This page has been designed to give you and your family some basic information about hand surgery, and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions, which the doctors, nurses, physiotherapists and occupational therapists will only be too happy to answer.

Why is the operation necessary?

Most hand operations are designed to relieve pain and stiffness or correct deformity. Hand surgery can be quite complicated and your surgeon and hand therapist will explain this to you fully before your operation.

You will usually be admitted to the ward the day before surgery. This type of surgery may also be required in some cases following an injury or accident in which case you will be admitted to the ward from the Accident and Emergency Department.

The nursing staff will meet you and show you around the ward. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor will have seen you in the pre-assessment clinic and arranged for your pre-operation tests. These are usually an examination, an x-ray and blood tests.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent. The anaesthetist will discuss the type of anaesthetic best suited to you. The procedure may be performed under general anaesthetic; a local anaesthetic block is sometimes used. This means you are numbed from the shoulder down for the duration of the procedure, a sedative is usually also given. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

Your hand therapist will also come and see you before the operation to teach you the exercises you need to do after the operation, to help you to recover.

The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision, remember that the staff are here to help you and answer any questions you may have.

You will not be able to eat or drink for a period of time before your operation, the nursing staff will advise you on admission. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once you are in the anaesthetic room you will be given an injection in your hand to put you to sleep if you are having a general anaesthetic. If you are having a local anaesthetic block the anaesthetist will explain this to you fully. The local anaesthetic block provides a good form of pain relief after surgery, but you will experience some numbness from your shoulder downwards. This will wear off as the effect of the local anaesthetic diminishes.

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward. When you come back from the operation your arm will be elevated in a blue foam sling (Bradford sling). It is extremely important that your hand is kept elevated at all times, to prevent swelling that could hinder your recovery.

You may have a ‘drip’ in your arm that ensures that you get plenty of fluids, as you are unable to take anything by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

Depending on your surgery you may start physiotherapy the next day; your hand therapist will explain this to you if required.

You may also have one drainage tube in your wound. This will drain into a small bottle and prevent any blood collecting around your wound, which could cause painful swelling. These are normally removed about 2 days after the operation.

You will also have stitches in the wound and these are usually removed 10 – 14 days after the operation.

Many patients worry about how painful hand surgery will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

In some instances it is possible for you to be given a type of pain relief that enables you to control the amount of painkiller you receive yourself (Patient Controlled Analgesia). Further information about this is available on the ward, and will be explained to you if you are to be given this. You will be monitored closely by the nursing staff after your operation and they will keep you comfortable.

Getting up and about

You will be able to get up the day after surgery and you may require an x-ray. Your surgeon and hand therapist will decide exactly which exercises are required. They will devise an individual programme for you, which may include the use of splints. Your hand therapist will explain in detail how to use any splints you are given.

What problems can occur?

No operation is without the risk of complication. Your surgeon and therapist will explain any particular risks/complications of your operation before surgery.

Swelling is common after surgery and might be treated.

Is the operation always successful?

The surgeon’s expectation of your operation will be discussed before surgery (usually when initially seen in Outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your discharge from hospital

Your length of stay in hospital will usually vary depending on your progress. Once you are moving your hand well, you will be discharged home as soon as suitable arrangements can be made.

Usually you will be required to attend for outpatient hand therapy to continue with treatment. Your hand therapist will arrange this with you prior to discharge.
Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

If your named nurse feels you and your carer will require extra support, she will discuss this with you and with your permission arrange for you to discuss your needs with the hospital social worker and occupational therapist.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of your discharge

On the day of your discharge your named nurse will give you some things to take home with you, these will include:

• A letter for your GP (in some instances this will be posted). This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
• Medication Any medication you have bought into hospital will be returned to you. You will also be given a 7-day supply of any new medications. The nurse will advise you on how and when to take these.
• Dressings All hand dressings should be left undisturbed until the Consultant sees you in clinic. If you have any concerns you should ring the ward or your hand therapist.
• Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic. If transport is required this can be arranged by contacting your GP providing a weeks notice where possible. If for any reason you are unable to attend your appointment please contact the Outpatient Department to rearrange the appointment.
• Care Plan If you have a care package arranged you would receive a copy of the care plan from the Social Worker before your discharge home. This is for your own information.
• Discharge Record This provides details about your stay and is for your own information.
• Patient information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
• Valuables Please ensure you have all your valuables with you.

General advice after discharge

Your hand should remain elevated for at least 2 weeks following surgery, unless you are advised otherwise. Any problems please contact the ward or your hand therapist.

• Exercises Keep doing the exercises you have been told to. If you require any extra assistance, to do your exercises, ask to see the hand therapist when you attend the Outpatient’s Clinic, after you are discharged from hospital. Keep your hand elevated.
• Cars and Driving It is inadvisable to drive while wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm.
• Work How soon you are able to return to work will depend on the type of job you do. You should discuss this with your surgeon when you see him in the Outpatients Department.
• Wound Care Keep your wound dry until your stitches have been removed. Your stitches will be removed when you attend the outpatient’s clinic. Once these have been removed, you can bath or shower, as you feel able.
• Pain Take your painkillers as prescribed. Do not take more than the stated dose. Ring the ward or your hand therapist for advice, if you notice any swelling, increased pain, or if your wound starts to ooze. Contact your doctor if you have any pain or swelling in your calf or if you have any chest pain.
• Follow up You will be followed up as an outpatient at regular intervals after your discharge from hospital. Please use this opportunity to ask questions and discuss any concerns you may have. You are also welcome to call the ward for advice, following your discharge from hospital.