Signs and symptoms
- Unable to fully flex finger or thumb into the palm
- May experience pain where the tendon has been injured
Diagnosis
- The majority of injuries can be found by history and physical exam. However in some patients, especially if the injury occurred several weeks or months ago, an MRI may be necessary.
Background
“Flexor tendon” is a general term that describes any of the tendons of the forearm/hand that facilitate active wrist and finger forward movement (flexion). Two tendons in particular, the FDS and FDP, control many important finger movements. These tendons are at risk of damage from anything that cuts, crushes, or otherwise creating trauma to the palm side of the hand or fingers.
A tendon repair is an immensely delicate procedure, and the repaired structures are very susceptible to tears if you do not follow doctor/therapist instructions. Listen closely to all education provided to you, and try to remain patient — recovery can take up to 4-6 months. However, if you try to rush the recovery process, you will likely end up interrupting or delaying the healing process. Any unintentional tendon damage that occurs post-operatively will likely require another surgery to fix it.
The following is a general guide, but everyone’s exact situation and rehabilitation process is slightly different. Flexor tendon injuries are typically severe and complex injuries that involve multiple structures. If more than one tendon was repaired, or more than one surgical procedure completed in the same operation, your recovery may be different and/or longer than the process described below.
Hand Therapy
Week 1:
- The bulky dressing will be removed. It may be replaced with a light compressive dressing, or wrap for swelling control. A custom-made removable splint will also be made which fits over the back of your hand/wrist/forearm and keeps your wrist and knuckles slightly bent, but your fingers straight. It is extremely important that this splint stay on at all times (day and night), until you are told otherwise. It will help protect your repaired tendons, while allowing you to do special exercises. You will need to cover it when you bathe, and keep it dry.
Week 2:
- Toward the end of week 2, you will meet with your therapist. He will instruct you on exercises to complete within the confines of the splint, in which you use your unaffected hand to passively move your surgically-repaired hand and fingers. Complete these exercises every single day, at least 4-5 times per day. The exercises are designed specifically to maximize movement and range of motion SAFELY, without putting unnecessary stress on the repaired tendon. If your therapist does not specifically instruct you to do something, do NOT do it. During this time period, scar management techniques will also be completed. Your therapist will perform these during therapy, but will also instruct you on how to do them at home. These massage techniques will help prevent sticky scar tissue from building up around your healing tendon, restricting its movement.
Week 3-4:
- Within the confines of the splint, active range of motion exercises will be initiated. Your therapist will show you how to do these safely, without straining the healing tendon. During therapy, massage techniques will continue to be used to soften and flatten your scar, and to prevent excessive scar tissue build-up. Your therapist may use other tools such as kinesiotaping, therapeutic ultrasound, manual techniques, and compression wrapping to facilitate healing and maximize motion.
Week 4-5:
- Your therapist will typically instruct you by this point to begin taking your splint off a few times a day while completing the exercises. You will be shown how to do this safely and carefully, and on a regular basis — however, you must continue to wear the splint between exercise sessions and while sleeping.
Week 5-6:
- If all has gone well up to this point, you will be able to gradually stop wearing the initial splint. Depending on how your range of motion has progressed, a smaller splint may be created for you to position your fingers and maximize range of motion. Continue exercises that are provided to you, but even if your splint is discontinued, do not attempt a tight grip, and do NOT squeeze your hand against resistance (this includes avoid any stress balls, tennis balls, hand exercisers, foam blocks, etc). Your repaired tendon is still very much healing, and still at high risk of ruptures/tears if you squeeze your hand/fingers.
Week 8:
- VERY GENTLE strengthening exercises may be started around this time, depending on your doctor/therapist’s instructions. Again, your tendon is still actively healing, and you MUST still avoid any heavy hand use (no gardening, cooking, cleaning, squeezing, pushing/pulling, sports, picking up grandchildren, etc). Your therapist will slowly progress you toward increasingly-resistive exercises and activities.
Week 10-12:
- You can start slowly incorporating your hand into light activities like dressing, combing hair, and turning door knobs.
Week 15-16:
- Heavier weights and resistance to the hand and fingers can slowly begin. You can begin using your hand in progressively-heavier home activities like sweeping, gardening, yard work, etc.
*There are several numbered “zones” that surgeons use to classify flexor tendon injuries, ranging from the tips of the fingers to the far end of the forearm. This is a general guide, but different zones heal at different rates and require different considerations; your doctor/therapist will give you more information about your particular injury.
