Month to Month Post Surgical Guidelines

Weeks 0-4: Cast/Dressing on

If extreme hand swelling, hand/finger color change or cast tightness is noted, contact the doctor’s office or emergency room. Mild swelling can be helped by raising the hand above the heart for 3-5 minutes hourly. Try not to sleep with the arm hanging downward. During the day, keep free fingers moving. Keep the cast dry. Most likely, you/your child will not need to see the MD until the 4 week visit when the cast comes off. You may want to begin organizing post-operative therapy now so it will be in place at week 4.

Weeks 4-8: Therapy begins

Splints on at all times (day and night) except during exercise and bathing Exercise 3-5 times daily for 15 minutes Therapy 2-3 times weekly Scar management *Focus on these exercises for training new motor patterns in isolation.

Weeks 8-12: Keep working

Splints usually discontinued (possible pm use) Exercise 3-5 times daily for 15 minutes Therapy 2-3 times weekly Scar management *Focus on motor patterns and begin light functional tasks.

Weeks 12-16: Winding down

Exercise 1x daily for 15 minutes Therapy 1-2 times weekly Scar management if desired/needed *Focus on using new motor patterns in daily life tasks and resume pre-operative therapy plan.

Exercises and photography are property of the Cerebral Palsy and Neurologic Upper Extremity Service at HSS and are not to be distributed without written permission. Not to be followed without a written MD prescription.

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Procedure Specific Post Surgical Guidelines

Four weeks after surgery, the real work begins!  After the doctor’s vistit when the dressing comes off and the splint is fabricated, therapy starts.  Below are some examples of exercises that may be prescribed after surgery.  Not all patients have all procedures and these exercises are meant to be given out by a professional and reviewed for the proper technique.  Exercises are meant to be progressed by a professional following MD orders.  These exercises will give you an idea, however, of the type of exercises that will need to be done.  Most families are comfortable with the home program in 2 to 3 days. 

Exercises and photography are property of the Cerebral Palsy and Neurologic Upper Extremity Service at HSS and are not to be distributed without written permission.  They are not meant to be performed without a written MD prescription.  Even if a patient has had a listed surgery, their individual protocol may vary.  The following guidelines are organized by body part and procedure.

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Home Exercise after Elbow Procedures

Elbow: Bend and straighten 10x 
Hint: Relax shoulder

• Begin lying down then try sitting up.

• If bending is difficult at week 5 gentle leaning on the arm to assist it may begin.

• Massage gently in front of elbow.

• Wear scar management at night.                                                 

Level One: Drop in bending and Push straight.
Level Two: Bending and Push straight.
If you need help: Bending or straightening (push straight both with palm up and down to get a full stretch at different angles)

Home Exercise after Forearm Procedures

Forearm: Palm up and relax 10x 10x
Hint: arm at side

• Gently help into palm up position then see if they can hold the position.

• If they can, have them try the motion themselves.

• This procedure is often more a help to keep the palm from being so down. Full turning up is not possible for everyone.                         

Level One: Use a table and the other hand to stretch into the palm up position and also try to hold the placed palm up position.
Helping	Holding
Level Two: Palm up and down. Watch the body trying to help and correct posture!
Palm up with leaning	Palm up & good posture

Home Exercise after Wrist Procedures

Wrist: Wrist up and back to center 10x 
Hint: keep a gentle fist

• Don’t force wrist down. 

• Don’t let the hand drift to the pinky side.

Level One: Help wrist up and relax down to mid position-don’t force down! To help keep a gentle fist, hold a cylinder.
Level Two: Wrist up and gently down (not more than 75%).

Home Exercise after Thumb Procedures

Thumb: Keep open during other exercises 
Hint: massage web  

• Scar management at night.

• Massage after exercise session 2 minutes.

• Don’t lead with thumb tip, try to make the web big.

• Early on (weeks 4-8), it is not necessary to focus on moving the thumb. Just watch the thumb during the other exercises.

• At weeks 4-8, if the web is progressing slowly, isolate by practicing bringing thumb out.

Leading with tip *not correct	Opening web *correct	Blocking tip

Home Exercise for the Fingers

Fingers: Open and close gently 10x    
Hint: should move easily

• Wear finger splints if you have them!

• Full opening and closing should be present by week 6.

Open fingers	Close fingers

Scar Management after Surgery

• Scar management helps the scar to heal. You should have silicone compression scar management provided by a professional. Wear silicone scar compression at night only. It stays on with a snug stockinette. The most important sites are the elbow and thumb web.

• If a rash develops, stop using the silicone until the rash is gone. Then start using it again every other night.

• Do gentle scar massage with some type of lotion once the wound is healed and all the scab is gone.

• Keep the sun off the scar. A good trick is to carry a 30 sunblock for the lips in your pocket so you can liberally reapply when you are outdoors.

Silicone example

ADLs after Surgery

When the cast comes off at 4 weeks, gentle using the hand in daily tasks can begin with the splint on. Bathing with the splint off can also begin. Gym and contact sports are still on hold for now. 2 weeks after the removable splint has been on, therapy at home can include 5-10 minutes of light table top activity during each exercise session. When the removable splint is discontinued at 8 weeks post-operatively, all activities can begin with the exception of heavy lifting and contact sports, those wait until cleared by the operating surgeon.

Remember these are all guidelines and regular therapy and MD visits are imperative!

Exercises and photography are property of the Cerebral Palsy and Neurologic Upper Extremity Service at HSS and are not to be distributed without written permission. Not to be followed without a written MD prescription.

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