Pre-operative planning for rehab


The limb requiring surgery will need to avoid strenuous activity or significant loading over the first 2-3 weeks after surgery.  If you are dependent on the use of your arms for transfers or wheelchair or crutch use you will need to prepare for changes to activities of daily living. This might include additional support or equipment for that time period.  If you are able to walk and manage your daily activities with one arm, there should be only a few adjustments immediately after surgery, including protecting the surgical site, and getting some assistance with dressings and pain medication. 

If you use a manual wheelchair, you  may require additional nursing for wound care and medication management for pain, additional assistance for transfers, wheeling or hand function activities.  

Caregivers may need to provide wound dressing care and possibly increased personal care in the immediate postoperative period for 1-4 weeks.  Consider planning for possible changes in dressing, feeding, meal prep, hygiene activities, and transfers due to reduced use of the limb requiring surgery. 

Information for your doctor and therapist / clinicians/allied health prior to surgery:

  1. You may have more than one nerve transfer procedure and it is important to maintain a supple and flexible arm, to keep swelling down.
  2. It is important to maintain passive range of motion (PROM) before and after surgery to make sure your joints don’t get stuck in the same position. In some cases, your joints may already be very tight and it is very important for you to work with your therapist to improve range of motion. PROM exercises in the arms focus on the shoulder, elbow, wrist, and finger joints, and in the legs focus on the hip, knee, ankle and toes
  3. A daily stretching program is the first priority, early after surgery. The goal is to have the joints in the affected area be as flexible as possible so that when nerve reconnections happen, there is less stiffness for your muscles to work against.  For the most part you will have to use your other hand or ask your caregiver to help you stretch. Priorities for stretching are:
    a. Finger joint flexion and extension.
    b. Wrist pronation is more important than supination.
    c. Ideally wrist and hand is in “position of function” and remains supple
    i. Wrist 20 degrees of wrist extension.
    ii. Fingers 30 - 40 degrees of MCP flexion and IP flexion
    iii. Thumb abducted 30 degrees and opposed to line up with index finger.
    iv. Splinting - sometimes more than one type especially for the hand.  See splinting section.
    v. IP flexion bands or splints to improve IP flexion.
    vi. MCP flexion - Combined finger flexion splint.
    vii. Thumb spica
    viii. Pronation positioning
    ix. Hot wax treatments for stiff joints.
  4. Swelling control treatments (Isotoner compression glove / compression sleeves / elevation) to reduce hand swelling.  Distal to proximal massage to reduce edema may help.  Keep limb elevated for part of the day to decrease swelling.
  5.  Pain control and desensitization (improving tolerance of body part being touched and moved).

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