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  1. #1
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    Finger tendon graft surgery, off the bike for a while

    Hey guys. I have been lurking here for the last few weeks while I contemplate my injury, upcoming surgery, and a looooong period of downtime ahead. I figured I would post my situation and resulting recovery process for anyone who is unlucky enough to have to go through this kind of injury.

    Back in June, I severed both tendons in my right index finger. A dumb accident with a broken wine bottle. Both my flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) were cut completely.

    I had it repaired immediately and was off the bike for several months, but was able to start riding again a few months ago (albeit with my finger taped to the middle finger). But last monday, I found out the repair failed (via MRI) and I will need to have a tendon graft to replace the tendon. I am scheduled to start the first stage of a two stage tendon graft this Wednesday. According to the doc, I will need to be off the bike for nearly a year in total. At the very minimum, 9 months.

    Basically, the first surgery is to insert a temporary ďflexibleĒ rod to rebuild the tendon channel. Three months later, after the hand has healed up, the second stage is to transplant a tendon from somewhere else (wrist or leg) into the rebuilt channel. After that, I am off the bike for another 6-9 months.

    The tough part is, I finally met a group of great riders here in NYC (just moved last year) and was really starting to step up my riding and the real kicker is that I just built a new bike up and only got to ride it twice (yesterday and today) before I am down for surgery. I have been seriously considering just not getting it fixed (and never being able to curl my finger closed or make a fist again).

    Trying to stay positive and I plan on training my butt off while Iím down by running, going to spin classes, indoor trainer, whatever. Iím hopeful that I can start riding easy stuff (flat single track, maybe dirt roads) with a single hand braking setup on the left sometime next summer. We will see.

    Iíll keep posting back my progress.

    J

  2. #2
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    On my second day post surgery. Typing one-handed so i'll keep this short.

    The surgery went smoothly. Doctor confirmed that the original repair had failed. He removed it and my scarred up A3 pulley. The pulley was rebuilt with a tendon graft from my wrist (not sure which one yet) and the flexible Hunter rod was placed in the finger.

    I have a big cast now, but will be back in monday for something removable so I can start PT. PT in this first stage will consist of passively flexing the finger to maintain full ROM.

    Pain level isn't too bad. I think I will stop taking the painkillers after today.

    Been passing the time looking at upgrades for my bike as well as an indoor trainer. I have set a goal to come out of my recovery in better cardio shape than when I started!

    Take care,
    J

  3. #3
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    Two weeks and change out from stage 1 surgery, 4 months out from the original injury and first surgery (primary repair). The stitches came out on Monday and I am now allowed to use my right hand again around the house as long as I don't use my index finger. I was also cleared to begin working out again as long as I don't really use my hand. So far that has meant one spin class and a nice strenuous hike this morning. I am pretty good at typing with 9 fingers now, though as a software developer, it is certainly a hinderance for my job.

    My daily PT regimen involves passive motion exercises (curling my finger into the palm using my good hand) and massaging my scars. I've included a nice gross out picture below. I have an even nastier one, mid-surgery, if anyone is interested

    I'm going a bit stir crazy not riding. So far I have purchased a new rear derailleur and a heart rate monitor for strava. But buying cool stuff isn't quite filling the void that not riding has left. I plan to start aggressive trail running on the same trails I normally ride on as an adrenaline substitute. I might even start a meet up group here in NYC to try and find some running buddies.

    The next surgery is scheduled for Jan 22. I hope I am at least back in the saddle for easy riding by April.

    Finger tendon graft surgery, off the bike for a while-img_2434.jpg

    I just keep telling myself that I am lucky its a finger and not a leg or foot.

  4. #4
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    good luck nice sutures
    lets see the other one
    Keep The Rubber Side Down

  5. #5
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    good luck man!

  6. #6
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    that is grisly, man!
    take up trail running, it helps tremendously. just don't fall on that hand if you trip up!!
    you'll get a trail fix and keep your endurance in check. did that for a few months while i busted my hand up last year... it passes the time so nicely.

    best of luck to ya.

