Hand elevation is a simple yet powerful strategy recommended immediately following hand or wrist surgery. It uses gravity to assist the body’s natural healing process by encouraging the flow of fluids away from the surgical site. Consistently maintaining this position significantly reduces post-operative swelling and lessens associated pain.
Why Elevation Is Essential for Healing
Swelling (edema) occurs naturally after surgery as the body sends fluid and healing cells to the injured area. Excessive fluid accumulation slows healing and causes intense discomfort. Gravity helps drain this excess fluid through the venous and lymphatic systems, which clear waste products and return fluid to central circulation.
Reducing fluid buildup prevents the swelling from becoming dense and restricting movement. When the hand is kept low, increased fluid pressure presses on delicate nerve endings and blood vessels, resulting in throbbing pain. Elevation lowers this pressure, decreasing pain and improving circulation for better tissue oxygenation and nutrient delivery.
Achieving Proper Hand Positioning
The most effective elevation technique requires the hand to be positioned consistently above the level of the heart. This height ensures gravity works optimally to minimize swelling and is more beneficial than simply resting the hand on a nearby surface.
When lying down, use several pillows or a specialized foam wedge to support the entire forearm and hand, ensuring the hand is the highest point. The elbow should be slightly bent and the wrist kept straight, avoiding sharp bending that restricts circulation through the joint.
While sitting, place the arm on the back of a chair or use a stack of pillows on a table, keeping the hand higher than the chest. If standing or walking, use a temporary sling adjusted so the hand is positioned up toward the opposite shoulder, preventing it from hanging down.
Duration and Timing of Elevation
Continuous elevation is typically required when swelling is most pronounced, usually lasting for the first 48 to 72 hours. During this acute phase, the hand should only be lowered briefly and infrequently for necessary activities, such as dressing or light movement.
Some surgeons may advise maintaining strict elevation for up to seven days, depending on the extent of the surgery and the patient’s swelling response. Once initial swelling subsides, transition to intermittent elevation, raising the hand whenever resting or sitting for an extended time.
A good indicator to reduce frequency is when the hand no longer feels a noticeable throbbing sensation upon being lowered below heart level. Always follow the specific schedule and duration instructions provided by the surgical team, as they are tailored to the exact procedure performed.
Signs of Incorrect Elevation
A common error is allowing the hand to hang down, often called the “pendant position,” which immediately increases swelling and pain. Another mistake is using a sling that positions the hand below the elbow or waist, nullifying gravity’s effect. Ensure the support used does not cause the wrist to be sharply bent, which impedes blood flow.
If elevation is insufficient or incorrect, you may notice persistent or worsening swelling. Increased throbbing pain not relieved by pain medication or elevation signals excessive pressure buildup that requires attention. Other signs of complication include numbness, tingling, or a change in fingertip color, indicating restricted circulation that requires immediate contact with your surgical team.