Rehabbing from surgery.

December 30, 2007 4:56 PM

Has anyone out there had to rehab severed extensor tendons in your thumb and/ or index finger?

After going one on one with a kitchen knife I severed both extensor tendons in question. Yeah, it never turns out quite like you hope. Anyway, both were surgically repaired. At this point post-op I will not start rehab for a few more weeks and am still in a monster splint.

What can I expect?

posted by caveat empress to health & fitness (5 comments total)

I managed to nearly sever the extensor tendon on my ring finger... It was a tad short of needing surgery... but I managed to get by without surgery.

It meant wearing a strange little cast thing on my hand for a month or so...It consisted of a wire extension over my finger with a rubber band that would pull my finger into a straight postion.

Rehab consisted of (once it had healed some) twice a week visits to the occupational therapist for about two months.

The mistake in my treatment was too much tension on the finger which now means that it has a bit of a backwards bend to it at the first knuckle... not a huge problem...just a bit strange...

The biggest drawback was I couldn't play the violin for that period of time... and typing was difficult........

now things are pretty much fine....
sorry to hear about the injury!
posted by HuronBob at 6:35 PM on December 30, 2007

My boyfriend severed 7 tendons in 4 fingers (his thumb was spared) a couple of months ago when he accidentally put his hand through a plate of glass. His tendons were severed further up his forearm, though, so I don't know how similar his recovery will be to yours, though.

Having said that: he was also in a monster split for awhile following surgery before beginning physical therapy, which he's been doing twice a week for about a month (he'll soon go to once a week). It was slow-going at first, but now he's got most of the movement back in his hand/fingers; his physical therapist and surgeon are both pleased with the rate of his recovery.

The main problems he's having are: 1) he's very sore and has limited movement in the mornings; it takes awhile (sometimes a few hours) for his hand to "warm up," as it were; 2) his movement in his index finger is limited (he can bend at the knuckle at the base of the finger but can't bend at the second knuckle or the tip to get his finger to curl in all the way), and he may have to have a second surgery for that; 3) a couple of the tendons further up his arm (around his wrist) are getting "caught" on some of the scar tissue from the surgery, which also limits his movement a bit. This is apparently not uncommon, and may work itself out over the next several months (but if not, he'd have to have another surgery to correct it -- too soon to tell if that's necessary at this point). Other than his soreness in the mornings, he hasn't had too much pain.

The main thing to keep in mind is not to push yourself beyond what they suggest when you start rehab -- if they tell you to do your exercises only for 5 minutes twice a day (or whatever), don't think that doubling up on them will make your recovery go twice as fast. It's a natural impulse to try to speed things along, but you can really overstrain yourself in the early stages, which could cause a setback.
posted by scody at 7:27 PM on December 30, 2007

I did this over 20 years ago to my right-hand index finger. In fact the finger was severed completely and reattached. I had to wear one of those monster splits for quite a while. I also got a bad cut across the 'web' part between index finger and thumb, which screwed up my grip.

The most important thing I remember being told was to keep bending the finger as much as possible, but not beyond where it was uncomfortable. At first it wouldn't bend too far, but I was told that if the tendons aren't stretched by a little bending at the start, I wouldn't be able to stretch them later and would lose motion in my hand.

The hospital will refer you to a physio or occupational therapist who'll be able to give you some specific exercises. I recall I was given a soft rubber ball to squeeze in later stages, but at first it was just the 'bend the finger' stuff. IIRC, at one point after the splint came off they taped the index finger to the middle finger to make it easier to do the bend exercises.

I was advised to rub Vitamin E oil into the finger because this apparently reduces the amount of scarring - specifically keloid scarring (that raised, white scarring you can get after surgery). Use the Vitamin E capsules you'd take as a supplement - they contain a higher concentation of Vitamin E than cosmetic Vitamin E oil. Pop the capsule with a pin and rub the oil in.

Now, many years on, I have 99% movement in that finger. I used to knit, but can't do that now because I can't hold the knitting needles - my hand goes into a claw. Things that require a hard grip in my right hand can sometimes prove troublesome - jar lids, taps, doorknobs. But I still type at 90wpm. I have no problem using a mouse for several hours at a stretch. I try to avoid bonecrusher handshakes - I offer my left hand instead. And although I have sensation in the tip and at the base of the finger, the middle section remains numb. I met someone else who'd had the same injury, and he reported the same thing.

I found that picking small things up was very difficult, especially coins. I had to practice this, and sometimes still find it hard.

In very cold weather, the finger goes blue. It's definitely a talking point when you take off your glove and you have a blue finger on a pink hand. The circulation is fine, btw, I've had it checked and I was told that 'blue finger' is a phenomenon associated with this type of injury.

The best thing, though, was this: About two weeks after the surgery, the whole top layer of skin on my hand peeled off, like a glove. It was the coolest thing ever. I kept my skin glove for a while, showed it to people and grossed them out, and tried to preserve it by rubbing it with Vaseline intensive care lotion, but it dried out and crumbled away. I really wish I still had it.
posted by essexjan at 2:26 AM on December 31, 2007

I helped rehab one of those, cut 4 tendons, one in two places. When they took off the cast, they didn't want him to pull on it much for fear of ripping the repairs. I brought the laptop in with a joystick and some kind of flight sim software, and he flew a little every day. The theory was, he couldn't close his hand too much around the joystick, plus it was in a position of function. By the time he was pronounced ready for rehab, he was back at work and didn't have time, and didn't need it anyway. (Dominant hand, so he was using it anyway after it was movable.)
posted by unrepentanthippie at 1:16 PM on December 31, 2007

Wow, I really appreciate these different perspectives -- I kind of have some ideas... as far as what can happen with therapy -- and after that is over I am worried (I worked with my hands in a very physical capasity) but, it is much better to hear some real scenarios versus medical professionals who want to give best case scenarios. I know that I will be tempted to 'over do' it with the rehab... So, I am going to keep reminding myself that it could cause a set back, and man... I do not want to go through this again due to my own further doing.

It sounds like playing the violin was possible after rehab - and this gives me hope that I will be able to play the flute again - but I had just purchased a guitar, and was not doing well with the fingering as it was.... at least I have an excuse if I cannot play a note on it after this is over!

I am bummed that I did not get the skin glove! I DID however get a few pictures with my camera phone in the ER, and was able to stay awake and watch the surgery, which was an amazing experience. The blue finger thing might be an excellent way to meet a guy though!

I do get to start some movement with my index finger Wednesday... In the meantime I am going to hunt down an old playstation or the like... and get pacman to start some of my own, at home rehab! Cool idea~
posted by caveat empress at 3:04 PM on December 31, 2007