  7. #7
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    Thanks for the wishes. Haven't hit the trails yet, but I have been running, spinning, and getting out for 7-10 mile hikes at least once a week.

    Hand has healed up nicely. I just do my "passive movement" pt exercises throughout the day. I still have to wear a brace out in public, but I have use of both hands at work and home which is nice.

    Here is the nasty picture for those with the stomach (don't say I didn't warn you! ). The cross hatch part is the rebuilt pulley system. It is made out of what used to be my flexor digitorum superficialis. The white rod is the Hunter rod that replaces my flexor digitorum profundus for the next three months to allow the tendon sheath to reform around it. The exercises I do every day are to move that rod back and forth. Stage 2 of the surgery replaces that rod with a donor tendon.

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

  8. #8
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    Duuuuuuuuuude!!!!! wow!!!! speedy recovery to you

  9. #9
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    Hi jminus I am not a biker but I recently had the same hunter rod replacement surgery on both my little, and ring finger on my right hand. I am two weeks post operation and was browsing the net trying to find stories of people who have had the same surgery when I happened upon you. My second surgery isn't scheduled yet. How are you doing? Looking for some inspiration to make it through this arduous process...have you met anyone who has had both surgeries?

  10. #10
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    Nonbiker,

    I am sorry to hear that you are on this same journey. I hope your recovery is going well. Like you, I really couldn't find much information about this type of surgery or the outcomes. Maybe we should start a blog about it I'm sure we are not the only ones looking for support or information.

    As for the surgery, I am doing well. I have pretty good passive motion (when warmed up) and the scars have healed quite a bit. I have developed a habit of doing my exercises any time I am in front of the TV or talking to someone (in meetings, etc). From a daily life standpoint, I am quite adapted to the non-functioning finger. I am back to touch typing believe it or not, and I have no issues doing things like tying my shoes, button shirts, or shaving. I have also stopped wearing the full hand/arm brace in public and instead use a piece of velcro to bind my index finger to my middle finger. This draws much less attention. I am so tired of explaining the whole accident/surgery to people.

    Probably the biggest issue I have is exercise. I am a 5-days a week gym kind of guy and I have had to make some serious compromises. I have been doing leg specific exercises, spin class, and running to try to fill the void. My upper body is definitely suffering for it. On the weekends I have been going on epic 10 mile hikes to get outdoors. Overall, I am coping and have definitely turned the corner of a mild case of depression that I had when this ordeal started.

    My biggest issue now is that I feel good enough to ride my bike, but I know I should really just keep taking it easy. A few weeks of riding isn't worth the potential lifelong downside of disrupting this phase of the surgery.

    The best advice I have is to focus on what you _can_ do and not what you can't. Pick up new hobbies, do things you normally wouldn't make time for. The more I get out and live, the less I think about my finger, and the more I feel like a "whole" person.

    Here are some pictures of the current state of affairs.

    Finger tendon graft surgery, off the bike for a while-img_2524.jpgFinger tendon graft surgery, off the bike for a while-img_2525.jpg

    Stay strong!

    Justin

  11. #11
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    Hi

    Hi jminus,

    Thank you for responding. Your hand actually looks really great. Hopefully my hand will heal as well as yours has. Right now, I cannot do anything with that hand, but hopefully I will be out of the big cast soon. It is really awkward explaining to people all the time what happened.

    I'd just started scar massage therapy, and I'm getting better at the passive motion. I understand that it must be hard not been able to do the things that you enjoy. At least on the bright side, we are going through the process in the winter and not in the summer.

    I would actually not be opposed to starting a blog, as there must be others who have had the same surgery and is looking for some support. At the very least, I hope you stay in touch and keep me updated on your progress and I will do the same.

    Attached are a couple pictures, of my hand as it is now. I hope to be where you are within the next couple of weeks. And hope to regain activity to some extent.

