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5 Ways to Recover Better and faster after Flexor Tendon Injury

common hand injuries -patient at hands On therapy

If you have cut your fingers, you might have suffered from a flexor injury that required surgery. So, if this has happened to you, this article is for you. I’m gonna talk about the five ways in which you could recover better, faster after a flexor injury. 

My name is Hoang Tran. I’m an occupational therapist and certified hand therapist and clinic owner in Miami, Florida. And I also teach other therapists to become certified hand therapists

What is a Flexor Tendon Injury?

Flexor tendon injuries are some of the worst hand injuries that anyone could have. Your flexor tendons, which are the tissues that aid in controlling hand movement, can suffer injury from a deep cut on the palm side of your fingers, hand, wrist, or forearm. Your fingers or thumb may not be able to bend due to a flexor tendon injury. And if you’re going through this, I’m really sorry. I know it must be so frustrating. It can be so depressing, and there can be so much confusion around what to do, what to expect. So, check out the video I did on the five ways to get the best and fastest recovery because I make some really important recommendations there.

This is one of the most severe and complex types of injuries for the hands. So, I’m gonna specifically talk about this zone, and it’s the zone in your fingers, because this tends to be one of the most severe zones. Our flexor tendons actually start in our elbow, right? So, the muscle starts here, and the belly is about this long, and then it becomes tendons. And that muscle belly divides into four tendons, and each of them goes to each finger. And that tendon’s called the superficial, and what it does is it bends your middle knuckle, and it helps bend your big knuckle, and also helps bend your wrist.

There’s a second tendon, also starts out in the elbow and becomes four tendons, and it goes to the tips of your fingers, and this is called the profundus. And what it does is it helps to bend the little knuckle of your finger, and because it crosses all of these other joints, it also helps to bend your middle knuckle, your big knuckle, and also your wrist, right? And one of the reasons why I’m explaining a little bit about anatomy is because, as someone with a flexor tendon, this is what I do for my own patients when they come into my clinic, and they, like, you know, a lot of questions on why. “What’s happened to me? Why do I have to be in this big old splint? Why do I have to stop moving for a period of time?” This is exactly what I’m telling them. So, if this is an injury that you are currently suffering from, this might help you to talk to your therapist, to talk to your doctor, and to get more clarity in terms of, you know, what you need to do and why you need to do what you need to do.

I’ve been teaching occupational therapists and physical therapists who’ve become certified hand therapists for a while, and what I can say is this type of injury has had the most changes in the academic world, in surgeries, and in how we do our therapy, right, how we progress our people who come in with these types of injuries, more so than any other type of injury over the last, you know, 15 to 20 years. I remember, over 15 years ago, going to a conference, and this one doctor pioneered this, what’s called a wide-awake approach. And back then it was like, “Oh, nobody’s gonna do it.” Now everyone’s doing it. They’re doing the surgery while you’re awake. It’s called a wide-awake approach. And when it comes to flexor tendons, right, if you have a cut in your fingers essentially between the big knuckle and the little knuckle, this zone right here. This zone right here is called no-man’s zone, or zone two, right, from a technical standpoint. When you cut that zone, you essentially are adverse to having cut both tendons. Majority of the time, if you cut one tendon in that area, you’ve cut both tendons.

And so, you know, one of the ways to get better and faster recovery after a flexor tendon is really understanding your injury, right? So, let me actually go over the five ways to recover better, and then I’m gonna go into detail a little bit about, you know, what you, as the person going through this, can think about, right? So, you know, I know a lot of people come to YouTube for how-to’s, but I think, you know, especially with this injury, it’s really important to understand, like, what’s going on, so you can know, you know, what the exercises really are that you need to do.

5 Ways to Recover after Flexor Tendon Injury

  1. Knowing your injury. 

This is why I’m explaining about your tendons. I’ve had patients come and ask, “Did I really need to have surgery?” And the answer is, “Yes. Yes, you really need to have surgery. Yes.” You go to the emergency room, they can stop your bleeding and everything. But, if the hand surgeon doesn’t repair, doesn’t sew the two ends of your tendons back, there’s no way for that muscle to pull on that tendon to move your fingers and to bend those joints, right? So tendons, in general, especially in the hands, if you have a full cut, you need to have surgery. Without the surgery, the consequences are, without the surgery, you just won’t be able to move your hand, which then means your hand becomes completely non-functional, right? Without those tendons, you can’t bend it. Number one, know your injury. And this is why it’s so important to know your injury.

  1. Ask questions

If you can’t remember them right when you’re at the doctor’s office or with your therapist, like, I encourage my patients, write them down. Write them down. That way, when you come in, you can ask me as many questions as you need, and you can ask them as many times as you need to ask them, because you need to be reassured that everything’s gonna be okay. You need to be reassured that, yeah, the tendon is intact. So, that’s one of the most common questions that I get. Like, did the surgeon do what he was supposed to do? Is that together? Is it been put together?

