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  1. #26
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    Hello fellow tendon injury sufferers! I hope you are all doing well.

    I ended up having my last surgery canceled (I was at the hospital already!) because of complications from cases before me. So I ended up having my second attempt at the phase 1 Hunter Rod surgery yesterday morning. Even though I had pulley reconstruction in my first attempt, some of the reconstructed pulleys had scarred shut and needed to be reconstructed again. This time my doc had to use some autograph from my palmaris longus in my wrist. I guess I'll find out how much was removed when I have my follow-up appointment next week.

    Because of my previous Hunter rod failure, my surgeon came up with an alternative technique. He ordered a special version of the Hunter rod that is supposed to be for people that are replacing the tendon with the rod permanently and using it for active motion. This rod is designed to be anchored into the bone directly. He drilled a hole in my finger bone and attached the rod with a metal wire. Apparently, this is a rather pioneering way to do this, as none of his colleagues here or around the country have tried something like this before. As long as the rod doesn't detach again I'm up for anything. I'm also going to be much more careful than I was last time, dialing back on my exercise pretty much zero and treating the hand as if it were inoperable.

    We're going to try and accelerated process for the second phase. I'll probably only be waiting 2 1/2 months (10 weeks) before I have my next operation.

    So far, so good. I'm getting pretty used to the whole process. Still suck at typing one-handed, although I have learned how to use chopsticks with my left hand!

    Take care, I'll check back in after my next appointment.

    Justin

  2. #27
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    Great to hear from you. Sorry about the reschedule - that has to be big anticipation and scheduling and then a let down.

    My phase 1 on my left thumb seems good so far. Feels odd doing scar massage when you can feel the entire rod wiggling around a little. I'm doing lots of passive PT and the OT people have me moving the wrist and doing gentle extensions to try to restore as much joint movement as possible prior to phase 2. My phase 2 is scheduled for April 2nd, exactly 8 weeks after my phase 1. Wrist extension was 0 degrees 2 weeks ago and I'm up to almost 45 degrees or so now from that.

    I bought a therabath paraffin bath for home. I highly recommend doing so! I can now do heat treatments 3 or more times a day instead of once a week. It is far better than a heating pad and has really helped the scar. Should have bought this 6 months ago when primary repair was attempted. I'll probably keep it for good, but figured the $150 cost was worth it since I'm in major rehab mode easily through the summer; could always craigslist it some day.

    Amazon Prime
    Amazon.com: Therabath Professional Paraffin Bath TB6, Lavendar Harmony: Beauty

    Good luck and I'll update right after phase 2.

  3. #28
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    Hi Justin,

    Glad to hear that you were able to have phase 2 and are recovering despite all the obstacles. Sounds very cool what your Doc was able to do improvising. My PT was telling me about an elderly person who had the rod permanently since a 2 stage surgery and all the PT would have been too much to handle.

    I'm a month out from Phase 2, and have started trying to do some placeholds where I use my left hand to bring my fingers down and then try to actively keep them down. So far I can see my pinky finger tendons are trying to work. They are staying down a little on their own, however they cannot "actively bend" as of yet. It still tbd what will happen with the ring finger.

    I'm trying not to get discouraged my the process and have faith that they will come back. Part of my problem is that I haven't been given a timeline of expectations for when things will happen. I will be talking to my Doc soon, and will update when I have more news...

    Also, thanks for the link codecruncher, I may consider purchasing.

    In the meantime - keep trekking on!

  4. #29
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    Thanks for the link codecruncher! That's a great idea. I just ordered one and it will be here next week, well before I get my cast off.

    I am glad to hear both making progress. Keep the faith! I know it can be hard. As an incentive to myself, I have decided to order a new bike part every week until I'm back on the bike. Somehow my wife actually agreed to this plan

    J

  5. #30
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    First I want to say that reading this topic has made me feel at least like I'm not alone.

    I dislocated my middle finger at the PIP joint during my first/last Crit race March 1st of 2013. Pedaled through an S-turn, lost traction and fell on my side. The race was held at an auto raceway so I was unfortunate enough to get to meet one of the safety barriers, a 5 foot diameter tire, with my straight middle finger. Went to the ER, had to wait because my dislocation was complicated by a "knuckle pad" on top of my PIP joint, that went missing inside my finger somewhere.

    A few days later it got massively infected, three rounds of different antibiotics, which meant 12 days before I got any PT help. The infection combined with my knuckle pad, combined with my Duputrens Contracture (a disease Northern Europeans get where you over-produce scar tissue, often leading to a hand filled with bumps and fingers that that curl toward your palm.)

