Remember the big thing with avocado hands a few years back? People were cutting the inside of their hands when cutting avocados?
Avocado hands pretty much was discussing what happens when you cut the palms of your hands or fingers so deeply that it cuts one or both of the 2 flexor tendons that we have in our hands.
Understanding Flexor Tendon Injuries
Flexor tendons in the fingers are one of the most critical elements that allow you to be able to make a fist. Imagine those tendons are like rubber bands, once cut, they snap back towards where the belly of the muscles are.
Flexor tendon injuries are injuries to the tendons that connect the muscles in the forearm to the bones in the fingers, allowing the fingers to bend. These injuries can range from partial tears to complete ruptures and can be caused by trauma, such as a deep cut or crushing injury, or from overuse.
Flexor tendons have to be repaired via surgery.
Treatment for a flexor tendon injury typically involves surgery to repair the tendon followed by rehabilitation therapy to restore finger function. Rehabilitation therapy involves a series of exercises and stretches designed to gradually increase the strength and flexibility of the injured finger. The length of therapy required for a flexor tendon injury varies depending on the severity of the injury and the individual’s response to treatment. Early intervention is critical for the best possible outcome, so it is important to seek medical attention promptly if you suspect you have a flexor tendon injury.
Patient’s story and importance of early intervention
I actually had a client come in with a laceration that the emergency room doctor missed. They sewed up the finger but then my client later discovered that she could not bend the small finger. After consulting with the surgeon who advised about doing the surgery, the patient came to me for a second opinion.
Not because I can do the surgery, but to find out if she really needed to have the surgery, the repercussions of not doing the surgery, and my opinion.
The surgery IS needed if you want to be able to bend the finger. No amount of therapy is going to make it bend without the reattachment. Surgery is required. Depending on which tendon was cut, how long ago the tendon was cut, and your activity level and functional requirements → can help you make the best decision for you.
So if you or someone you know has a flexor tendon laceration and required surgery…feel free to forward this email to them. It might help save them time and heartache.
What is the approach to flexor tendon repair?
Flexor tendon repairs have to follow a specific protocol – meaning when to start, how to progress, and when you are fully allowed to return to normal activities. The surgeries and the therapy required are one of the procedures that have changed THE MOST in the past 15 years.
It used to be that you couldn’t start moving it early….and everything was blamed either on the patient or (most likely) the therapist. Now, there’s been a lot of research and changes in the approach to surgery because it was found that when the surgery was not done well, there was an increased risk of rupture.
Now with the wide awake approach, the tendon is being done while you are awake so that the tendon can be tested to fix any potential issues before closing up. Surgeons can see if there’s a gap on the tendon when it gets pulled on.
The Role of a Certified Hand Therapist in Flexor Tendon Repair
Yes….for this type of injury and surgery, seek out a certified hand therapist who knows how to work with these types of surgeries. Not starting correctly or progressing correctly could lead to needing another surgery and prolonged time in hand therapy.
The Five-Step Plan for Recovery
This is a quick 5 step plan you should be following with your CHT
- Get started early 3-5 days even with the wound.
- Get fitted with a custom-fitted orthosis – it must be comfortable and stop all fingers from moving so that you wear it all the time.
- Get educated by your CHT on what to do and what NOT to do. This is essential to your recovery.
- Follow up is a must – frequency is determined by you and your specialist. I normally recommend 3 times a week at the beginning and then weaning down based on the complexities of the case. Why risk getting stuck?
- Progression towards full motion with no pain.
Hand Therapy is best when started 3-5 days post-operation. Even with the stitches, your therapist should be teaching you how to clean it, looking for healing, and signs and symptoms of infection. Keep it clean and there won’t be any issues!
You would be fitted with a custom fitted orthosis (i.e splint) on the first visit to wear at all times to protect the tendon surgery but allow you to move it very specifically with the instructions from the certified hand therapist.
Precautions to Take After Flexor Tendon Repair
The #1 precaution after a flexor tendon repair is to NOT use your hand. Yes…that can be hard but you can mistakenly use it, grip hard, and rupture the tendon which would require MORE surgery.
Exercises are specific based on the strength of the repair, the location, as well as the consensus between the hand therapist and the hand surgeon. Based on many years of experience, I do like to be more aggressive when I see there are risks of stiffness, and I like to slow down when someone is “healing” too well. That is usually an indication that there is not enough scarring.
Working with a skilled certified hand therapist when you have a flexor tendon repair is just as essential for a full recovery as it is when finding a great hand surgeon as well. Don’t skimp on the therapy.
It’s the difference between getting the best possible results or living with a stiff hand and requiring a second surgery.
We work with the majority of the hand surgeons in our area. Since I’ve been treating flexor tendon surgeries over the past >20 years, I’ve seen some easy as pie cases to the most complex cases that require multiple surgeries.
If you or someone you know is suffering after a flexor tendon repair (or even other hand surgeries), give us a call at the office to request speaking with our certified hand therapists.
We’ll help you get on what it takes to get the best possible results without risking another surgery.
We’ll even tell you if therapy is not helpful and that you need to have another surgery. Just get clarity on what your best options are.
PS. If you know someone who’s had surgery, grab my guide on what to consider after hand surgery….grab my free guide here.
Written by Hoang Tran
About the author – Hoang Tran; an expert in physical & occupational therapy
Hoang Tran is a 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 Miami 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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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.