Hand injury rehabilitation is a precise branch of physical and occupational therapy dealing with the hand, wrist and fingers after fractures, tendon and nerve division, ligament injuries and burns, after operations such as carpal tunnel release and tendon repair, and in longer-standing problems that leave stiffness, swelling and a weak grip. The hand tolerates immobility poorly: a few weeks of splinting produce stiffness and adhesions that are hard to reverse later, which is why rehabilitation usually starts early and at a carefully measured dose. A programme includes splints fabricated or adjusted to your hand for protection or for gentle lengthening, tendon-gliding and joint-motion exercises within a defined range, techniques to control swelling and scar, graded desensitisation when there is numbness or hypersensitivity after a nerve injury, and then progressive grip, strength and fine-motor work up to return to work. The timing of each stage after a tendon or nerve repair is governed by the surgeon's protocol: loading too early can rupture the repair, while waiting too long produces adhesions, and both errors happen when patients improvise. Results in the hand are cumulative above all else. Small doses repeated several times a day achieve far more than one long weekly session, and your adherence to the home programme is the single biggest determinant of the range you regain. This is not hand massage, and the benefit of exercise cannot be judged by how much it hurts; forceful stretching increases swelling and stiffness and sets you back. Electrical stimulation, therapeutic ultrasound and laser are adjuncts within specific windows and do not replace exercise and splinting. The limits are clear. Rehabilitation does not stabilise an unstable fracture, does not reconnect a divided tendon without surgery, does not release dense established adhesions that may need a procedure, and cannot accelerate nerve regrowth beyond its naturally slow pace. Full range is sometimes not recoverable after certain intra-articular fractures. Programme length is estimated initially and reassessed at each review, and suitability for every exercise is decided by clinical examination and the surgeon's report rather than by reading.
Procedure steps
- 1
Hand assessment and baseline measures
The therapist measures each joint's range with a goniometer, grip and pinch strength, and hand circumference for swelling, tests sensation and the function of the three main nerves, and examines the scar and skin. These numbers become a baseline so progress is measured objectively rather than by impression, and the surgeon's reports and imaging are reviewed before any exercise.
- 2
Protection, splinting and swelling control
A splint is fabricated or adjusted to protect the repair or hold the joints in a safe position, with defined wearing hours. Swelling is managed by elevation above heart level, active movement of adjacent joints and gentle compression when needed, with scar care once the wound is closed. Persistent swelling is the main enemy of range of motion.
- 3
Range of motion and tendon gliding
Specific exercises glide each tendon within its sheath and separate motion at each joint to prevent adhesions, within the range and dose set by the protocol. They are performed a few repetitions every hour or as prescribed rather than in one long block, and are stopped and reported at once if there is sharp pain or a sense of the repair giving way.
- 4
Strength, grip and desensitisation
Once the surgeon allows it, light resistance begins with putty or springs and is increased gradually while watching pain and swelling the following day. Where there is numbness or hypersensitivity, a desensitisation programme with different textures is added, along with education on protecting an insensate area from heat and cuts, which matters especially in people with diabetes.
- 5
Functional skills and reassessment
Training on real tasks: writing, buttons, a door key, the tools of your trade, with temporary adaptations where needed. Measurements are repeated and compared with baseline, and a graded return-to-work plan is built. No fixed number of sessions is promised: the plan is estimated initially and reassessed according to the range and strength actually regained.
Before the procedure
Tell the therapist the exact date of the injury or operation and bring the surgeon's report and your imaging, because the exercise protocol after a tendon or nerve repair depends on the type of repair and the week you are in. Remove rings and bracelets from the injured hand before swelling increases, trim your nails and clean the hand, and bring the splint or support you were given even if you are not wearing it. Also declare diabetes, rheumatoid disease or smoking, which affect healing and adhesion formation, and any blood-thinning medication. Do not push your hand beyond the range the surgeon allowed in the belief that you are speeding recovery, and do not soak the hand or apply creams or oils before the session unless advised.
After the procedure
Keep to the home programme at the prescribed dose several times a day; this determines the range you regain more than the number of clinic sessions does. Elevate the hand above heart level in the early phase to limit swelling, keep moving the shoulder and elbow even while the hand is splinted so they do not stiffen, and wear the splint during the specified hours rather than when it feels comfortable. Expect mild tightness after exercise that eases within an hour; pain that worsens at night and swelling that persists into the next day should be reported so the dose can be reduced. Seek medical care immediately if you have: **severe escalating pain out of proportion to the injury with swelling, skin colour change, sweating and sensitivity to light touch — this may be complex regional pain and needs early medical treatment, not more exercise**, **fever with redness or discharge from the wound**, **progressive numbness or weakness**, or a snap followed by sudden inability to bend a finger after a tendon repair.
Expected duration
Sessions usually last 30 to 60 minutes, with short home doses several times daily; programme length is estimated initially and reassessed at each review.
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