Swelling and elevation after surgery Info

After any operation on your hand or arm, the limb will swell. This is normal, it happens to almost everyone, and it is not a sign that anything has gone wrong. But swelling is also the main thing that makes the early days uncomfortable and stiff, so a little understanding, and a few simple habits, go a long way towards a smoother recovery.

Why your hand or arm swells

Two things are happening, and both are expected.

The first is healing itself. Surgery is a controlled injury, and your body responds the way it would to any injury, by sending extra blood flow and fluid to the area to begin repairs. This is the inflammatory response, and the puffiness, warmth and tightness that come with it are simply the visible side of healing getting under way.

The second is gravity. Your hand and arm are at the bottom of a long limb, and fluid naturally drains downhill. When the arm hangs by your side or rests in your lap, fluid pools in the hand and fingers and has a hard time getting back out. That is why a hand that felt fine first thing in the morning can look like a balloon by the evening if it has been hanging down all day.

What's normal, and how long it lasts

Some swelling is part of every recovery. Typically it builds over the first few days, peaks somewhere around day two to five, and then slowly settles over the following weeks as the healing fluid is reabsorbed and the limb starts moving again.

A few points worth knowing:

• It is normal for the hand to look and feel worse at the end of the day than first thing in the morning (gravity at work), and it eases overnight when the arm has been level.
• Lingering puffiness and stiffness can persist for months, long after the early dramatic swelling has gone. A slightly fat, stiff finger or a thick feeling across the back of the hand is common for a good while and is not a setback. It improves steadily with movement and hand therapy.
• The single biggest influence on how fast it settles is how well you keep the limb elevated and gently moving in those first days.

Elevation — the most important thing you can do

If you remember one thing from this page, remember this: keep the limb raised above the level of your heart. Elevation is by far the most effective way to control swelling, and it costs nothing.

The aim is to let gravity work for you instead of against you, so fluid drains back towards the body rather than pooling in the hand.

• When sitting or lying down, prop the whole arm up on pillows so the hand sits higher than the elbow, and the elbow higher than the heart. Don't just rest the elbow and let the hand flop down; it's the hand and fingers you most want to lift.
• Aim to keep it elevated as much as you can for the first few days, particularly the first two or three. After that, raising it for twenty minutes or so every few hours through the day keeps things moving.
• A useful rule: once letting the hand hang down no longer makes it throb, you can ease off the constant elevation.
• At night, set up your pillows before you settle so the arm stays supported and raised while you sleep; overnight is a long time for a hand to spend flat.

Keep the fingers moving — the muscle pump

Gentle movement is the partner to elevation. Every time you move your fingers, the muscles squeeze the veins and lymph channels and pump fluid back up the arm, a bit like squeezing a sponge.

• Unless we've specifically asked you to keep a finger still, gently make a fist and then fully straighten your fingers, slowly and repeatedly, several times an hour while you're awake.
• Do it with the hand elevated for the best effect, with pumping and gravity working together.
• Keep the joints that are free moving too. If your wrist is bandaged, keep the shoulder and elbow moving with gentle circles and bends so they don't stiffen up while the hand heals.
• Move within comfort. A gentle stretch is fine; sharp pain means ease off, and always follow any specific exercises your surgeon or hand therapist has given you.

Cold packs and light compression

A cold pack can take the edge off swelling and pain in the early days. Wrap it in a thin towel, never put ice straight onto skin, and don't rest it on an area that is numb or has reduced feeling. Keep dressings and casts dry. There's more detail (including when cold helps and when gentle heat is better later on) on our heat-versus-ice page.

A snug compression sleeve or wrap can also help, but only use compression if we've specifically advised it. The wrong wrap, or one applied too tightly, can do more harm than good by squeezing a limb that is already swollen.

A sling, and not letting the arm hang

When you're up and walking, your arm naturally drops to your side and the hand fills with fluid again. A sling keeps it supported and raised across your body while you're on the move, so the gains you've made resting with it elevated aren't lost. Use the sling for support when you're up and about, but take the arm out to do your gentle finger and elbow movements, and don't leave it dangling for long stretches.

When to seek help — don't wait

Most swelling is simply part of healing and settles with elevation and movement. But swelling can occasionally signal a problem, and a few warning signs need prompt attention. Trust your instincts: it is always better to have something checked and find it's fine.

A cast, splint or dressing that is too tight is the one that can't wait. As the limb swells underneath, the dressing can start to squeeze the nerves and blood supply. Contact us the same day, or go to your nearest emergency department, if you notice:

• Pain that is increasing, severe, or worse than you'd expect: especially pain that doesn't settle with your usual pain relief.
• A cast, splint or bandage that feels tighter rather than easier as time passes.
• Numbness, pins and needles, or burning in the fingers.
• Fingers turning pale, white, blue, dusky or cold, or that won't settle with elevation.

These together (particularly severe pain plus numbness or colour change in the fingers) should be treated as urgent.

Signs of infection also need same-day review:

• Swelling that is hot, red, and spreading, rather than easing.
• A fever, or feeling generally unwell.
• Pus, discharge or a bad smell from the wound or dressing.

Signs of a possible blood clot are an emergency: call an ambulance or go straight to emergency if you notice:

• Sudden swelling, pain or tightness in one calf or leg.
• Breathlessness, or chest pain, especially with the above.

For ordinary swelling that eases when you raise the limb and improves day by day, keep it up, keep the fingers moving, and raise any questions at your next clinic visit. When in doubt, ring the rooms; we would much rather hear from you.