Surgical Rehabilitation of the Hand

Careful coordination of surgery with pre- and post-operative therapy maximizes surgical results and often is the difference between a successful and an unsuccessful surgical result. The therapist has the best advantage in making a difference to the results of surgery if the patient can been seen ahead of time for pre-operative evaluation that can be compared to post-operative measurements.

Following surgery and a period of immobilization, there is a "golden" period of approximately three weeks when therapy can enhance or insure reconstructive procedures.  Because there are many small bones and joints in the hand with tendons which have to glide in order to produce movement, the period a hand must be immobilized for healing can be detrimental.  Tissues glue together in one wound when healing, and scar begins to form.  It is important that gliding surfaces be moved and that movement be made to the full extent of allowable limits as soon as possible.  There is always scar that forms on healing, but careful and specific movement allows scar to form and support where desired, but not to inhibit function where not desired.

Generally, best results are achieved when a patient can be weaned away from an immobilizing bandage or cast - not just released and allowed to use the hand.  They must learn and accept new ways of using the hand to maximize the results of surgery, and avoid old habit patterns they developed in order to use the hand when it was impaired.  A return to old patterns of hand use can in some cases undo the surgery, or recreate the same contractures of imbalance of the fingers.  Often additional splinting is needed to optimize positioning or support new tendon transfers until they become strong enough to perform intended functions.

Date Last Reviewed:  April 2017