection around the tendon where it is catching can reduce swelling on the tendon and allow it to glide freely again. About 50% of people will notice a substantial improvement with one injection but others might need another. About 75% of people get complete relief from their symptoms with this treatment.
The injection takes from a few days to weeks to work. It generally causes no side-effects but occasionally thinning of the skin or loss of skin colouring can occur around the site of the injection.
Even if the steroid injection works the triggering can come back. This is less common with surgery. With both surgery and steroid injections the triggering can happen on another finger.

Will I feel pain?

You will either be given local anaesthesia that will make just one finger or part of your hand numb that will cause you to sleep. The team will provide you with appropriate pain medication to help reduce any pain you might have after your surgery.
It is important that you take your pain relief on a regular basis for the first few days. When taken regularly the medication is kept at a constant level in your body and will control your discomfort more effectively. Any medication given to you will be explained before you leave the hospital.

What should I look out for at home?

Please rest for the remainder of the day and the following day to help you recover from the surgery. Avoid gripping or grabbing objects especially if hot or very cold. The anaesthetic will take up to 4-5 hours to wear off. You do not need to stay in bed. Gently moving around your home will help your blood circulation and help to prevent blood clots. Ensure you move your shoulder and elbow. Take your painkillers before the anaesthetic wears off.

Swelling: you can help to prevent or reduce swelling in your fingers by placing your arm on a couple of pillows when you are sitting or resting. You will also be given a sling. Wear this when you are not seated or resting. Any redness or increasing pain not settling with the painkillers prescribed needs clinical review to rule out any problems.

Dressings: you will have a padded bulky dressing over your wound. It must remain in place for at least 3 days at which point the bulky dressings can be taken down by yourself and the sticky plaster is left intact. Please do not get this wet till the sutures are removed or wound checked at day 12-14 from the surgery . If necessary, cover it with a plastic bag tied at the wrist or a large rubber glove.

Follow up appointments

You will be given a follow-up appointment to have your dressings and stitches removed, which will either be with the dressings nurses. Your surgeon may recommend that you attend hand therapy for a splint or exercises usually after the first 7 days. You will also have a follow-up appointment scheduled with the surgeon usually at 2 weeks for a face to face review.
These appointments will be given to you before you leave the hospital on the day of your surgery.
If we are unable to schedule any of the appointments that day, we will send you details of the appointment by letter.

This is a form of minimally invasive surgery which allows the surgeon to see the inside of the joint and is predominantly diagnostic and helps asses the status of the cartilage, bone and ligaments. With technical advancements, it is now increasingly being used to perform more complex therapeutic interventions.
Find out more: https://www.assh.org/handcare/condition/wrist-surgery-arthroscopy

Local anaesthesia with adrenaline has been shown to be safe and effective form of anaesthesia, which has many advantages for the patient which include less expensive, less time off work ( no need for pre-assessment checks in most cases), less time in hospital, the patient can communicate with the surgeon and be motivated with their rehabilitation specifically with the visual memory, no fasting required.
Find out more: https://www.topdoctors.co.uk/medical-articles/the-walant-technique-advantages-wide-awake-hand-surgery

A ligament is a thick band of tissue that connects two bones. Wrist ligament injuries are commonly missed following falls, sports injuries. Early recognition and guided management can help early return to function.
Find out more: Scapholunate ligament injury | TFCC injury