What is the recommended duration of rest before returning to normal activities with an overuse injury of the hand?

Management of Hand Overuse Injuries: Rest Period and Return to Activity

For hand overuse injuries, a rest period of 6 weeks is recommended before returning to normal activities, with a phased approach to rehabilitation during this time.

Initial Management Phase (0-4 weeks)

• Immediate interventions:

  • RICE protocol (Rest, Ice, Compression, Elevation) to manage pain and inflammation 1
  • NSAIDs are strongly recommended as first-line treatment for pain management 1
    • Ibuprofen at 1.2g daily (can be increased to 2.4g daily if needed)
    • Can be combined with acetaminophen (up to 4g daily) for inadequate relief

• Immobilization:

  • Splinting in functional position during rest periods 2
  • Avoid complete immobilization as immediate functional treatment is preferred over strict immobilization 1

• Activity modification:

  • Complete rest from aggravating activities
  • Pain-free walking and general conditioning as tolerated
  • Pool-based exercises may be initiated if available 1

Intermediate Phase (4-8 weeks)

• Progressive rehabilitation:

  • Begin low-load strengthening exercises 1
  • Manual therapy of the affected area 1
  • Gradual increase in activity level while monitoring symptoms

• Therapeutic exercises:

  • Targeted hand and wrist exercises
  • Incorporate exercises for proximal muscle groups (forearm, elbow, shoulder)
  • Focus on restoring normal movement patterns

Advanced Phase (8+ weeks)

• Return to activity criteria:

  • Complete resolution of pain during and after activity
  • Full range of motion compared to uninjured side
  • Strength symmetry >90% compared to uninjured side
  • Successful completion of activity-specific functional tests 1

• Gradual activity resumption:

  • Begin with modified versions of normal activities
  • Progressively increase duration and intensity
  • Monitor for symptom recurrence

Important Considerations

• Return to full activity should only occur after microscopic signs of injury have resolved 3
• Longer rest periods may be required for more severe overuse injuries
• The 6-week timeframe aligns with guidelines for moderate injuries, with severe injuries potentially requiring 8-12 weeks 1

Common Pitfalls to Avoid

1. Returning too soon: This is the most common cause of symptom recurrence and chronic injury
2. Inadequate rehabilitation: Simply resting without addressing underlying biomechanical issues often leads to reinjury
3. Ignoring pain: Pain during rehabilitation indicates potential ongoing tissue damage and should prompt activity modification
4. Neglecting ergonomic factors: Failure to address the causative factors of the overuse injury will lead to recurrence

When to Consider Further Evaluation

Surgical consultation should be considered if pain persists despite 3-6 months of well-managed conservative treatment, or if functional limitations significantly impact quality of life 1.