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Some surgeons, especially hand surgeons, may discuss a “step-wise” approach to pain control, beginning with gentle anti-inflammatories and painkillers such as ibuprofen(Advil) and acetaminophen (Tylenol) that have been proven very effective and with minimal side-effects. If after these you are still experiencing too much discomfort, you may consider taking pain medication as prescribed. The simplest way to approach pain control is to first make sure you are doing all three steps listed above:
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Controlling Postoperative Pain After Hand Surgeryįinally, your surgeon will discuss postoperative pain control with you. You should never perform active gripping or lifting with the involved hand after surgery unless your surgeon tells you it is permitted. This motion will help to “pump” extra fluid and blood away from the operative site and back towards your heart, thereby helping to minimize swelling. Gentle motion involves straightening your fingers and slowly bending them down towards your palm. If movement is permitted by your surgeon, he or she will likely leave them free, outside your surgical splint or dressing. It is very important to clarify with your surgeon if this is permitted because moving the fingers after certain procedures can cause damage or increase the risk of complications. The third intervention is gentle movement of the fingers. If you have a splint or bulky dressing on, it is still recommended that you use ice as long as you keep your splint or dressing completely dry.
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It is important not to place the ice directly on the skin, as prolonged exposure may cause frostbite, so consider wrapping a bag of ice in a thin towel. Keeping the operation site cool with a bag of ice will help to calm the inflammatory response somewhat and lower pain levels by dulling the pain signals sent to your brain. Activities during the day that require a lot of standing and holding the hand and wrist where it would normally be (below the level of the heart) will probably contribute to more swelling and increased pain levels. When sleeping, it may help to use a large mound of pillows, either beside you or on your chest, to keep your hand and wrist in this elevated position. Your surgeon might teach you the “hand above elbow, elbow above heart” rule. A simple way to think about this is to create a “downhill path” for blood and fluid to move from your fingertips to your heart using only gravity. The first simple thing to do in the inflammatory phase after surgery includes elevating the operated hand/wrist above the level of your heart. Having correct expectations before the surgery about pain and swelling will help the healing process proceed more comfortably. If you have friends or acquaintances who have had the same surgery but seem to feel more or less pain, this is nothing to worry about. Keep in mind that this response is different in different patients. Therefore in the first nights and days after your surgery, you can and should expect some amount of swelling, redness, and discomfort. This phase is important, not only to provide continued protection against infection but also to ensure that all the right cells are called to the site of the surgery to rebuild tissues to complete the healing process. In fact, the first phase of wound healing that every surgeon learns about in medical school is called the “inflammatory” phase. This always triggers a mild inflammatory response consisting of some degree of swelling, redness, and discomfort.
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So although your orthopedic hand surgeon is highly trained and experienced in fixing whatever problem you have (for example, a compressed nerve, arthritis, tendonitis, or broken bone) while exposing you to the least risk possible, the surgery itself involves making an incision, moving and retracting tissues and usually removing or cutting bone or tissue.Įven though it is performed in a sterile environment by a highly trained individual, the human body’s natural defense mechanisms and immune cells still see the procedure as something “abnormal.” They see that the skin has been cut and previously undisturbed structures have been moved and manipulated. Our cells, nerves, tendons, and muscles see and respond to surgical procedures in the same way they respond to an accident or injury. The first and best way to stay comfortable after hand and wrist surgery is to fully understand the human body’s response to the surgery itself.