Copyright © 2007 - 2011
Mathias Masem, M.D.
All Rights Reserved

Patient Instructions



Often the onset of pain is related to edema or overuse of your extremities. .Edema is swelling produced by trauma, immobilization, or circulatory restriction. Edema is part of an inflammatory reaction which can lead to formation of scar tissue and joint stiffness.


  1. Elevation of the extremity at all times is one way to prevent or limit edema. Support your arm with your elbow above your heart. Sleep with your arm across your trunk or on a pillow placed by your side.
  2. Coban can be used to reduce edema during day or night. Coban should always be laid in place with no tugging or pulling. Coban becomes more compressive with time and increased body temperature. Begin coban at distal portion of finger or hand and gradually wrap circumferentially. Overlap coban by inch so that it adheres to itself.
  3. Wear your cast or splint as instructed by your physician or therapist to allow injured tissues to rest and be supported.
  4. Use coban compressive wrap if instructed by your therapist.
  5. Actively exercise as instructed by your physician or therapist. Too little or too much motion can increase edema.
  6. Retrograde massage using oil or lotion will help decrease edema. Start at the fingertips and work up the arm, past the elbow. Apply pressure only in this direction to promote flushing the edema toward your lymph nodes.
  7. Contrast baths cause vasodilation (warm water) and vasoconstriction (cold water) in the body's cells which decreases swelling and relieves pain. Place two tubs large enough so that you don't have to bend your hand or arm in an awkward position. One tub is filled with warm water @ 99 F. and the other cold tap water @ 66 F. Alternate hands between tubs beginning with cold for one minute, then warm for one minute for a total of 11-15 minutes. Always end in cold water.
  8. Icing is an excellent way to relieve pain, swelling, inflammation or muscle spasm. Limit the time of ice application to 10-15 minutes. Ice the inflamed or swollen area at least 3 times daily. Use any of the following icing methods: ice pack, alcohol pack, iced towel, ice massage.
  9. TENS (Transcutaneous electrical nerve stimulation) can often reduce or eliminate pain. TENS must be prescribed by your physician. A specialist in the use of TENS will instruct in the appropriate use and placement of the TENS unit. This may include your treating hand or physical therapist.
  10. Never let your edematous arm hang down at your side, soak your hand in hot water, or apply splint straps too tightly.


PROBLEM SOLVE whether symptoms arise because of faulty posture, poor lifting techniques, muscle fatigue, or lack of rest breaks. Then, take positive measures to change risk factors than can decrease or ELIMINATE the discomfort.

SEEK HELP from your physician, nurse practitioner or therapist if you cannot manage symptoms of discomfort on your own. Examples may include:

  • You cannot perform your assigned exercises without increased discomfort.
  • You are consistently awakened from sleep due to discomfort.
  • Your discomfort interferes with performance of work duties and activities of daily living.