    Had two months of PT, one month where they were helping me heal from the infection and another month of them pushing a finger that had tendons stuck together and too much scar tissue to move.

    Saw three different hand surgeons, some who told me to cut it open and some who said to wait. I waited till 2014 with a frozen middle finger because I needed a new kind of insurance to be able to pay for the surgery without going broke.

    I had the surgery 3 1/2 weeks ago and have been in PT almost every day since. On Monday of this week, 3 weeks to the day from the surgery, and after a good hard PT I went home and while eating a doughnut the tip of my finger stopped working. I had an MRI which showed that my flexor tendon attaching to the tip of my finger had ruptured at the PIP joint. My surgeon called me and said I need to get in for surgery immediately so that the muscle holding the part of the tendon that is in my palm doesn't disappear into my arm. Like everyone here the method of replacement is to get a tendon from my wrist, or near my Achilles tendon or even from a toe. He's hoping that he won't need to open up the entire finger again if he can cut a hole in my palm and at the tip of my finger. He said I'll be in a splint for 6 weeks.

    I have lots of questions about why the rupture happened, was it the PT? Was it me picking up too much weight with my right hand? Was it the few MTB rides, that I got clearance from my PT, to make? Was my tendon compromised by the infection I had? Was the Tenolysis surgery too much for the tendon?

    I'd appreciate any insights you guys might have. Thanks

  6. #31
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    Vanillat,

    As someone who has had a rupture and then a subsequent failed phase 1, all I can say is not to beat yourself up over it. From what I understand, the general consensus by the medical community is to treat tendon injuries aggressively, as lack of motion tends to be the primary issue most people have and the chance of rupture is not affected (% of patients) by the aggressive treatment. Sure doesn't feel like a good trade-off when it happens to you, but equally bad is not having any movement in your finger at all with an intact tendon.

    Have you had the surgery yet? I'm surprised they would not try to reattach the existing tendon. This two phase stuff is pretty last resort.

    Best of luck with the surgery.

    Justin

  7. #32
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    Hey Justin,

    I'm having the surgery Monday morning. The doctor/surgeon said that because the tendon was likely weakened by a low blood supply that the two ends might not be healthy enough to re-attach. It's also speculation until he gets in there. The rupture happened at the PIP joint where I might have something that rubbed on the tendon. But who knows. Thanks for the support.

    Alex

  8. #33
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    Alex,

    I forgot to mention, the hardest part about the whole injury has been mental for me. In the grand scheme of things, we can get on just fine without a finger. It wont even really effect your riding once you adjust your braking habits. I have to force myself to keep perspective. I can't ride _now_, but there is no doubt that I will get to ride again, regardless of the outcome with my finger. You just have to look around this forum a bit to realize how much worse things could be.

    Not to mention, as athletes, we are used to regular endorphin doses. I think going through exercise "withdrawal" has really contributed to the mental challenge.

    J

  9. #34
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    Best of luck on Monday!! Hang in there - this type of injury can certainly be frustrating given the lengthy and complicated rehab. Let us know how you're doing.

    I'm excited even seeing my thumb IP joint move 4 mm via the silicone rod. That's more than I've seen since early August last year! T-minus 11 days to phase 2 graft surgery (and hopefully the final surgery to put all this behind me).

    The OT is amazing. In the span of 5 weeks I've gone from depressed that my wrist extension is 0 to basically back to normal. It is so tight right after surgery that you don't ever think it will feel anywhere close to normal again....and yet it comes around faster than I thought. My OT person created a "reverse splint" that I wear at night which provides a gentle extension stretch to the wrist and thumb.

    Think about the paraffin bath for home. I'm using mine 3x a day - feels awesome and my scar is responding very well.

    Do you guys sleep with the small silicone sheets stuck/taped to your hand? I've had those after both surgeries; the OT people gave them to me right away after suture removal.

    How heavy was the doughnut, a 2 hander?

  10. #35
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    Justin you are so right. Every time I go to PT that perspective hits me right between the eyes. It can always be worse and I can get by with a finger that't not 100%.

    Alex

  11. #36
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    Codecruncher, I bought the wax bath! Waiting for my stitches to come out before I use it.

