Dr. Ekkehard Bonatz answers your questions about what to expect after you’ve had hand surgery.
Q: I’ve been told I will have a cast, splint, or brace. What does that mean?
A: Many surgeries require a short time of protection to allow your body to start its recovery from your procedure. Leaving surgery, your hand, wrist, or forearm may be wrapped with a bulky dressing. Surgeons will frequently include a splint as a part of the dressing. It is a rigid part of the dressing that is intended to protect the surgical repair and add to comfort. A splint typically covers only part of the surgical area, leaving some room for swelling. Depending on what is needed for your particular surgery, your surgeon may recommend that you return to the office after a few days for a dressing change or a change to a full cast.
A cast is applied by wrapping fiberglass tape or plaster around your hand, wrist, or arm. The cast hardens and forms a rigid hollow tube around your extremity. It holds the surgical area still during the healing process. It may need to be changed over time to account for swelling, wound care, suture removal, or to take x-rays. Some surgeries require a brace during the healing process.
Braces (also sometimes referred to as splints) can come in multiple forms. A brace may be fabricated to your extremity or may come pre-fabricated. Braces are removable and allow you to take a shower, let your wound air out, and move the operated area around depending on your post surgery plan. If you feel your dressing, cast, splint or brace is causing excessive pressure, you should contact your surgical team immediately.
Q: How much pain will I have after surgery?
A: Surgery means that, in order to resolve an injury or problem, you have had some sort of intentional disruption of or injury to your body tissue. So, naturally there will be some discomfort. This is normal! Everybody’s pain experience is different and can change over time or with different types of procedures. Please tell your surgeon about any past surgeries and your pain experience during recovery. Your surgeon will take steps to keep you as comfortable as possible.
The discomfort will usually decrease within a few days of your surgery, maybe sooner. Frequently, your surgical team injects local numbing medicine to improve your immediate post-surgical pain. The numbing medicine typically lasts for several hours after your surgery. You should start taking pain medicines as directed by your surgical team, and most people try to be proactive about pain control early after surgery until you have a good handle on your pain levels. A combination of acetaminophen (Tylenol or Tylenol Arthritis®) and a non-steroidal anti-inflammatory medication (ibuprofen, Advil®, Aleve® or similar) often works well. Take these as directed by your surgical team and be clear with your team about if and when you are allowed to take these medications after surgery and if there are medications that you should avoid due to interaction with other medicine, medical conditions, increased risk of bleeding etc.
Swelling pain is difficult to manage, and pain medications do not address swelling pain very well. To avoid excessive swelling, begin elevating your extremity as much a possible as soon as you can comfortably do so after surgery. Some people also find ice can be helpful after surgery, either placed on the arm or in the armpit. Please confirm with your surgical team if ice is safe for you to use after surgery.
Q: How about opioids/narcotics?
A: You may be given a prescription for a narcotic to use after your procedure. Narcotics help to control pain in a different way than acetaminophen, non-steroidal anti-inflammatory medications (NSAIDs), ice and elevation. Narcotics can cause drowsiness. You may take these pills in addition to your over-the-counter pain pills as prescribed. Please be aware that many opioid pills contain acetaminophen or an NSAIDs as a part of the pill, so you must take care to avoid excessive doses of any of these ingredients, which can also be found in many over-the-counter pain medications. The opioids work best just for a few days and can quickly lose their effectiveness. You may not drive a motor vehicle and should not make other important decisions while under the influence of a narcotic. If your surgeon prescribes narcotoics, the prescription will likely be for a small number of pills due to the both the short-term effectiveness of the medication and the fact that opiod medications can be highly addictive. If you have had problems with narcotics in the past, it is important to discuss this with your surgical team so you can make a safe and effective pain management plan for your recovery.
Q: What if I can’t sleep after surgery?
A: After surgery you may find yourself too uncomfortable to go to sleep. This is not unusual and should get better within days of surgery. Once your swelling decreases and you become more used to your post-operative dressing, splint or cast, sleep will become easier. You can talk with your surgical team about whether elevation, sleeping in a recliner, or other modified positioning might help with post-surgical sleep.
Ekkehard Bonatz, M.D., Ph.D., is a partner at Southlake Orthopaedics in Birmingham and Hoover, AL. He specializes in hand and upper extremity surgery. He is also a faculty member of the hand and upper extremity fellowship program at the University of Alabama at Birmingham. His surgical training was at the Baptist Medical Centers in Birmingham and at UAB, where he completed his orthopaedic surgery training. He subsequently trained in hand and upper extremity, microsurgery, and reconstructive surgery at UAB.