    I am actually using windows 7 speech recognition functionality, so that I do not have to physically type with my right hand. If you have windows 7, you can actually set up speech recognition by going to the ease of access setting on the control panel. All you will need is a headset.Name:  photo 2.JPG
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    Wishing you a speedy recovery,

    Non biker







    Quote Originally Posted by jminus View Post
    Nonbiker,

    I am sorry to hear that you are on this same journey. I hope your recovery is going well. Like you, I really couldn't find much information about this type of surgery or the outcomes. Maybe we should start a blog about it I'm sure we are not the only ones looking for support or information.

    As for the surgery, I am doing well. I have pretty good passive motion (when warmed up) and the scars have healed quite a bit. I have developed a habit of doing my exercises any time I am in front of the TV or talking to someone (in meetings, etc). From a daily life standpoint, I am quite adapted to the non-functioning finger. I am back to touch typing believe it or not, and I have no issues doing things like tying my shoes, button shirts, or shaving. I have also stopped wearing the full hand/arm brace in public and instead use a piece of velcro to bind my index finger to my middle finger. This draws much less attention. I am so tired of explaining the whole accident/surgery to people.

    Probably the biggest issue I have is exercise. I am a 5-days a week gym kind of guy and I have had to make some serious compromises. I have been doing leg specific exercises, spin class, and running to try to fill the void. My upper body is definitely suffering for it. On the weekends I have been going on epic 10 mile hikes to get outdoors. Overall, I am coping and have definitely turned the corner of a mild case of depression that I had when this ordeal started.

    My biggest issue now is that I feel good enough to ride my bike, but I know I should really just keep taking it easy. A few weeks of riding isn't worth the potential lifelong downside of disrupting this phase of the surgery.

    The best advice I have is to focus on what you _can_ do and not what you can't. Pick up new hobbies, do things you normally wouldn't make time for. The more I get out and live, the less I think about my finger, and the more I feel like a "whole" person.

    Here are some pictures of the current state of affairs.

    Click image for larger version. 

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    Stay strong!

    Justin

  12. #12
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    Considering tendon rod procedure

    Hi everyone,

    I enjoyed reading through these posts. I am considering a fifth finger surgery (tendon rod procedure) to correct scarring in my finger that I injured three years ago. My injury was in Zone II - No Man's Land -- via a kitchen knife accident. I had three unsuccessful surgeries (two ruptures), and two surgeries that though successful still resulted in a lot of scar tissue. The hope is that my scarring will be less so with the tendon rod procedure. I live in NYC and have had two surgeons and three physical therapists. Absolute nightmare. I am not a bike rider but I am a certified yoga teacher, and haven't been able to practice the way I used to. I'd love to know how you are tracking with the tendon rod procedure. All my best ~

  13. #13
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    Hi littlelotte,

    I'm curious to find out how Justin's second surgery went. I'm two months out from the first phase of the hunter rod surgery, and I have a lot of scarring. I actually had my post-op visit today, and my doctor is a bit concerned because my fingers won't extend all the way and she thinks it's due to the scarring - which she says she'll remove when she does Phase 2 surgery if it doesn't get better by then. Also month 2 is when the scarring is the worst she told me.

    Out of curiosity, are you able to bend your fingers actively now? Hopefully next month I'll have better news to share. Best of luck!

  14. #14
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    Tendon rod procedure

    Hi nonbiker,

    I actually haven't had the surgery yet, but I am scheduled to do it next week. Have you been moving your finger passively, and when you had the tendon rod put in, did they do a tenolysis to remove scar? Are they doing a tendon graft for the second surgery and removing the tendon rod? Were you in any pain during the first surgery, and how long was it after the first surgery that they had you begin passive motion?

    My understanding is that the silicon rod is supposed to make it less likely that scar will form and that since they don't have to open up the incision again for the second surgery (just an incision on the bottom and top - and they slide the tendon through the silicon channel), you have a better chance of less scar forming.

