After your surgery · Nicholas Genovese, M.D.
de Quervain release (first dorsal compartment release)
Surgery to free the thumb tendons at the thumb side of the wrist
About your surgery
- The tunnel over two thumb tendons at the thumb side of the wrist was opened so the tendons can glide without pain. Pain with thumb use usually improves quickly. Tenderness and swelling around the incision can last several weeks, and the skin near the incision may feel numb or sensitive for a while.
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
Keep the plaster splint and surgical dressing clean, dry and in place until your first post-op visit unless your surgical team tells you otherwise.
You may shower after 24 hours only if the entire splint and dressing are sealed inside a waterproof bag.
Do not remove the splint to bathe, and do not soak or swim until the incision is fully healed and your care team clears you.
Splint or sling
- Wear the plaster thumb and wrist splint continuously until your first post-op visit.
- At that visit, your care team will tell you whether to continue a removable thumb splint and when it may come off for motion.
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
- Until your first post-op visit, keep the thumb and wrist protected in the plaster splint and use the hand only for light daily tasks.
- Do not lift more than a coffee cup, pinch forcefully, or perform repetitive thumb or wrist motion until cleared.
- After the first visit, increase activity only according to the splint and therapy plan your care team gives you.
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
Motion of the unprotected fingers
Start: day 1 — gently move only the fingers that are free of the splint
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.
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
- A thumb tendon that snaps or pops over the wrist bone when you move the thumb
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
Tendon gliding
Start: after your first post-op visit, when your surgeon or therapist clears you
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.
Wrist motion
Start: after your first post-op visit, when the plaster splint is removed and you are cleared
With your forearm resting on a table, gently bend the wrist down, back to straight, and up, then side to side. 10 times each direction, 3 times a day. Only when your surgeon says the wrist may move.
Thumb motion
Start: after your first post-op visit, when your surgeon or therapist clears you
Touch the thumb tip to each fingertip, then move the thumb out to the side and away from the palm. 5–10 times, 3 times a day, when cleared.
Scar massage
Scar massage
Start: only after the incision is fully closed and your care team approves
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: after the incision is healed, if the skin is sensitive
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
- Begin the home program or formal therapy after your first post-op visit and only when your surgeon or therapist clears motion.
- After clearance, progress from gentle thumb and wrist motion to scar care, then gradual pinch and wrist strengthening as directed.
What not to do yet
- Until your first post-op visit, keep the thumb and wrist protected in the plaster splint and use the hand only for light daily tasks.
- Do not lift more than a coffee cup, pinch forcefully, or perform repetitive thumb or wrist motion until cleared.
- After the first visit, increase activity only according to the splint and therapy plan your care team gives you.
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
- A thumb tendon that snaps or pops over the wrist bone when you move the thumb
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.