What is the appropriate post-operative rehabilitation plan for a 45-year-old patient following hand or wrist surgery to prevent stiffness and ensure proper healing?

Post-Operative Hand/Wrist Surgery Rehabilitation Plan

Immediate Post-Operative Management

For this 45-year-old patient following hand/wrist surgery, immediate active finger motion exercises should begin now, even while immobilized in the splint, to prevent the most functionally disabling complication of finger stiffness. 1

• Active finger range of motion exercises must be initiated immediately at the first encounter following surgery, as finger stiffness is extremely difficult to treat after fracture healing and may require multiple therapy visits or additional surgical intervention 1
• Finger motion exercises do not adversely affect adequately stabilized fractures and represent an extremely cost-effective intervention with significant impact on patient outcomes 1
• The splint should be used for comfort only, not as a barrier to finger movement 2

Early Mobilization Protocol (First 1-3 Weeks)

Wrist motion exercises should NOT be started routinely in the early post-operative period following stable surgical fixation. 1

• Early wrist mobilization (starting at 1 week) shows no significant difference in pain, function (DASH scores), or complications compared to delayed mobilization 1
• Range-of-motion exercises for the wrist should begin within the first postoperative days only after confirming adequate fracture stability 2, 3
• Above-chest level activities should be restricted until fracture healing is evident 2

Home Exercise Program Structure

A supervised home exercise program is an appropriate and effective option for this patient's rehabilitation. 1

• Home exercise programs show equivalent outcomes to supervised therapy in patients healing without complications (no finger stiffness, no complex regional pain syndrome) 1
• The program should include:
  • Active finger motion through complete range of motion multiple times daily 1
  • Wrist range of motion exercises once cleared (typically after initial healing) 1
  • Progressive grip strengthening exercises as tolerated 4
  • Wrist stability training combined with grip exercises to improve pain, function, and muscle strength 4

Exercise Prescription Details

Specific exercise parameters should follow this structure:

• Frequency: Range of motion exercises should be performed multiple times daily (5-7 days per week) 1
• Duration: Initial sessions of 10 minutes, progressively increasing by 5 minutes per session until 30 minutes is reached 1
• Intensity: Exercises should be performed within pain-free range initially, using pain threshold as a guide 1
• Progression: Start with 2-3 repetitions and work up to 10-12 repetitions as tolerated 1

Critical Monitoring Points

The patient must be re-evaluated immediately if any of the following occur:

• Unremitting pain during follow-up 1
• Unusual or persistent fatigue 1
• Increased weakness or decreased range of motion 1
• Joint swelling or pain lasting more than one hour after exercise 1
• Development of finger stiffness despite exercises 1

Common Pitfalls to Avoid

Several factors can contribute to finger stiffness and must be actively prevented:

• Pain, swelling, and patient apprehension or lack of understanding are the primary contributors to finger stiffness 1
• The splint should not obstruct finger motion - ensure the patient understands they can and should move their fingers while wearing it 1
• Do not wait for "healing" before starting finger exercises - this is the most critical error leading to permanent stiffness 1
• Avoid morning exercises if significant stiffness is present upon waking 1

Adjunctive Treatments

Additional modalities may provide symptomatic benefit:

• Local heat application (paraffin wax, hot packs) before exercise sessions may be beneficial 1
• Cryotherapy may be used in the first postoperative weeks for pain and swelling control 1
• Topical NSAIDs are preferred over systemic treatments for pain management due to safety profile 1
• Oral analgesics (paracetamol up to 4g/day) should be first-line for pain control if topical treatments are insufficient 1

Long-Term Management

Rehabilitation should be goal-based rather than strictly time-based:

• Continue progressive strengthening exercises emphasizing grip strength and wrist stability 4
• Functional exercises should be incorporated, including activities that simulate daily tasks 1
• Long-term follow-up should be adapted to individual patient needs and response to treatment 1
• Patient education about joint protection principles and pacing of activities is essential 1