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The Two Questions That Change Your Outcome Aren’t About Pain.
Before hand surgery, ask five things. What does a realistic good result look like? What will I lose? What happens if I wait? Exactly what can I move, and from when? Is hand therapy booked, and how soon does it start?
Write the list down, bring someone with you, and repeat the plan back in your own words before you leave the room.
Most people leave a surgical consultation having asked about pain and time off work, and having never asked the two questions that actually matter.
- What does a GOOD result look like for this operation?
- And what happens if I do nothing?
Everything below is downstream of those two.
Skip them and you find out the answers later, at the worst time. At week 3, when you realize nobody booked therapy. At month 3, when the thumb that “should be better by now” turns out to be exactly the result the operation was designed to give. Neither is a complication. Both are a conversation that didn’t happen.
What result should I realistically expect from hand surgery?
- What is realistic, not best case? Carpal tunnel release usually resolves night symptoms very reliably. Fusion surgery trades movement for pain relief on purpose. Arthritis surgery in the thumb does not restore a young thumb. Know which deal you are taking.
- What will I lose? Every operation costs something. Grip strength, range, sensation over the scar, a bit of rotation. Ask for the specific loss, not reassurance.
- How long until I know the final result? For a small release, often around 3 months. For thumb-base or joint surgery, often 6 to 12 months. Knowing this stops you judging the operation at week 6.
- How many of these do you do a year? A fair question, asked politely, and the answer matters more for uncommon operations than common ones.
- What is the failure or recurrence rate, and what happens then? Recurrence of Dupuytren’s is common. Ganglia come back. Knowing the number beforehand turns a disaster into an expected outcome.
What happens if I don’t have the surgery?
This is the question surgeons respect most and get asked least.
- If I wait six months, what changes?
- Does waiting close any doors or make the surgery harder?
- Is there a version of this where the damage becomes permanent?
The answer separates the conditions where you have time from the ones where you don’t. I think of it as a window. Some hand problems sit in an OPEN window: waiting costs you comfort, not function. Some are CLOSING: there’s a deadline in the biology, and you’re near it. A few are already shut, and the goal changes.
- Usually time on your side: trigger finger that clicks but isn’t locked, a ganglion that doesn’t bother you, thumb-base arthritis you’re managing with a splint. Trying therapy first is reasonable, and surgery stays available.
- Clock running: carpal tunnel with numbness that never switches off, or wasting of the muscle at the base of the thumb. Nerves that have been squeezed for too long don’t always recover fully after release. See carpal tunnel syndrome.
- Clock running fast: a cut tendon. A flexor tendon is ideally repaired within days. Weeks later, the ends retract and a simple repair may no longer be possible. See flexor tendon repair.
- A useful line in the sand: with Dupuytren’s, the usual cue to consider treatment is when you can no longer lay your hand flat on a table.
More on that decision in hand therapy or surgery.
Ask what you lose, not just what you gain. Every operation is a trade, and the good ones are still trades.
What should I ask about the operation itself?
- Anesthetic. Local, regional block, WALANT (wide-awake), or general?
- The day. Day case or overnight? Can I eat beforehand? Do I stop any of my meds, especially blood thinners, and who decides?
- The cut. Where exactly is the incision, and how big?
- Stitches. Dissolvable or removed, and when? Usually around 10 to 14 days if they come out.
- Hardware. Is there any metalwork, pins or wires, and do they come out later?
- Getting home. Can I drive myself home? Almost always no.
What should I ask about recovery and hand therapy?
This is the part that gets skipped. In hand surgery, the rehab is not an add-on. For tendon and joint work it contributes as much to the outcome as the operation.
- Will I need hand therapy, how soon, and how many sessions? “Sometime after” is the wrong answer for a flexor tendon repair, where therapy typically starts within the first week.
- Is that booked, or am I arranging it? People routinely lose three weeks here, and those three weeks matter.
- Am I in a splint or cast, for how long, and can it come off to wash? Custom-made or off the shelf? Who adjusts it when the swelling goes down?
- What am I allowed to move, from when? Get this in writing. Fingers, wrist, elbow, shoulder, each one.
- How do I shower, dress and use the toilet? See life with one hand after surgery.
When can I drive, work and use my hand again?
Ask with dates and weights, not “when it feels right”. Then sanity-check the answer against the typical ranges. Your surgeon’s protocol always wins over this list.
- Carpal tunnel release: desk work often within 1 to 2 weeks; heavy gripping and pushing usually 6 weeks or more.
- Trigger finger release: desk work within days to a week; gym and heavy grip around 6 to 8 weeks.
- Broken finger or thumb with fixation: at least 6 to 8 weeks protected; the bone takes 6 to 12 weeks to heal.
- Thumb-base arthritis surgery (trapeziectomy): cast or splint for 4 to 6 weeks, a useful pinch around 3 months, strength still improving up to a year.
- Flexor tendon repair: splint for about 6 weeks, no heavy gripping until around 12 weeks.
- Driving: never in a cast or bulky dressing; only once you could grip the wheel and steer in an emergency. Check your insurer’s position too.
If the answer you get is wildly shorter than these, it’s worth asking “is that for this operation, in my job?” A courier and an accountant don’t return to work in the same week.
What complications should I ask about?
- The specific ones. What are the complications of THIS operation, not surgery in general?
- The wound. What should it look like on day three, and what would worry you?
- Out of hours. Who do I call, and what is the number?
- Neighbors. Is there any risk to the nerves or tendons nearby?
One to raise directly: unusual, escalating pain with swelling, stiffness and color change is not normal post-operative pain. Ask what they want you to do if that happens. See CRPS.
How do I actually ask a surgeon all these questions?
- Write them down and hand over the list. Nobody minds, and it stops you forgetting the important one.
- Bring someone. You will not retain half of what is said, which is normal.
- Ask permission to record the explanation on your phone.
- Repeat the plan back in your own words before you leave. Mistakes surface immediately when you do this.
- Ask for the written protocol to bring to your first therapy session.
The patients with the smoothest recoveries are almost always the ones who arrived at their first therapy session knowing exactly what they were and weren’t allowed to do.
What can a hand therapist do before surgery?
- Try the non-surgical route properly first, where the window allows it. Night splints for carpal tunnel, a splint and tendon exercises for trigger finger, a thumb-base splint for arthritis. A splint worn properly for 6 to 8 weeks is a real trial; one worn twice is not.
- Measure your starting point. Range, grip and pinch strength before surgery give you something honest to compare against later.
- Get the house ready. One-handed setup, the right clothes, the bathroom sorted.
- Teach the first-week exercises while your hand still works, so day 1 isn’t the first time you’ve heard of them.
More on the job itself in what a hand therapist does.
Get it checked today if
- You’ve cut your hand or finger and can’t bend the tip or middle joint. Don’t wait for a routine consultation.
- A finger or the hand is red, hot, swollen and throbbing, especially with a fever. Go to the ER.
- You felt a pop at the front of the elbow with bruising and weakness turning the palm up.
Get it checked if
- Numbness in your fingers has become constant rather than coming and going.
- The muscle at the base of your thumb looks flatter than the other side.
- A finger is now locked bent, or won’t lie flat on a table.
- You were told to wait and see, and it’s getting worse rather than holding steady.
You are not being difficult. You are the only person in the room who has to live in this hand afterwards.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Your surgeon knows your hand; this list makes sure you leave the room knowing it too.
Part of: Recovery after hand, wrist and elbow surgery: every week-by-week guide
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.