After your surgery · Nicholas Genovese, M.D.
Carpal and cubital tunnel release together
Releasing the median nerve at the wrist and the ulnar nerve at the elbow in one surgery
About your surgery
- Both nerves were released in the same surgery: the median nerve at the wrist (carpal tunnel) and the ulnar nerve at the elbow (cubital tunnel). You have two incisions, one in the palm and one on the inside of the elbow. Recovery follows both the carpal tunnel and cubital tunnel guides.
Day of surgery
The first three days
Keep your hand higher than your heart as much as you can. Rest it on pillows when you sit or sleep. This is the most important thing you can do for swelling and pain.
Put ice over the dressing or splint for 15–20 minutes at a time, several times a day. Never put ice directly on the skin, and do not let the dressing get wet.
Move the parts that are not in the dressing or splint: open and close your fingers, and gently move your elbow and shoulder every hour while awake.
Some swelling, bruising and soreness are normal. Bruising can travel down into the fingers.
Use the hand for light tasks only. Do not lift anything heavier than a coffee cup with the operated hand until your surgeon tells you that you can.
Dressing and bathing
You may remove the outer elastic (ACE) wrap from the elbow 24 hours after surgery, or loosen it sooner if it feels too tight.
The elbow dressing underneath is waterproof. Leave it in place until your first visit.
The hand dressing is not waterproof. Keep it dry for 3 days by covering it with a waterproof bag when you shower. After 3 days you may remove it, let water run over the palm incision, pat it dry and cover it with a clean bandage.
If you went home with a wrist splint, keep it on, clean and dry until your first visit and cover it for showers.
Do not soak either incision until the stitches are out and the incisions are fully closed.
Splint or sling
- Avoid keeping the elbow bent past 90 degrees for long periods, including at night.
If you had a nerve block
A nerve block keeps the arm numb for about 8–24 hours. Protect the arm while it is numb: keep it in the sling or on pillows, and keep it away from heat, cold and sharp edges.
Start your pain medicine before the block wears off, usually the evening of surgery or before bed, so the pain does not catch up with you.
Pain control
Follow the plan your surgeon gave you and the directions on your prescription labels. Unless you were told otherwise, the plan below works well for most patients.
Acetaminophen (Tylenol 8 HR Arthritis Pain, 650 mg): one tablet every 8 hours for the first 3 days, even if your pain is mild, then as needed. Do not take more than 3,000 mg of acetaminophen a day from all sources. Many prescription pain pills also contain acetaminophen, so count them too.
Naproxen 500 mg (or the anti-inflammatory your surgeon prescribed): twice a day with food for the first 3 days, then as needed. Only take it if anti-inflammatory medicine is safe for you. Do not take it if you have kidney disease, a stomach ulcer or stomach bleeding, take a blood thinner, are pregnant, or were told to avoid these medicines.
Stronger prescription medicine for breakthrough pain: take it only as written on the label, and only if you need it, usually at night. It can cause drowsiness and constipation. Drink 6–8 glasses of water a day and use a stool softener such as Colace while you take it. Do not drive, drink alcohol or make important decisions while taking it.
The worst pain is usually in the first 48 hours. Most patients need nothing stronger than acetaminophen and naproxen after 3–5 days.
Prescription refills and changes are handled during business hours only, not at night or on weekends.
Activity and lifting limit
- First 2 weeks: lift no more than a coffee cup with the operated hand; do not lean on the elbow.
- Weeks 2–6: increase light activities; avoid heavy gripping, vibrating tools and long periods of elbow bending.
- After 6 weeks: return to full activity as comfort and grip allow.
Driving
Do not drive while you are taking prescription pain medicine, while your arm is numb from a block, or while a splint or dressing keeps you from controlling the wheel safely.
Exercises to start now
Finger motion (open and close)
Start: day 1
Open your hand fully, then slowly close it into a comfortable full fist. 10 times every 1–2 hours while awake. Move within the splint or dressing; do not force it.
Tendon gliding
Start: day 1
Move slowly through five positions, holding each for 3 seconds: straight hand, hook fist (knuckles straight, middle and tip joints bent), tabletop (knuckles bent, fingers straight), straight fist, full fist. 10 rounds, 3–5 times a day.
