After your surgery · Nicholas Genovese, M.D.
Scapholunate ligament repair or reconstruction (with wrist denervation)
Surgery to repair or rebuild a key ligament between two wrist bones
About your surgery
- The ligament between the scaphoid and lunate bones in the wrist was repaired or rebuilt, and small pins are usually placed to hold the bones while the ligament heals. Small pain nerves to the wrist may also have been cut (denervation) to reduce wrist pain.
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 splint and dressing clean, dry and in place until your first follow-up visit. Do not remove, trim or adjust the splint, and do not put anything inside it.
You may shower after 24 hours. Cover the whole splint with a waterproof bag or cast cover. If the splint gets wet, cracks, loosens or shifts, call the office.
If the splint feels too tight, or your fingers become very swollen, cold, blue or numb, you may unwrap and loosely rewrap the outer elastic (ACE) wrap. Do not remove the hard plaster underneath.
Do not soak the arm in a bath, hot tub, pool or the ocean until the stitches are out and the incision is fully closed.
Splint or sling
- Keep the splint and dressing on until your first visit.
- After the first visit you will move to a cast, worn until about 8 weeks after surgery.
- At about 8 weeks the pins are removed and you will change to a removable splint and start therapy.
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 the pins are removed at about 8 weeks: do not move the wrist or perform lifting, pushing, pulling, forceful gripping, twisting, weight-bearing or axial loading with the operated hand.
- Weeks 8–12: wear the brace as directed. Avoid forceful or sustained gripping, painful end-range stretching, resisted wrist exercise and weight-bearing through the hand.
- Weeks 12–16: increase activity only as directed. Avoid impact, sudden traction, heavy gripping or lifting, and forceful pushing from a chair. A gentle countertop weight shift is allowed only if specifically cleared late in this phase.
- After week 16: heavier work, sports, golf, racquet activity and manual tasks require surgeon clearance and should not cause reactive pain or swelling.
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: full fist and full extension
Start: day 1 — 10 repetitions every hour while awake
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.
Protected tendon gliding
Start: day 1 if the splint allows and your surgeon or therapist approves — keep the wrist still
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.
Thumb-tip motion
Start: day 1 — 10 repetitions, 4–5 times a day, within the splint
Keep the wrist protected. Gently bend and straighten the tip joint of the thumb 10 times, 4–5 times a day. Move the thumb toward the fingertips only if the splint design and your care team allow it.
Elbow and forearm motion with the wrist protected
Start: day 1 — 10 repetitions, 3–4 times a day, only if permitted
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.
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.
Swelling control
Start: day 1
Keep the hand above heart level when resting and pump the fingers open and closed often. If the fingers stay puffy after the first week and your surgeon or therapist approves, wrap each finger lightly with Coban from the tip toward the hand. Remove any wrap that makes the fingertips cold, blue or numb.
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
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
Protected wrist motion after pin removal
Start: weeks 8–10, after the pins are removed and you are cleared
After the K-wires are removed and you are cleared, make small, smooth, pain-free wrist movements through the middle of the available range: bend forward and back, move toward the thumb and little-finger sides, and use the protected dart-thrower arc your therapist shows you. Repeat each 10 times, 3–5 times a day. Do not force the motion.
Gentle assisted wrist motion
Start: weeks 10–12, only if approved
At weeks 10–12, and only when cleared, use the other hand to gently assist wrist motion. Do not force the wrist or stretch hard at the end of the range. Stop for sharp pain or increased swelling the next day.
Very light grip
Start: weeks 10–12, only if approved
When cleared at weeks 10–12, use a soft sponge or extra-soft putty for 1–2 sets of 10 gentle squeezes. Keep the effort submaximal and under the 5–10 pound demand set by your care team. Do not use hard putty, grippers or gym handles.
Controlled wrist and forearm strengthening
Start: weeks 12–16, only if approved
After 12 weeks and only when cleared, begin gentle four-direction wrist isometrics. Progress to 1-pound wrist bending, straightening and forearm rotation or a light resistance band, plus light grip and pinch. Avoid heavy resistance and impact.
Progressive strength and loading
Start: after week 16, only after surgeon clearance
After 16 weeks, gradually rebuild resistance, endurance, coordination and work- or sport-specific loading only when motion, pain, swelling and imaging are satisfactory and your surgeon has cleared the next phase.
Scar massage
Scar massage
Start: after the incision is fully healed 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 fully healed and your care team approves
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
- Weeks 0–8 while the pins are in place: protect the wrist. Continue approved finger, thumb-tip, elbow, forearm and shoulder motion without moving the wrist.
- Weeks 8–10 after pin removal: begin small, smooth, pain-free wrist motion in the removable splint as directed.
- Weeks 10–12: add gentle assisted wrist motion and very light grip only when your surgeon or therapist approves.
- Weeks 12–16: progress to controlled wrist and forearm strengthening with very light resistance when cleared.
- After week 16: increase strength, endurance, balance and work- or sport-specific loading in stages only after surgeon clearance.
What not to do yet
- Until the pins are removed at about 8 weeks: do not move the wrist or perform lifting, pushing, pulling, forceful gripping, twisting, weight-bearing or axial loading with the operated hand.
- Weeks 8–12: wear the brace as directed. Avoid forceful or sustained gripping, painful end-range stretching, resisted wrist exercise and weight-bearing through the hand.
- Weeks 12–16: increase activity only as directed. Avoid impact, sudden traction, heavy gripping or lifting, and forceful pushing from a chair. A gentle countertop weight shift is allowed only if specifically cleared late in this phase.
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
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.