Most people expect to undergo a course of physical therapy after their hand surgery to help the area recover and to restore normal function, but fewer people are familiar with how they can benefit from working with a physical therapist in anticipation of undergoing the surgery. Many times after we’ve sustained an injury or if we’ve been dealing with symptoms for a long time, we naturally decrease our level of movement and exercise to avoid provoking uncomfortable or painful symptoms. You may have even undergone a period of immobilization in a splint or cast to allow an acute injury to heal. While this choice will most likely accomplish the goal of reducing your symptoms, it doesn’t necessarily put you in the best position for an easy recovery from surgery if pain, stiffness and weakness in the area are still present.

If the surgery isn’t an emergency, there are many ways that a physical therapist can help prepare you and your body for the upcoming procedure. The better condition the hand and, let’s face it, your entire arm is in, prior to surgery, the easier it is to recover to your normal activity level.

COMMON HAND SURGERIES

People undergo hand surgeries for many different reasons. Sometimes, in the case of acute injuries like a tendon laceration or fracture, surgery is an emergency, and in those cases the focus of physical therapy will be on recovery after the fact. Many other surgeries, however, happen after a period of conservative care and chronic symptoms. These types of surgeries provide an opportunity for patients to choose a course of prehabilitation prior to the procedure. While there are several types of surgeries for the hand, here is a list of common surgeries that may benefit from a course of prehabilitation:

Carpal tunnel release: creates more space for the median nerve and tendons of the wrist and hand

Dupuytren's contracture fasciectomy: removal of the fascia that tightens and causes the Dupuytren’s contracture

Trigger finger release: release of the A1 pulley system that can restrict tendon movement causing the trigger finger mechanism

Tendon repair: repair of an injured tendon

Ganglion cyst removal: excision of a symptomatic ganglion cyst

Knuckle (MCP joint) replacement: replacement of the knuckle joint to treat severe osteo- or rheumatoid arthritis

Trapeziectomy: Removal of a small bone at the base of the thumb to treat thumb arthritis pain

Fracture repair

If you decide to work with a physical therapist to help with pre-hab hand surgery related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

Looking for the cause of an injury

While full recovery and return to play is the ultimate goal when it comes to injury rehabilitation, a physical therapist has much more to offer. We are interested in identifying the factors that may have predisposed you to the injury in the first place so that we can make a plan to address them. This helps decrease your risk for future injury. Here are some factors that we look for when assessing a player:

• Muscle strength, power and endurance
• Flexibility and mobility in muscles and joints
• Sleep, nutrition and recovery time
• Training schedule
• History of prior injury
• The physical demands of a player’s position on the team

While some injuries are unavoidable, there may be times when internal and external factors play a role. Identifying these factors allows us to address them with a good physical therapy program or give advice on beneficial modifications to your training.

Movement and Performance Analyses