Frequently Asked Questions: Patient Instructions for Hand & Upper Extremity Procedures

Patient Instructions for Surgery

NOTE: Dr. Hanlon's Surgery Scheduler Will Call You with the Date and Time of Your Surgical Procedure.

Surgical Times are ESTIMATED TIMES ONLY. Plan for delays at the hospital by bringing a book, music, etc.

1. Medical/Cardiac Clearance:
• If instructed, a Medical or Cardiac Clearance must be completed before surgery.
2. Lab Work:
• You will arrive at the hospital 2 to 3 hours before your surgery. Pre-Surgical Lab work will be completed at that time.
3. Decrease Post-Op Swelling To Increase Healing:
• Do NOT use Anti-Inflammatory medications, at least 1 week before surgery (unless instructed otherwise by Dr. Hanlon).
• Anti-inflammatory medications include: Aspirin, Motrin, Ibuprofen, Advil, Aleve, and Naprosyn.
• Anti-inflammatory supplements include: Vitamin E, Ginko, Feverfew, Ginseng and Garlic.
• If you have any questions about the medications that you are currently taking, please ask Dr. Hanlon's RN, Sonja.
• It is OK to take Tylenol before your surgery.
4. Infection Prevention:
• Wash with BETIDINE SCRUB (This can be purchased over the counter at most drug stores or at Horse Feed Stores)
• Start Washing 2 Days BEFORE Surgery

Washing Instructions
• Wash 2 times a day for 2 minutes each time.
• Concentrate on the area that will be operated on.
• Clean under your fingernails.
• Each time that you wash you should work up lather.
• Finally, rinse off all of the Betadine.
• NO Manicures for 1 week before surgery.

1. DO NOT EAT or DRINK ANYTHING (Including Water) 8 Hours BEFORE Surgery:
• This is a Life Saving Instruction.
• You may take your regular medications the morning of surgery with a SIP of water (unless instructed otherwise by Dr. Hanlon or his RN First Assistant).
2. Transportation:
• You need to arrange for transportation from the hospital after your surgery (by a friend or family member).
• This is required by law and is strictly enforced by the Surgical Facilities.
3. Clothing:
• Wear comfortable clothes that you can easily pull over a bulky bandage.

IF POSSIBLE, You should arrange to have someone stay with you for the first night after surgery.

1. Numbness:
• It is normal for the surgical area to be numb after surgery.
• This numbness will wear off and you will experience discomfort 12 to 24 hours after your surgery.
• Please take your medicine as instructed to keep your pain at a tolerable level.
2. Ice:
• If You Have Had Surgery On Your Fingers, DO NOT USE ICE directly on your fingers.
• You may use Ice after all other Surgical Procedures.
• Ice packs may be used to control pain and to decrease swelling for the first 48 hours.
• Fill a Gallon Size "zip-lock" bag full of ice.
• Place bag of ice over your bandage, where the surgery was done.
• Protect your skin from the ice by placing a cloth between your skin and the bag of ice.
3. Showering:
• You may begin showering 2 days after your surgery.
• However, you may NOT get your bandage wet.
• Place a heavy-duty plastic bag over your bandage and secure it above your bandage with a rubber band.
• If your bandage gets wet, please call the office as it will need to be changed in order to prevent an infection.
4. Medication:
• You may begin All of your Regular Medications after your surgery (unless instructed otherwise by Dr Hanlon or his RN First Assistant).
• Take all of your Post-op Medications as prescribed by Dr. Hanlon.
• If you suspect any side effects from the medicine, please contact the office and / or discontinue the medication.
• PLEASE NOTE: Medication Refills are NOT given after office hours or on the weekend. Please plan ahead and call during regular office hours.
5. Return Appointment:
• Unless instructed otherwise, you will need to schedule an appointment for approximately 1 week after surgery.
6. Sun:
• Avoid direct sun exposure to the incision until the scar is no longer red.
7. Problems / Concerns:
• If you have any questions or concerns, please call the office @ (602) 553-3113.
• Messages are checked throughout the day and will be returned as soon as possible.
• Dr. Hanlon is On-Call everyday for all of his post-operative patients.
• You may have Dr. Hanlon paged by calling: (602) 553-3113 and following the prompts.

