In short. Why surgery alone is not enough in the hand: what splinting, oedema control, and graded exercise actually do, and how therapy decides the final result.
Key points
- Too little movement and the tendon adheres to its bed while the joint stiffens.
- Too much and the repair pulls apart.
- The therapist finds the window between those two and moves it week by week as the repair gains strength.
In hand surgery the operation is the beginning, not the treatment. The same tendon repair that gives one patient a supple finger gives another a stiff one, and the difference is usually not the suture technique but what happens in the weeks afterwards. Hand therapy is not recovery support; it is part of the treatment.
What therapy actually does
It manages oedema, because a swollen hand cannot move and a hand that cannot move becomes stiff. It controls position, because a hand rested in a bad position for three weeks may lose range that then takes months to regain. It prescribes movement in the right amount at the right time, and it protects the repair from the forces that would rupture it. It also treats scar, because a scar that is not cared for can tether a joint.
Splinting
A splint is a tool with a job, not a resting place. A protected-movement splint holds a repaired tendon within a safe arc while allowing it to glide. A static splint holds a joint in its best position and prevents a contracture forming. A dynamic or serial splint gradually stretches a structure that has tightened. The class of device is what matters, not the brand: a custom thermoplastic splint is fitted to the individual hand and adjusted as swelling settles and movement improves.
Dose and timing are the whole art
Too little movement and the tendon adheres to its bed while the joint stiffens. Too much and the repair pulls apart. The therapist finds the window between those two and moves it week by week as the repair gains strength. This is why a therapy programme is written out in stages rather than given as general advice, and why appointments matter as much as exercises.
What therapy can and cannot do
It can preserve movement, reduce swelling, keep a scar soft and mobile, retrain a transferred tendon, and rebuild the strength and coordination needed for work. It cannot undo a joint that has already stiffened beyond a certain point, cannot make a repaired nerve conduct faster, and cannot substitute for surgery when a tendon is divided or a contracture is fixed. It works best alongside an operation, not instead of one.
How long it takes
Protected programmes run for six to twelve weeks. Strengthening and return to heavy use continue for three to six months. Sensation after a nerve injury is retrained over many months, and cold sensitivity can persist for a year or more. Final assessment is at twelve months or longer, and no outcome is guaranteed.
Seek care if
- A splint becomes too tight, or the fingers turn pale, blue, or cold inside it.
- Swelling increases rather than settles, or the hand becomes hot and red.
- Movement is suddenly lost, or a sharp pop is felt during an exercise.
Frequently asked questions
Why is hand therapy needed if the operation went well?
Because in the hand the operation is the beginning of treatment. Therapy controls swelling, keeps the hand in a good position, prescribes movement in the right dose and protects the repair, and it is often what decides the final result.
What does a splint actually do?
A splint is a tool with a job. A protected-movement splint holds a repaired tendon within a safe arc while it glides, a static splint prevents contracture, and a serial splint gradually stretches tightened tissue. The class of device matters, not the brand.
How long does hand rehabilitation take?
Protected programmes run for six to twelve weeks, and strengthening and return to heavy use continue for three to six months. Sensation after a nerve injury is retrained over many months, and cold sensitivity can persist for a year or more.
Risks & Limitations
- Incomplete return of sensation or movement. Nerve recovery is slow — roughly a millimetre a day — and some feeling or movement may never come back.
- Stiffness and contracture. A stiff hand is the commonest reason a technically good operation gives a disappointing result.
- Rupture of a tendon repair with forceful use too early in the protected period.
- Infection, which may require antibiotics and further surgery.
- Scarring and scar contracture. Scars are permanent, may stay sensitive or cold-intolerant, and can tether a joint or a web space.
- Growth disturbance in children, which may require later surgery as the hand grows.
- Prolonged hand therapy. Splinting and graded exercise are part of the treatment, not optional aftercare.
- No outcome is guaranteed. Final assessment is made at 12 months or longer, and longer still in growing children.
When to Seek Care
- A hand that becomes pale, cold, blue or numb, or fingers that change colour.
- A wound that becomes red, hot or discharging, or a fever above 38 °C.
- Sudden loss of movement after tendon repair, or a pop felt in the finger.
- Severe pain or swelling in a cast or splint, or a splint that has become too tight.
- Bleeding that does not stop with gentle pressure.
- New or worsening numbness or weakness at any stage after surgery.
References & Further Reading
- American Society for Surgery of the Hand (ASSH) — hand and upper limb condition guidance
- American Society of Plastic Surgeons (ASPS) — reconstructive and hand surgery guidance
- Cochrane Library — systematic reviews in hand surgery and hand therapy
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.