Massaging the Wound

Brain and nerves
1

OK, I had the operation on my right hand 23 days ago, bandage was off after 48 hours and I changed the dressing for a new one. Second dressing on for about 4 days then I took it off to air the stitches. Stitches removed at day 14 and all looks fine.

I've now been told to massage the wound with Vitamin E cream, so found a tube of moisturiser with Vit E but the actual wound is still a thin scab of dried blood and I can rub the cream on, but I'm not really massaging the site. The skin to either side of the wound is slightly peeling away, as expected, but how hard should I be rubbing at the site? It doesn't particularly hurt, but it is a hard line of dried blood, Should I be digging my fingers in, or do I wait for the scab to fall away? Or should I wait weeks before massaging ???

2

You can get scar pads (they're like band-aids that have a scar softening gel on them) that you wear for up to 12 hours at a time. It will soften the scar and help to diminish the size. As far as how hard to massage - go with how much you can tolerate before it hurts too much.  Try not to pick at the scab - you don't want to make it bleed or open up. The scar pads will eventually help it fall off on it's own.

Good luck!  Let us know if you have any other questions.

Jacqui

3

Hello Mark! Two quick questions: Did they say why you should rub the scar? And when you're doing it, can you feel some pain only from the scar or do you also feel a cutting pain (like somone's choping a chisel or a knife into the hand) approx 1 cm from the scar parallell to the scar, where the median nerve lies?

4

Hi Ken, I have no pain. It;s just I was told to massage the wound after the stitches came out with Vit E cream. This will stop it scarring too badly and encourage repair under the skin.

Trouble is the wound still has hard dry blood, along the knife incision and where the stitches went in. I apply the cream and rub it gently in, but I would not really call it massaging the site...more of a gentle rub. there is no pain, but I do not want to pull the scabs off. i would imagine this would cause further scarring!!! It is now a few days later and the skin either side of the wound has pulled away from the wound, dry and dead. Scabs nearly all gone, but I'm still applying cream with a gentle rub and not massaging deeply in....

Am I doing it right?

5

Ok, so I see. I was told by the surgeon it wasn't necessary for me to touch the scar or even have plaster on to protect it. Daily activities would be enough to lose the eventual pain from the scar as time went on, he said. He massaged my scar gently and I wasn't in no real pain from the scar, the pain instead came from the median nerve when he was doing it, according to him. And especially when the ligament isn't healed each pressure on the scar will affect the median nerve.

But my physio therapist's opinion was the opposite! But each time she rubbed my scar a bit harder my hand got very weak and very very painful, the whole thing came back from pre op mode or worse, so we had to skip it really, just wearing the plaster instead.

Personally, I think it's a matter of how it looked like during the surgery in each individual case! The surgeon said that each time you do massage on to the scar you're also pressing on the carpal tunnel again, and in my case she wasn't a fan of that. But now 9 months after surgery I've just begun to do some massage there after all, since I've read  so many positive things about it on this forum and since it can be rewarding up to at least 12 months after surgery. And even if it takes at least 12 months for the skin layers over the carpal tunnel ligament to heal, I'm ready for it.

So Mark, I would have called the surgeon and asked what the opinion was about the massage of the scar, how and how much you should do it. In fact, I think these advices are a bit individual and case based. In my case, when I went back two weeks after the surgery to remove the stitches in the palm and down to left of my wrist, the 7 cm scar looked pretty much like it looks today really. Absolutely no blood except very small dots when the metallic stitches were removed. I washed the hand in water and a specail soap according to his instrucion there and then and the surgeon removed the stitches and finally washed my hand again with sterile solution of some sort. Do you still have visible blood in the scar? Now after four weeks I'm quite certain you could use some sterile solution to wash it off, don't you think? Furthermore, I think you're doing it just right when you say you're doing it gently. Instead, increase the pressure over time. But my advice is: call them and ask! Each case could be individual.

Question though: I have two sorts of pain in one fingertip when typing. When I rub gently on the plaster above the scar it affects that hurting fingertip in a good way instantly. It really does, makes it a tiny bit bigger or what can I say to describe it...  As if more blood is going there or as if the nerve pain signals goes somewhere else. HOW is that possible?? No other fingertip on the hand is affected by the massage of the scar. I do this several times a day now.

I would REALLY appreciate if anyone on here, Mark or someone else, had a medical explanation for this, since when I'm rubbing the scar I'm definitely NOT rubbing the median nerve, from where the pain in that particular fingertip has it's origin, according to my surgeon. How can the pain be affected?

6

Hi Ken, it does seem that EVERY case is different, and every surgeon/doctor gives different advice. We all seem to follow roughly the same course and it is good to hear feedback from others further ahead with the cure.

I have very little pain after 4 weeks, I never needed pain killers at all but did have some strange shooting pains up my fingers for the first few days, like red hot wires poked along the finger, but they only lasted half a second and I just stopped what I was doing; this was nearly always stretching to do something, like flick an electric switch or pull a plug out.

Now I just have very slightly numb ends to my middle fingers and this comes and goes during the day, and occasional twinges if I'm carrying too much weight, like dragging a large desk around the house!