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Patient Instructions: AFTER Trapezial-Metacarpal Joint Arthroplasty

1. Maintain full finger motion of all joints.
2. Report any discomfort or pain at the pin site or loosening of the cast.

1. Follow the "Patient Instructions for Warm Water Soaks" instruction sheet.
2. Complete motion exercises in order to get your hand flat on a table surface.
3. Complete motion exercises in order to touch your thumb to the base of your little finger.

1. Begin Pinch and Grip Strengthening exercises.

1. NO Forceful grip for 3 months after surgery.
2. Do NOT do any Strengthen Exercise until 13 weeks AFTER Surgery.

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Limitations After Carpal Tunnel Release Surgery

1. Do NOT bend your wrist against any resistance for 10 weeks after Carpal Tunnel Release Surgery.
2. Do NOT lift weight greater than 10 pounds for 10 weeks post-op Carpal Tunnel Release.
3. All other wrist motions can be completed as tolerated.

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Patient Instructions for Joint Jack Use

Goal: To increase finger straightening
Frequency: Apply Joint Jack 3 times a day (for a total of 30 minutes each time) and in the evening before going to bed.

• Whenever possible, the Joint Jack applications should be done immediately after soaking your hand in warm water.

1. Apply the Joint Jack over the palm side of the finger with the "thumb screw" backed out as much as possible.
2. Wrap the Velcro strap around the finger, centered over the middle joint, and apply moderate tension to the strap so that you feel some tension.
3. Then tighten the thumb screw until you feel moderate discomfort (but NOT pain).
4. After 10 minutes, you will note that the Velcro strap has loosened. Retighten the thumb screw until you feel the initial amount of discomfort.
5. Leave the Joint Jack on your finger for 10 more minutes, then repeat the tightening process for 10 additional minutes.

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Patient Instructions for Using COBAN Wrap

Goal: Decrease swelling
Frequency: Complete "Wrap" 4 times a day

1. Wrap COBAN from the tip of your finger towards the base of your finger.
2. Leave COBAN on for 45 minutes to 1 hour at a time.

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Patient Instructions for Massage

Goal: Decrease scar tissue formation and desensitize skin
Frequency: Complete massage as often as possible through out the day.

• Whenever possible, massage should be done immediately after soaking your hand in warm water.

1. Lubricate your finger(s), hand, wrist, etc. with a good lotion (examples: Curel, Aveeno, Lubriderm, etc).


2. Apply gentle, deep pressure to the injured area with the finger tips and /or thumb of your uninjured hand.


3. Gradually increase the pressure as your discomfort allows.


4. Pressure should be applied in 2 ways:


1. First by pressing in one spot and "rolling" your thumb in a small circular motion moving a little each time to place your thumb over another sore spot
2. Pressing firmly, slide the pressure along the extremity in a finger to elbow direction

• Tissue massage is NOT simply "sliding" your fingers lightly over the skin.
• You MUST apply deep pressure while massaging.

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Patient Instructions for Cast Care

Goal: To increase comfort, and to provide information for the care of your cast

• Do not get your cast wet.
• Do not put anything down your cast.
• If your cast gets wet, or if something is in your cast, call the office your cast will need to be changed.

• Keep your hand above the level of your heart.
• Move your fingers and thumb (that are not casted).

• Minimize sweating:
• Stay cool.
• Decrease activities that result in sweating. For example, vigorous exercise.
• Use warm air
• Point a hair dryer at the area where you are itching (outside of your cast).
• Turn the hair dryer on to warm.
• This warm sensation can replace the sensation of itching.

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Scotchcast Waterproof Cast Material (Ref #A4590)

The Institute for Bone & Joint Disorders would like to offer you a casting product that is more convenient. We realize that having a fracture and needing a cast can alter your life style. This product is waterproof.

If you are interested in having this waterproof cast material, our charge is an additional $20.00, which is NOT covered by your insurance. This fee must be authorized by you and collected from you at the time of your cast application.

We must also have your written authorization.