And usually, there’s a couple things that I do to check to make sure the tendon is intact. And, you know, there are things that we can look for, like, so, for example, when someone comes in and they have no sensation, one of the things that we look for is, like, how is the sensation returning? Because sensation returns very slowly. Just know that sensation returns very slowly. 

So, if you’re impatient, you’re like, “But I can’t feel it,” just know that that sensation returns back really slowly, and there are ways in which we could, like, see how much that sensation is coming back. But the most important thing is, like, making sure that those tendons get moving. and get moving really fast. So, some of the questions you could be asking was, “What was repaired?” Right? “What was repaired? One tendon? Two tendons? Were there any nerves? Were those repaired?” Because it’s really important for you to understand, and then your therapist needs to understand that as well, like, what was repaired, so that they know what to do in terms of therapy. Right?

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When can I start moving? When can I start moving? What is the protocol that you use? Right? So, you can ask these questions to the surgeon, you can ask these questions to the therapist, and a lot of times, I bring this up, because I feel like, you know, my patients don’t know to ask these questions. And they’re really important, because in flexor tendon injuries, ideally, you want to start as soon as possible. You can start as soon as three days. There are some protocols now, some surgeons do the wide-awake approach, and they’re starting in the OR. 

They’re starting in the OR, meaning while they’re putting, tying your tendons together, you’re awake and you’re seeing, they are seeing that the tendons are able to move. And by seeing that those tendons are able to move, they can see that the repair was strong, that there was no gap in the tendon. So, they can, you know, have an eyeball, and then they can see that you’re able to move well. And then, right after they wrap you up and everything, you’re still able to move a certain amount, even with all that post-op dressing.

And then, by day three, even as late as day five after surgery, you want to be taken out of all that bulky dressing, and then put into a different type of splint. So, there’s various different types of splints, depending on the protocol, but those splints are meant to protect the repair. And the reason why all of your fingers need to be included is because, remember, at the very beginning of the video, I said that it’s one muscle belly, and divides into four tendons. So, just because you cut one tendon, we have to lock down all your fingers, and that’s because if you start moving all the other fingers, then you’ll move the one that was repaired as well. So, how, you know, when to start, and what the protocol is, is really important.

  1.  Seek out a really great hand therapist. 

Seek out a hand therapist in which you can ask these type of questions to. Like I said, at Hand Therapy Secrets, I teach other therapists the exact protocol, how to move people. And what I’ve been noticing a lot is, you know, just people with these type of injuries coming in and asking me, and I cannot give medical advice. Just like this is right now, I’m not giving any medical advice to anyone. This is just me sharing with you what I do in my clinic and how I advise my own patients when they come into my clinic. You want to find a really great hand therapist in which you can ask these questions to, someone who’s gonna spend time with you, someone who’s gonna spend time and answer these questions for you.

  1. Get a second opinion if you’re not sure. 

We get a lot of people coming in, you know, as second opinions, but I can tell you right now, when it comes to protocols, your first month in therapy is really key to getting moving right, and to getting to know how your recovery is going to be. This is a minimum three-month recovery period if you cut your flexor tendons. The first month, we’re getting as much passive range of motion as possible. We’re working on closing up your scar, reducing your swelling, softening your scar once your incisions close, and getting that tendon to start gliding. So, the first four weeks are gonna be really important, and it can determine how fast or slow you go in the following next several months. And then, that can go for, you know, four to six weeks, and then we wanna come out of your splint, and we want to start moving actively, and start to use your hands gently through your everyday living. But we want to get as much motion as possible. And then, by then, we can start to strengthen a little bit.

And then by 12 weeks, which is 3 months, you can do the majority of everything. You just don’t wanna do extreme, heavy gripping up until, like, 15 weeks. This is a very generalized protocol. There are definitely nuances to this protocol. There’s, you know, various protocols out there that your doctor might follow, your therapist might follow. I particularly like to go a little bit faster versus a little bit slower, because, like I said, surgeries have advanced, and, you know, surgeons are doing these surgeries much stronger, and so it’s a lot safer. But, of course, it just depends on how you are doing. So, that’s why it’s so important for you to find a local certified hand therapist that’s gonna help you, who has experience. And if you feel like you’re not getting results, like, I encourage it all the time, go get a second opinion. People are on YouTube getting second opinions, learning, researching. And I think it’s valuable to go in your community and find somebody. A lot of times, people come to us, like I said, you know, looking for that second opinion, to see, like, “What’s going on? What’s going wrong? What’s going right? What should I expect?” you know, just someone who can answer these questions for you in an honest way.

And then number five is to participate. I mean, I’ve gotten some of the best recoveries when the person that I’m working with, my patient, participates, right? These exercises that are given are very repetitive. And hand injuries, they can be very depressing. And so, because you don’t see the recovery as fast, it can be very, you know, demoralizing. It can be very depressing. You start to think about, like, what’s gonna happen with your life if you can’t fix your hands. Majority of people need their hands just to feel and be independent in their lives. People need their hands to be able to work, right? to be able to work. What’s gonna happen from a professional standpoint if you can’t get your hands right?