    Things are going well, saw the Dr. on Friday and started doing my phase 1 PT again. Basically, just gentle passive motion of the index finger, not forcing anything and leaving it in the splint unless I am doing the exercises. Other than that, I am not doing any sort of physical activity. I'm definitely packing on some weight. Ordinarily, I would reduce my diet to compensate, but I am afraid of running a calories deficit while I am trying to let my body heal itself. So getting fat is my only option

    I had two splints made this time, one that immobilizes index and middle finger, the other just does the index. It is actually specifically designed to let me type with both hands (9 finger typing is better than 5!) while preventing any excess movement of the index finger. If anyone is interested, I could take some pictures.

    Stitches don't come out until this week. Can't wait to take a shower without a bag wrapped around my hand again! (I have learned that we have to enjoy each little milestone)

    Hope you are all doing well.

    Justin

  12. #37
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    Hi all,
    I just wanted to provide an update. As of today I am six weeks post-Phase 2. I have been going to PT twice per week and recently started working on active place-holds: I use my non-injured hand to bring those two fingers down, an actively try to hold them in place. That has been working which means that those tendons are gliding through the tunnels and are holding up. I am still unable to bring those two fingers down willingly. Hope no-one is hearing this for the first time like me. But, I was recently told that those two fingers will never move independently but that in time when my three non-injured fingers come down the other two will come down as a result of the surgery. This essentially means the little finger or ring will never bend on its own, by itself, but will bend when the other three go down.


    I am now out of the splint as of today, and instead use a wrist guard. Rubber bands have been added to my buttons to keep those two fingers bent and keep flexion against them. It's supposed to help with keeping the tendons gliding throughout the day, as the rubber bands/ tension keeps the fingers moving up and down. (SEE Picture). And, I'm still in a splint at night. Otherwise I'm hanging in there...GL alex as you begin the journey, and to everyone else who are already on it!
    Attached Images Attached Images  

  13. #38
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    Nonbiker,

    Glad to see things are moving the right direction for you.

    I have been aware of the loss of independent motion for some time now. Not because my doctor told me directly, but rather because I inferred it from the description of the procedure. Essentially, they attach the tendons to a "healthy" muscle because the old one has atrophied during the first phase.

    I was upset to hear this because the index finger is the most independent finger and I will never recover the dexterity I once had. However, after living with out any control in that finger at all now for 9 months, I have come around to feeling that any ability to move my finger at all will be a welcome change.

    Does it feel strange? I suspect our brains will rather quickly readjust the motor control to make the movement seem "normal" and we won't really miss what we had before. I noticed this has started to happen already with me. I can touch type (doing it right now) with only nine fingers!

    J

  14. #39
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    Hi Justin,

    I'm glad that you were aware. I didn't want to be the one to tell folks had they not heard. I hadn't thought of that though, that was very perceptive of you. I knew I wouldn't be at 100% like I was before, but didn't expect that news.


    It does feel strange. It's weird because before I was told I kept "willing" the finger to move and expecting to see results, since my place holds were going so well. I couldn't understand why the finger wouldn't bend at all...In time I should adapt and hopefully not notice it, but its pretty obvious to me right now. I haven't yet attempted to use the hand for light activities and want to air on the side of caution for a couple more weeks or so. I'll let you know how it feels once I start to use for some of my more routine activities.

    And, I feel for you on the index finger. It is very independent, but like you said our brains will hopefully adapt and it will be something that you wont notice too much or think about in time. Some use is definitely better than no use. For me its nice that those two fingers aren't just sticking straight up anymore. They do sort of maintain a more natural position when my hand is at rest.

  15. #40
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    Wow that is quite a contraption. Probably shares a lot of similarities with devices from the Inquisition.

  16. #41
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    good one Alex You should see the looks I get at work!

  17. #42
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    nonbiker - your scar looks great for 6 weeks post surgery after so many other procedures. Sounds like you are doing as well as expected - glad to see things coming along for you.

    Seeing your splint makes me aware that your OT is more involved than mine. I never had rubber bands holding my thumb in flexion. The thumb grasp is hard to live without, but I had learned to "lobster claw" items where it is really just side pressure grabbing things vs. a real solid closure around it.

    My surgeon hopes to avoid a button on my nail since I have more of the tendon left on that end to form a solid suture he thinks.

    Justin - you'll celebrate the day after suture removal with a shower and paraffin treatments. You'll love it.

    One week out from my phase 2 graft on 4/2. Will update post surgery.

  18. #43
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    @codecruncher - I have a very good OT. She has been very involved, calls my doctor to ask questions/make suggestions, and modifies my PT routine based on how my hand is progressing. I was lucky to find her - she is a doctor of PT and really knows what she is doing. I started with another PT who I quickly realized didn't know what she was doing and stumbled upon this one by accident.