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Patient Instructions for Water-Proof Cast Care

Goal: To increase comfort and to provide information for the proper care of your waterproof cast

• Do not go into the Ocean or Lakes with your waterproof cast.
• Oceans and Lakes contain sand and dirt which will get inside your cast and cause skin irritation and infection.

• Do not put anything down or in your cast.

• Keep your hand above the level of your heart (the middle of your chest).
• Move your non-casted fingers and thumb.

• Decrease sweating:
• Stay cool.
• Decrease activities that result in sweating. For example, vigorous exercise.
• Use warm air
• Point a hair dryer at the area where you are itching (outside of your cast).
• Turn the hair dryer on to WARM (not hot).
• The warm air can decrease the itching feeling.

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Patient Instructions for Warm Water Soaks

Goal: To increase motion
Frequency: Complete Warm Soaks 3 to 4 times a day for 15 minutes a time.

• 1 container or a deep sink (large and deep enough to immerse your hand and wrist into)
• 1 small soft sponge
• Warm water (the temperature of a warm bath/shower or Jacuzzi)

1. Immerse your hand into the warm water.
2. Continually squeeze and relax your grip on the sponge.
3. When your hand is completely warmed (about 2 minutes of soaking), complete the following exercises:
• Slowly and firmly push your fingers towards your palm (as in making a fist). You may use your uninjured hand to help your injured hand make a fist.
• Move your wrist in a "side to side" motion (toward your thumb, and than toward you little finger).
• Rotate your hand so that your palm is up (toward your face), then rotate your hand so that you palm is down (toward the floor).
• Place your injured hand, palm down, on the bottom of the sink. Press on the top of the injured hand (with your uninjured hand) in order to stretch you fingers and wrist out.

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Patient Instructions for Clorox Soaks

Goal: Decrease incidence of infection and aid in healing of open wounds
Frequency: Complete Warm Soaks 3 to 4 times a day for 15 minutes a time

• Household Clorox (laundry bleach)
• 1 container or a deep sink (large and deep enough to immerse your hand and wrist into)
• 1 small soft sponge
• Warm water (the temperature of a warm bath/shower or Jacuzzi)

1. Mix 2 teaspoons of household Clorox (laundry bleach) into1 gallon warm water in a bucket or deep sink.
2. Immerse your hand into the warm water.
3. Soak hand until water is cool.
4. Complete range of motion exercises (IF instructed) while soaking.
5. After soaking, rinse with plain tap water.

• Slowly and firmly push your fingers towards your palm (as in making a fist). You may use your uninjured hand to help your injured hand make a fist.
• Move your wrist in a "side to side" motion (toward your thumb, and than toward you little finger).
• Rotate your hand so that your palm is up (toward your face), then rotate your hand so that you palm is down (toward the floor).
• Place your injured hand, palm down, on the bottom of the sink. Press on the top of the injured hand (with your uninjured hand) in order to stretch you fingers and wrist out.

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Patient Instructions for Contrast Baths

Goal: Decrease swelling, increase circulation
Frequency: Complete 2 times a day for 15 minutes a time
Supplies Needed: 2 containers, each large enough to immerse your arm and hand to 6 inches or more above the swollen area

Instructions:

1. Fill 1 container with cold tap water with a few ice cubes to cool the water to about 60 degrees Fahrenheit. Fill the 2nd container with warm water (about the same temperature as a warm shower or bath).


2. If you have an open unhealed wound, add 1 teaspoon of plain Clorox (laundry bleach) to each container. When finished with the contrast bath session, rinse the Clorox water off of your hand with plain tap water.


1. Begin by placing your extremity in the warm water for 2 minutes
2. Then immerse your extremity in the cold water for 30 seconds
3. Then soak your extremity in the warm water for 1 minute
3. Continue to switch between the warm and cold water with 1 minute in the warm and 30 seconds in the cold for a total of 15 minutes.


4. Continually open and close your hand (try to make a tight fist each time you close your hand) and move your wrist up and down during the soaks.


5. Always finish in the warm water.


6. You may have to add more ice cubes to the cold water in order to keep the temperature at a constant level.


7. You may have to add more warm water to the warm water container in order to keep the temperature at a constant level.

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