I only had a dressing/plaster on for the first 4 days, it's been open to the air since then but I did "try" and keep it dry until the stitches came out at day 14. Since then I've showered as normal and just been careful not to rub it dry...just pat it dry. 

The red scabs have now completely gone, but the skin on either side of the cut is dry and flaky and each time I shower a bit more falls away. the scar area is  a bit redder than my usual skin and that is where I am applying the Vit E moisturising cream. I'm not concerned about a scar, so will not bother with scar pads, as it is it appears to run as a continuation of my life line and will be hardly visible.

i just remember the nurse telling me to massage the wound well with the cream and although there is no pain, with the loose skin I'm loathe to press in too hard yet!

I still can't make a tight fist, it's hollow in the middle and it's difficult to touch thumb to little finger...only just possible; where on my left hand (unoperated on) I can rub my thumb all the way down my little finger easily.

7

Hi Mark!

I remember for some months(!) after surgery I suffered from spasms in the palm, especially around the scar but also in the fingers, so they were moving and there was nothing I could do to prevent it, like a Parkinson patient. The surgeron had 35 years of experience but haven't heard of such thing before. These spasms now have disappeared though. The spasms in the palm were a result of nerve ends trying to find each other again they thought. It was a very uncommon sight, but you could see the muscles in the hand around the scar moving automatically, not under my control. But I'm still sensitive to hot and cold surfaces on my fingertips and water and that (especially now when I'm having a setback). Screaming out loud when hot water reaches the fingertip of my middle finger. it's burning. Then touching the fingertip mildly helps a bit, but rubbing it makes it worse - so it's a fine margin really. Typing is a struggle and it feels like my tendons are very stiff and I just found out I have very soar points around my elbow and when I touch those my fingertip burns! It's all connected so it seems.

But I do tendon gliding exercises - do you also Mark?  And I do nerve gliding exercises, but they're making my thumb worse (the only thing having a negative effect on my thumb actually, daily activities haven't), so I have to be very careful doing them. You shouldn't pull your thumb, just gently holding it with the other hand.

What kind of bandage did you get? Did you have a stiff one so to say? Mine were filled with gypsum and stiff. I could move my fingers though, except for the thumb, which could only be moved halfway into the palm. I had no problems making a fist or touch all the fingers right away with the thumb when the surgeon removed the bandage after 2 weeks. That was also unusual, he said.

MARK! Be careful. Don't carry heaving stuff, desks and stuff. Absolutely not for the first 1.5 to 3 months. Not at all!

8

My bandage was very soft, just padding really and was removed after 48 hours leaving just a patch/dressing which I took off a few days later. Still can't make a tight fist, I can if I  roll my fingers using the other hand...tighter anyway, I can still see air. the Dr told me to use my hand and wrist as normal and if it started hurting, back off for a day or two. I've driven my car virtually every day, no problem. Parts of my palm are a bit sore, feel a bit bruised but no longer a funny colour, they were slightly brown for a week or two (the whole inside palm). My fingers don't look swollen to me, but others say they are still larger than the other hand. Never heard of tendon gliding, but I haven't seen my surgeon yet, just the nurse who removed stitches. Maybe at week 6 they will encourage this step. I can't do lots of things (make a fist) but I can do nearly everything as normal with no pain at all, then I suddenly get a tingle, not painfull but obviously lets me know I should not do that again!!

9

Obviously, the procedures differ a bit. I got several papers with exercises I was told to do from 20 hours after the surgery. The bandgage as I said was stiff, very large blue one, rock hard. Pumping finger exercises several times a day, shoulder rotation exercises and so on. I was also told to do the dishes manually, normal household activities and almost everything except from carrying heavy things, from the day after the surgery.

I wore the gypsum filled bandage for 14 days. My hands were not swollen or miscoloured at all afterwards, instead they became swollen a week after they were released from the bandage and still are sometimes - nine months later. I have to keep moving them.

A tingle? Are you sure it means you should stop from what you're doing? Have they said that? My fingers and hand tingles all the time, I can't stop doing things because of that. That's just how it is. And in my case it might be something else as well, who knows, lack of nutrition perhaps? Raynaud's?

You don't have to worry if you can drive the car and hold a steering wheel. Making a fist is normally hard during the first couple of months they say, but keep working on that! Make sure to hold your hands right up in the air above your head a minute first though, so the fingers become less swollen before making the fist. If they're still swollen when you're making the fist, an unnecessary pressure is put to the median nerve inside. Fingers can be swollen inside, even if it's not particularly visible, my surgeon said.

10

That was interesting and new advice, I'll give it a go, raising my hand before fist clench and internal swelling. The hand doesn't quite feel like mine yet, but it is only day 28.

I get the tingling in my hand from strange contortions (i.e. using paper when visiting toilet!!!) Otherwise I'm doing most things now just being a bit cautious, like not putting dog lead around wrist in case they suddenly yank me off my feet (Two black labradors).

No one has told me to stop if hand tingles, but I have not spoken to anyone about it either, won't see my surgeon until week 6. Only seen nurse when stitches removed and everyone said try and do what you normally do but if it hurts, STOP. Not really had any pain, just twinges and they have got a lot better each week.