Ulna head replacement: aftercare advice

You have had surgery to replace the joint at your wrist, between the radius and ulna bones. This bone is known as the Distal Radio-Ulnar Joint (DRUJ). This joint allows rotation of the wrist. During surgery the joint is replaced with an implant, to improve wrist rotation and reduce pain.

Over the next few weeks you will be given advice by your therapist about:

• your rehabilitation

• the management of your hand and wrist.

Getting a good result from this surgery is directly related to the effort you put into your rehabilitation. Please follow the advice and guidance below.

When can I return to my daily activities?

• Recovery from this operation can be slow. It can often be 3 to 6 months before you can start normal heavy activities again. This is to allow the soft tissues surrounding your new implant to heal and become stable.

• You can use your hand for light activities during the first 6 weeks, wearing a splint for at least the first 2 weeks. Light activities include using the telephone, and getting washed and dressed.

• Most patients can return to driving 4 weeks after their operation. However, this is a decision you need to make with your surgeon or therapist.

• When you return to work depends on the job you do. Please discuss this with your surgeon or therapist.

2 to 3 weeks after your surgery

• We will replace your plaster with a lighter wrist splint. You must wear the lighter splint for a further 4 weeks. You may remove your splint each day to wash your arm / hand. After 4 weeks you may be able to start taking the splint off for light activities, as guided by your hand therapist.

• You may have dissolvable stitches. These stitches will gradually fall out and disappear around 2 weeks after your surgery.

• If you have non-dissolving sutures, these will be taken out either by:

  • your therapist at your follow-up appointment; or

  • by the nurse at your GP surgery around 2 weeks after your surgery.

  If your GP practice nurse removes them, you will need to book this appointment yourself.

• Compared to non-smokers, smokers are more likely to have complications after surgery. Complications include delayed tissue healing and infections. If you need support to stop smoking, please contact One You Kent on 0300 123 1220, or email.

• Elevating (raising) your hand is important to prevent swelling and stiffness in your fingers. Remember not to walk with your hand dangling down by your side. Do not sit with your hand held in your lap.

• You can start scar massage once your wound has fully healed and a scar is forming. Use a small amount of moisturiser (such as E45 or Diprobase), and massage your scar in deep circular motions. This helps prevent:

  • hypersensitivity

  • the tendons becoming stuck to surrounding structures, causing problems with the movement of your hand

  For more information, please read our Scar massage leaflet or speak to your therapist.

Exercises: 2 to 4 weeks after your surgery

Your splint supports your wrist, whilst leaving your thumb and fingers free. It is important to keep your thumb and fingers moving fully, so that they do not become stiff.

• These exercises should not be painful, but may feel slightly uncomfortable. Take your normal pain medication (such as paracetamol) if needed. If you are unsure, please contact the Hand Therapy Service.

• Always exercise gently and slowly.

• Remove your splint 4 times per day to do the exercises below.

• Aim to do 5 to 10 of each exercise.

It is normal for these exercises to be uncomfortable, but they should not cause pain. If they do:

• Try more gentler / smaller movements, with less repetition. Build up slowly.

• If your wound has healed fully and the dressings are off, you can do the exercises after warming your hand up in warm water or using a heat pack. This can help with pain and stiffness.

You may use your operated hand for light activities. Wear the splint for support and comfort as much as you need to during the day. You must wear the splint overnight and any ‘at risk’ times. ‘At risk’ includes being in busy places and on public transport.

Do not perform any strenuous activities or weight-bear through your hand. Weight bearing is leaning through the hand, for example when pushing yourself out of a chair or doing a press-up.

4 weeks after your surgery

• Continue with the above exercises.

• You can start driving once you feel safely in control of the vehicle. Make sure you are confident enough to make an emergency stop. Avoid long journeys until you feel more comfortable.

• Continue to massage your scar at least once a day for up to 6 months. This will keep the scar supple while it is still maturing.

6 weeks after your surgery

• Around 6 to 8 weeks after your surgery you will have an appointment with your surgeon. At this appointment your surgeon will check your progress.

  If the implant is stable, depending on your progress, your therapist may teach you some new exercises. These exercises will vary between patients, so are not included in this leaflet. You will be given a separate leaflet with all the instructions you will need.

• Continue to wear your splint overnight for a further 6 weeks. You can wear your splint as needed in the daytime for comfort.

• With the guidance of your therapist, gradually increase your activity levels over the next few weeks. Aim to get back to most of your normal daily activities at around 12 weeks after surgery. It may take up to 6 months to return to some heavier activities and sports, but this does vary between individuals.

• Do not force your hand into painful gripping or pinching tasks.

• Continue to massage your scar at least once a day for up to 6 months. This will keep the scar supple while it is still maturing.

12 weeks after your surgery

• You can stop wearing your splint 12 weeks after surgery.

• You may return to all heavier activities and sports. Only do this if your wrist feels comfortable enough. You may still choose to wear the splint to support your wrist in certain activities for a bit longer if this helps. It may take up to 6 months to return to some heavier activities and sports, but this does vary between individuals.

• Continue to massage your scar at least once a day for up to 6 months. This will keep the scar supple while it is still maturing.

• Follow advice from your therapist on how to protect your joints to get the best long-term outcome from your surgery. For more information, please read the Advice on protecting your joints leaflet.

Remember that getting a good result from this surgery is directly related to the effort you put into your rehabilitation. Please follow the advice and guidance given to you by your therapist.

Will I have follow-up appointments?

Yes. How many appointments you have and how often you have them will depend on your recovery. You will discuss this with your therapist at your first follow-up appointment.

What if I have any questions?

If you have any further questions, please speak to your therapist.

• Hand Therapy Team
  Telephone: 01227 783065; option 2

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