    Good luck with Phase 2 on the second, I feel for you also with the thumb! Stay positive, I'm seeing progress, hope you will too!

  19. #44
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    Update - I had my 3rd (and hopefully last) surgery on 4/2 - this was the second phase tendon graft. Everything went well, but my surgeon did say it took a long time because I had formed a lot of scar tissue down by my wrist (although I had pretty good flexibility heading into the surgery). I got to keep my silicone rod that was in me for 2 months for memories.

    Saw the OT the very next morning on 4/3 and they removed the surgical dressing and got me into a splint right away. I also started passive thumb flexion, finger glide exercises, and some light press and holds of the thumb right away. I'm down to just ibuprofen already for pain and swelling.

    So far so good!

    Finger tendon graft surgery, off the bike for a while-phase-2.jpg

  20. #45
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    Hi Codecruncher,

    Happy to hear that your surgery was successful despite the scar tissue. Your hand looks good in terms of swelling. Good luck with PT as you continue along the journey.

    Thanks,

    Paula

  21. #46
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    Codecruncher - I initially had my right thumb flexor tendon sewed back together after an accident with a knife when I was 18. It was kept in a hard cast for 6 weeks with no movement (big mistake) and when the cast was taken off, my thumb had scarred stiff to where I could not bend it, even after PT... I lived with this for 10 years...

    I decided to have tenolysis surgery to release the scar tissue from the flexor tendon. The surgery was done on 3/19/14 and seemed as if it was a success since I was able to see my thumb fully bend for the first time in 10 years while it was being operated on, before it was sewed back up. 1 day after the surgery I had the bandage wrap taken off and started PT and movement of the thumb as much as I could.... It had become swollen and was hard to bend, but I was told to keep working at it 10-15 times per day... It remained swollen... Long story short, the tendon ruptured 12 days after.... I was doing the exercise where you hold the bottom of your thumb and try to bend the tip... I did it too hard, heard a pop and that was it... I could no longer bend the thumb. I was devastated to be back to square 1.

    2 days after the tendon ruptured I went in and had tendon graft surgery...they used my palmaris longus as the new tendon.

    This was on 4/2 as well!

    It looks exactly like your thumb, but they did it in one phase.

    It has been 9 days since the surgery and I have been doing PT - The doctor said the tendon is stitched and woven together, so it is strong enough and shouldn't rupture... I am still not able to bend the thumb, other than wiggle the tip slightly and my palm and wrist are still sore and swollen. I had a lot more range of motion stretching the tip of my thumb to under the callus part below the pinky yesterday, but today I woke up very sore and swollen and a lot less flexible. I may have over did the PT and have been taking it real easy today trying to keep it splinted and elevated.

    I know these things take time and a ton of patience... I wish I would have been more patient after the 2nd surgery and avoided the rupture!

    My questions I hope you can answer are:

    How much movement are you getting out of your thumb? Is it swollen/painful still? Are you able to make a fist?

    Thanks and good luck with your recovery!
    Last edited by online2; 04-11-2014 at 11:18 PM. Reason: overlooked previous comment

  22. #47
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    My first primary repair attempt way back in August, 2013 resulted in a ton of swelling that didn't resolve for about 8 weeks or more. But the last two surgeries despite being more invasive and involving the wrist had very little swelling. I'm convinced several factors were the difference:

    1. Get out of the post-op dressing ASAP. 24 hours or less is ideal.
    First surgery I was stuck in post-op stiff dressing for 4 days with no movement and the dressing was so thick that any ice was ineffective. Next two surgeries I was out of the dressing and into a splint within 24 hours. This let me apply cold packs with an ace bandage right to the area 4 times a day.

    2. Cold
    I keep chilling it down 2-3 times a day for the first 2 weeks after surgery. I have 3 blue freezer bags and rotate them through and just use an ace bandage to "stick" them to the hand. (1) above prevented me from doing this well during the primary inflammation phase in the first surgery.

    3. Passive PT was started immediately the next day after surgery.
    This gets the tissues moving and provides pathway and action for fluid to drain. First surgery this was delayed by a week.

    4. Ibuprofen
    First surgery they never told me to take anything. Next two surgeries I initiated the topic and since I did not have any bone involvement, they said Ibuprofen would be fine. I continuously take the lowest dose to keep it in my system for the first 2 weeks after surgery. I only needed the stronger narcotic pain pills for 1 day after all the surgeries so transitioning down to Ibuprofen was quick. I don't need it for pain, but for its anti-inflammatory properties.