These two fingers, plus your thumb, give you fine motor ability. It allows you to put your earrings on, button your…to type, that kind of stuff. Like, you can actually type without bending your fingers, but, you know, it’ll hurt you after a while, but… It’ll hurt something else after a while. But, you know, to be able to, you know, open doors, turn keys, that kind of stuff, these are the two fingers. These two fingers, your ring finger and your small finger, it’s what gives you power, right? So, all the parts of your fingers are important in one way or another. These two fingers plus your thumb, it’s what gives you power. So, if you cut these two fingers and you feel like, “Yeah, I’m just not as strong,” it’s because these two fingers plus your thumb give you power in your grip. And obviously, you need all of them to have maximum power. So, this is why it’s so important, you know, to participate in your therapy, so that you can get the best possible recovery.

Is it possible, you know, to be able to fully open and to be able to fully close, make a fist? Absolutely. Absolutely, it’s possible. I’ve seen it happen. But what happens with these flexor tendon injuries is that there’s so many consequences. You can have scarring. Some people just scar really darkly. Sometimes people with more melatonin, like, I scar really densely, I scar really darkly. And, you know, that’s what causes the scarring to adhere and lock down those tendons, doesn’t let it glide. That’s why, you know, the very beginning stages of your recovery after flexor tendon is so important. And it is. If you can get started sooner, if you can work with a therapist that you trust, it is possible for you to get full recovery.

Now, if you wait, right? If you wait, because maybe it hurts, maybe you’re not seeing the recovery as fast as you would like, it’s going to slow your recovery down. There’s two consequences to this type of surgery, is if you’re too aggressive, too fast, you can “rupture” the tendon. But what research has found, and it’s in every textbook when it comes to flexor tendon from a surgeon, therapist, you know, studying this, is that if there is a gap in the repair, that is the highest risk of rupture, not just, like, oh, the therapist didn’t do their job, or the patient, you know, was too aggressive. Obviously, there’s those aspects to it. But first and foremost, the repair has to be strong enough where the two tendons are held together. And that’s gonna reduce your risk of a rupture.

The second consequence of these types of injuries is the scar adhesion. The scar adhesion is probably the most number-one issue. And that’s why getting to, you know, a trusted therapist is so important, because scarring becomes such an issue very, very, you know, fast, very early on. And if you don’t move the tendons, and you scar down really, like, tough and thick and dense on the inside, you’re at risk for requiring a second surgery. And that’s for a whole nother video, because there’s a lot to go into what is required, you know, before and after a second surgery. But, if you want the best possible recovery, you don’t wanna have second surgery, those are the five ways. Really understand your injury, ask questions, ask them as many times as you need. Don’t feel bad. It’s your injury. Don’t feel bad about asking questions. Find a really great therapist who’s gonna take time to answer these questions for you.

Seek a second opinion if you really need to. Trust your gut. I tell my patient, “Trust your gut. If you want a second opinion, go ask.” Majority of the time, people are coming to us here at Hands On Therapy Services as a second opinion. So, by then, we’re already battling a certain amount, right? And then, participate. But I think that when you understand all of those things, when you understand your injury, and you’re able to ask questions, and you’re working with someone you trust, you do participate. You do participate. We get the best possible recovery for our patients when they participate. So, if you’re, like, “I’m not getting results,” check out those five things, and consider, you know, what you need to do to help get the best possible recovery for you.

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Hand injuries are extremely debilitating. They’re extremely difficult. That’s why there’s, you know, board-certified hand surgeons, and there’s board-certified, you know, hand therapist, certified hand therapist. And it’s because injuries to the hand are very complex, but it’s possible to get really great results. I know because I’ve seen it. We’ve been able to get really great results for people. And sometimes, you know, it’s all based on the type of injury, right? Not all injuries are the same. I’ve had people cut in machines, you know, their fingers, almost losing their fingers, and getting great results. I’ve had people cut their tendon with a butter knife, which is the craziest stories, but that’s happened. I’ve had people just cooking, and some random, you know, accident happens, a knife just kind of falls or, you know, gets bumped or something, and it cuts their flexor tendons.

Final Thoughts

I think I’ve seen, you know, a lot in my over 20 years of working as a hand therapist, that I can tell you right now, even without, you know, knowing what’s going on with you, that there’s a lot of possibility, and it’s just about finding the right therapist to work with, to give you some insight. But the sooner, the better. The sooner, the better. Don’t wait. Don’t wait. Because, when you wait, your recovery is gonna just look different. All right? So, if this has helped you, please leave a comment below, and let me know if this has helped you in terms of getting a better understanding of your injury, and knowing what you can do next. All right. Thanks so much for watching.

Want to know more about Flexor Tendon Injury?

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 About Hoang Tran – an expert in physical & occupational therapy  

Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!). 

The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

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