Objective To explore the effects of a multimodal perioperative hand function rehabilitation training program on the recovery of adolescent patients following surgery for Hirayama disease. Methods Adolescent patients with Hirayama disease who underwent anterior cervical decompression and fusion (ACDF) in the orthopedic department were selected as study participants. They were divided into groups based on the time of admission. Fifty-one patients admitted between May 2023 and May 2024 were assigned to a control group, receiving conventional postoperative functional exercises for ACDF. Forty-nine patients admitted between June 2024 and May 2025 were assigned to an intervention group, where a multimodal hand function rehabilitation training program was developed and implemented. The compound muscle action potentials (CMAP) of the abductor pollicis brevis and abductor digiti minimi, as well as upper limb mobility, were compared between the two groups post-intervention. Results Forty-eight patients in each group completed the study. At 8 and 24 weeks postoperatively, the CMAP measurements of the abductor pollicis brevis and abductor digiti minimi in the intervention group were significantly superior to those in the control group. Significant time and interaction effects were observed for both muscles, and a significant inter-group effect was observed for the abductor digiti minimi (all P＜0.05). At 24 weeks postoperatively, the intervention group′s scores for upper limb disability and symptoms were significantly lower than those of the control group (P＜0.05).Conclusion The implementation of multimodal-based rehabilitation training can improve the compound muscle action potential of the abductor pollicis brevis and abductor digiti minimi in adolescent patients after Hirayama disease surgery, thereby promoting the recovery of upper limb functional activities.