Shoulder motion
Start: day 1
Gently raise the arm, roll the shoulders and move the neck several times a day so the shoulder does not stiffen while the hand or elbow heals.
Elbow and forearm motion
Start: day 1, gently
Gently bend and straighten the elbow, then turn the palm up and down. 10–15 times, 3 times a day, when your surgeon says the elbow may move.
Your first post-op visit
Your first post-op visit is usually about 2 weeks after surgery. The date and office are on your appointment card. If you cannot make it, call (858) 560-0242.
When to call the office
Call the office at (858) 560-0242 immediately if you have any of the following:
- Fever above 101.0 °F or chills
- Redness, warmth or red streaks spreading from the incision
- Drainage from the incision, especially cloudy or bad-smelling drainage
- Pain that is getting worse or is not controlled by your medicines
- New or worsening numbness, tingling or weakness
- Fingers that turn blue, white or cold, or stay very swollen after elevating your hand for an hour
- A splint or wrap that still feels too tight after you loosen the outer elastic wrap and elevate your hand
- Bleeding that soaks through the dressing
- Numbness or weakness that is clearly worse than before surgery
If you cannot reach us and the problem is urgent, go to the nearest emergency room or call 911.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or new calf pain or swelling.
After your first post-op visit: home exercises
General principles
Start these at or after your first post-op visit, when your surgeon or therapist tells you to.
Exercises by phase
Median nerve glide
Start: 2 weeks
Move slowly through six positions, holding each 3–7 seconds: soft fist with the thumb outside; fingers straight with the thumb tucked; wrist bent back; thumb out to the side; palm turned up; a light stretch of the thumb with the other hand. 10–15 rounds a day. You should feel a gentle glide, not a shock. Back off if tingling increases.
Ulnar nerve glide ("OK glasses")
Start: 2 weeks
Make an "OK" sign with the thumb and index finger. Slowly bring it up to your face like putting on glasses, then lower it. 5–10 times, 1–3 times a day. Stop short of any electric feeling into the small finger.
Scar massage
Scar massage
Start: about 2 weeks
Start only after the stitches are out and the incision is fully closed, with no scabs or drainage (usually about 2–3 weeks). Use a fragrance-free moisturizer such as Aquaphor. Press firmly enough to move the skin and massage in small circles, then side to side and up and down. 2–3 minutes, 2–4 times a day for 6–8 weeks. Protect the scar from the sun for several months.
Desensitization
Desensitization
Start: about 2 weeks, if needed
If the skin around the scar is very sensitive, rub it with a soft material (cotton ball, soft cloth) for 1–2 minutes, then slowly progress to rougher textures such as a towel or denim. Light tapping around the tender spot and moving the hand through a bowl of dry rice or beans also help. 3–6 short sessions a day. Mild discomfort is fine; stop if it causes sharp pain or a flare that lasts hours.
Hand therapy
- Therapy can start after your first visit.
- Weeks 0–2: swelling control, finger motion, tendon glides, gentle elbow motion.
- Weeks 2–4: scar massage, desensitization, median and ulnar nerve glides.
- Weeks 4–6: gradual grip strengthening as comfort allows.
What not to do yet
- First 2 weeks: lift no more than a coffee cup with the operated hand; do not lean on the elbow.
- Weeks 2–6: increase light activities; avoid heavy gripping, vibrating tools and long periods of elbow bending.
When to call the office
Call the office at (858) 560-0242 immediately if you have any of the following:
- Fever above 101.0 °F or chills
- Redness, warmth or red streaks spreading from the incision
- Drainage from the incision, especially cloudy or bad-smelling drainage
- Pain that is getting worse or is not controlled by your medicines
- New or worsening numbness, tingling or weakness
- Fingers that turn blue, white or cold, or stay very swollen after elevating your hand for an hour
- A splint or wrap that still feels too tight after you loosen the outer elastic wrap and elevate your hand
- Bleeding that soaks through the dressing
- Numbness or weakness that is clearly worse than before surgery
If you cannot reach us and the problem is urgent, go to the nearest emergency room or call 911.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or new calf pain or swelling.
About these instructions
These instructions are general guidelines for patients of Nicholas Genovese, M.D. Your surgeon may change your plan based on your surgery and how you are healing. If anything here differs from what your surgeon or therapist told you, follow their instructions, and call the office before changing any activity, splint use or therapy.