Metacarpal Fracture ORIF Starter Exercise Guide

1. Hand & Wrist Elevation and Swelling Control

What it helps: Controls the swelling that is the main cause of stiffness after hand and wrist surgery. A swollen hand cannot make a full fist, and fingers left stiff in the first weeks are much harder to free later than the wrist itself is.

How often: every hour while awake sets of 10 slow fists, daily.

1. Rest the hand higher than your heart. Sitting, prop it on pillows or on the back of a sofa; standing, rest it on the opposite shoulder; lying down, support the whole forearm on cushions.
2. With the hand up, slowly make a loose fist and open it fully, spreading the fingers.
3. Repeat the slow fist-and-open several times, then let the hand rest in the raised position.
4. Come back to it regularly through the day rather than doing one long session.

Tip: Above the heart is the part that matters. A hand resting on your lap or in a sling at waist height is not elevated, and this is the commonest reason swelling does not settle.

2. Finger Range of Motion

What it helps: Keeps the finger joints moving through their full range — preserving the bend and straighten you need to grip, pinch, and use your hands for everything.

How often: 2–3 sets of 10, daily (several times).

1. Open the hand wide, fingers straight.
2. Make a full fist, then open again.
3. Bend each finger one at a time toward the palm, then straighten.

Tip: Smooth, comfortable motion through the whole range.

3. Tendon Gliding (Finger Glides)

What it helps: Keeps the finger tendons sliding freely through their sheaths and the carpal tunnel — preventing stiffness and catching, and keeping the hand smooth and supple.

How often: 2–3 sets of 5–10 of each, daily.

1. Start with fingers straight.
2. Bend just the top two knuckles into a "hook," then straighten.
3. Make a full fist, then straighten.
4. Bend the big knuckles only into a "tabletop," then straighten.
5. Make a "straight fist" (fingers curled but knuckles flat). Move slowly through each.

Tip: Move smoothly through the whole sequence.

4. Blocking Exercises (Isolated Joint Motion)

What it helps: Forces a tendon to glide rather than letting the finger move as a single unit, which is how stiffness at one joint gets missed. It is the most reliable way to recover movement at a specific joint after a tendon repair or a finger injury.

How often: 2–3 sets of 10 per joint, daily.

1. Rest the injured hand palm-up on a table.
2. With the other hand, hold the finger firmly just below the joint you want to move, keeping the joints closer to the palm completely still.
3. Now bend and straighten only the free joint beyond where you are holding, slowly and through as much range as it will go.
4. Move the holding hand to the next joint along and repeat.

Tip: The point is isolation. If the whole finger is curling as a unit, move your holding hand closer to the joint you are working.

5. Thumb Range of Motion

What it helps: Keeps the thumb's wide range — reaching, pinching, and opposing to the fingers — which is behind nearly every grip and pinch task the hand does.

How often: 2–3 sets of 8–10 each, daily.

1. Move the thumb out away from the palm, then back.
2. Touch the thumb tip to each fingertip in turn (opposition).
3. Make gentle circles with the thumb. Keep it comfortable.

Tip: Smooth, pain-free motion.

6. Gentle Neck Isometrics

What it helps: Strengthens the deep muscles that support and steady your neck without moving it — a safe, comfortable way to build the support that eases neck pain.

How often: 5 each direction sets of Hold 5–10 seconds, daily.

1. Sit tall with a gentle chin-tuck. Place your palm on your forehead.
2. Press your head lightly into your hand and your hand back into your head — a steady, comfortable push with NO movement of the neck.
3. Hold, relax, and repeat. Do the same with the hand on the back of the head, then each side.

Tip: Light pressure — about 20–30% effort. This is not a strength test.

7. Walking Program

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

How often: throughout the day.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tip: Use your assistive device as directed.

8. Scar Massage & Desensitisation

What it helps: Keeps the scar soft and mobile rather than tethered to the tissue underneath, and settles the hypersensitivity that makes a healed scar uncomfortable to knock or lean on. It is also what most helps the deep soreness in the heels of the palm after a carpal tunnel release.

How often: 2–3 sets of 3–5 minutes, daily.

1. Wait until the wound is fully closed and any stitches are out — usually around two to three weeks. Check with your care team if unsure.
2. Put a little unscented moisturiser or plain cream on the scar.
3. Press firmly with a fingertip and move in small circles along and across the scar, firm enough to move the skin over the tissue beneath rather than sliding over the surface.
4. Then rub different textures over the area — a towel, a soft cloth, clothing — for a minute or two, building from soft to coarser as it becomes tolerable.

Tip: Firm enough to move the skin is the point. Light stroking feels pleasant and does very little.

Recovery reading

• Carpal Tunnel Surgery Recovery
• Trigger Finger Surgery Recovery
• Wrist Fracture (Distal Radius) Recovery
• Hand Therapy & Swelling After Surgery
• All Hand & Wrist recovery guides