    I can passively flex my left thumb (MP + IP joints) as much as my undamaged right thumb. I can form a fist by passively bringing in my thumb and then actively flexing my four fingers. My wrist is still tight - only back to neutral, no extension yet but they don't have me working on that quite yet - probably this next week I'd guess. I can actively wiggle my IP joint a little - have not tried more yet since I'm only 10 days out of surgery (just enough to let me know it is still connected!).

    Will update progress - hang in there. Hope both of our graft repairs work and give us near-normal action for our natural lives.

    Sounds like you didn't need a 2 stage repair since you didn't need any pulley or sheath repair.

    Dealing with a frozen IP joint for 10 years must have been very frustrating. I'm surprised you had much IP joint range heading into tenolysis unless you were constantly moving it passively headed into it.

  23. #48
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    Finger tendon graft surgery, off the bike for a while-surgery.jpg


    This is a picture from the day after surgery. I am now on the tenth day, just like you are... Today, where the wrist incision is, it is really swollen... I think I worked it way too hard the other day. I have been moving the hand downward (bending the wrist in) and trying to pull the thumb back to the hitchhiker or thumbs up position (very stiff and hard to do) and then moving the wrist back and bringing the thumb to the callus part under the pinky. I was VERY flexible the other day and was able to bring the thumb under the pinky repeatedly, then the next day it got painful and I lost the range of motion. I am now just trying to keep it elevated and not mess with it much until I see the physical therapist on Monday and see what they say...

    I need to learn to be patient with this, as hard as it is...

    My thumb just slightly wiggles back and forth at the tip at this point... I am hoping to gain more once the swelling goes down.

    The thing I want to avoid is waiting too long for the swelling to go down and having scar tissue form... It's very frustrating.

    Thanks for your feedback and keep us updated. Good Luck!



    Quote Originally Posted by Codecruncher View Post
    My first primary repair attempt way back in August, 2013 resulted in a ton of swelling that didn't resolve for about 8 weeks or more. But the last two surgeries despite being more invasive and involving the wrist had very little swelling. I'm convinced several factors were the difference:

    1. Get out of the post-op dressing ASAP. 24 hours or less is ideal.
    First surgery I was stuck in post-op stiff dressing for 4 days with no movement and the dressing was so thick that any ice was ineffective. Next two surgeries I was out of the dressing and into a splint within 24 hours. This let me apply cold packs with an ace bandage right to the area 4 times a day.

    2. Cold
    I keep chilling it down 2-3 times a day for the first 2 weeks after surgery. I have 3 blue freezer bags and rotate them through and just use an ace bandage to "stick" them to the hand. (1) above prevented me from doing this well during the primary inflammation phase in the first surgery.

    3. Passive PT was started immediately the next day after surgery.
    This gets the tissues moving and provides pathway and action for fluid to drain. First surgery this was delayed by a week.

    4. Ibuprofen
    First surgery they never told me to take anything. Next two surgeries I initiated the topic and since I did not have any bone involvement, they said Ibuprofen would be fine. I continuously take the lowest dose to keep it in my system for the first 2 weeks after surgery. I only needed the stronger narcotic pain pills for 1 day after all the surgeries so transitioning down to Ibuprofen was quick. I don't need it for pain, but for its anti-inflammatory properties.

    I can passively flex my left thumb (MP + IP joints) as much as my undamaged right thumb. I can form a fist by passively bringing in my thumb and then actively flexing my four fingers. My wrist is still tight - only back to neutral, no extension yet but they don't have me working on that quite yet - probably this next week I'd guess. I can actively wiggle my IP joint a little - have not tried more yet since I'm only 10 days out of surgery (just enough to let me know it is still connected!).

    Will update progress - hang in there. Hope both of our graft repairs work and give us near-normal action for our natural lives.

    Sounds like you didn't need a 2 stage repair since you didn't need any pulley or sheath repair.

    Dealing with a frozen IP joint for 10 years must have been very frustrating. I'm surprised you had much IP joint range heading into tenolysis unless you were constantly moving it passively headed into it.

  24. #49
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    Sutures removed yesterday. Woo-hoo! I can ditch the garbage bag for showers now. No infections so far and I just cleaned out the paraffin bath and will start using it tomorrow.

  25. #50
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    How is your range of motion coming along? The tip of my thumb wiggles a little bit now, but not much... How about scarring?



    Quote Originally Posted by Codecruncher View Post
    Sutures removed yesterday. Woo-hoo! I can ditch the garbage bag for showers now. No infections so far and I just cleaned out the paraffin bath and will start using it tomorrow.

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