Two things wreck sleep after hand surgery, and they are related.
The hand ends up BELOW the heart, so it swells. Swelling stretches the tissue around a fresh wound, and that is what throbs at 3am.
Fix the position and you fix most of the pain. Almost everything below is a variation on that.
Nights one to three, the hard ones
- Elevate on pillows, not on your chest. Hand higher than the elbow, elbow higher than the shoulder. A stack of two or three pillows alongside you, forming a ramp
- Take pain relief BEFORE the block wears off. If you had a local or regional anaesthetic, the numbness ends abruptly, often in the middle of the night. Set an alarm and take the dose before that happens. Chasing pain is far harder than staying ahead of it
- Keep taking it regularly for the first two or three nights rather than only when it hurts
- Move your fingers when you wake. Ten slow, gentle movements within whatever range you have been allowed. It pumps fluid out and the throb often settles within minutes
- Do not let it dangle when you get up for the bathroom. Hold it against your chest
Positions that work
- On your back with the arm on a pillow ramp beside you. The best option, and the one most people abandon by night two
- On your side, operated hand up, cuddling a pillow so the hand rests on top of it
- Semi-reclined — a recliner chair, or pillows behind your back. Many people sleep better sat up for the first two nights, and there is no shame in it
- Never on the operated side. Body weight through a fresh wound is exactly what it sounds like
A long body pillow or a bolster is the single most useful purchase here. It stops you rolling and it holds the ramp in place.
Swelling is the pain. Elevation is the painkiller you don’t have to swallow.
Splints in bed
If you have been told to wear it at night, wear it at night. Night is precisely when you lose control of position, which is why the instruction exists.
If it is cutting in, causing numbness or waking you with throbbing, that is not something to tolerate until your next appointment. Ring your therapist. A splint that wakes you is a splint that needs adjusting.
See wrist splints.
Practical bedroom fixes
- Old towel under the arm in case of any ooze in the first nights
- Water and medication within reach of your GOOD hand
- A lamp you can switch on one-handed
- Loose sleeves. Wriggling out of a fitted sleeve at 2am is nobody’s idea of a good time
- Keep the room cool. A warm room makes a swollen hand throb more
Patients who sleep propped up for the first three nights consistently report a better first week than those who insist on lying flat. It is not sophisticated advice. It just works.
How long the bad nights last
Most people find nights one to three the worst, with clear improvement by the end of the first week.
By two weeks, sleep is usually close to normal apart from position. Beyond three weeks, pain that is still waking you every night is a reason to be seen, not a reason to endure.
Ring someone if
- Pain is INCREASING after day three rather than settling
- Fingers are swollen, dusky, cold or numb
- The cast or splint feels tight enough to throb regardless of position
- Fever, spreading redness, or discharge with an odour
- Burning pain far beyond what the operation explains, with swelling and colour change — see CRPS
If you wake at 3am throbbing, the first thing to change is the height of your hand, not the dose of your tablets.
See also life with one hand and swelling after a hand injury.
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.