    All that said, I am on my now sixth surgery (three repairs - one was a tendon graft, two tenolysis), and it seems I scar badly, so who knows how this will turn out. I really hope everything works out for you! Scar tissue is HORRIBLE.


    Quote Originally Posted by nonbiker View Post
    Hi littlelotte,

    I'm curious to find out how Justin's second surgery went. I'm two months out from the first phase of the hunter rod surgery, and I have a lot of scarring. I actually had my post-op visit today, and my doctor is a bit concerned because my fingers won't extend all the way and she thinks it's due to the scarring - which she says she'll remove when she does Phase 2 surgery if it doesn't get better by then. Also month 2 is when the scarring is the worst she told me.

    Out of curiosity, are you able to bend your fingers actively now? Hopefully next month I'll have better news to share. Best of luck!

  15. #15
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    p.s. jminus has awesome passive motion. I wish I could extend my finger like that!

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    Hey nonbiker and littlelotte,

    Sorry for the slow reply, I was home for the holidays and pretty much unplugged from the internet.

    I have not had the second phase of the surgery yet, I'm scheduled for the 22nd of this month. Current status is about the same as my last picture. Pretty good passive motion, finger still swollen (thought not as bad). I am binding the finger when I am out in public with a finger strap, leaving it unguarded around the house, and sleeping in a brace every night. Still off the bike, but running quite a bit.

    Regarding littlelotte's questions about the first phase of the hunter rod surgery: I don't think the pain was any worse than the initial repair attempt. If anything, it was less. I started passive motion after one week and within about three weeks, I was able to get my finger pretty much all the way closed.

    I can't quite extend it flat normally. There is probably about a 15-20 degree bend during the day. However, when the hand is "warmed up" I can passively get the finger to go flat, even a little hyper extended. My PT and Doc have me doing passive extension as well as closing the finger in order to try and maintain that motion. I also have developed my own technique of pressing the finger against a curved wall (curved such that the finger hyper extends) in my shower each morning until it loosens up. My understanding is that extension can be worked on more easily with braces that are worn at night.

    littlelotte, your ordeal makes mine sound like a walk in the park. I am not sure I will do another surgery if this one doesn't take. From what I have read, hunter rod surgery is essentially the last resort. My current surgeon didn't even want to try and fix the rupture. Just told me that this was my best option to get some use of my finger back.

    I guess we will see!

    I would be interested in exchange surgeon names via PM if you guys are curious about who is seeing who. I know at least littlelotte is here in NYC where I am.

    J


    Quote Originally Posted by littlelotte View Post
    Hi nonbiker,

    I actually haven't had the surgery yet, but I am scheduled to do it next week. Have you been moving your finger passively, and when you had the tendon rod put in, did they do a tenolysis to remove scar? Are they doing a tendon graft for the second surgery and removing the tendon rod? Were you in any pain during the first surgery, and how long was it after the first surgery that they had you begin passive motion?

    My understanding is that the silicon rod is supposed to make it less likely that scar will form and that since they don't have to open up the incision again for the second surgery (just an incision on the bottom and top - and they slide the tendon through the silicon channel), you have a better chance of less scar forming.

    All that said, I am on my now sixth surgery (three repairs - one was a tendon graft, two tenolysis), and it seems I scar badly, so who knows how this will turn out. I really hope everything works out for you! Scar tissue is HORRIBLE.

  17. #17
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    Hi jminus and littlelotte,

    jminus I'm happy to hear that you are doing well. It sounds like your recovery is coming along nicely. I'm at the two month mark, and can do the passive motion, but like you my fingers do not extend flat normally. I am also wearing the brace at night, and my doctor says that she will not delay the surgery because of it, but did seem a bit concerned and said that scar tissue can result in the fingers not extending properly. I'm in PA, and would be happy to share my surgeons name - she is awesome! I should have the second surgery sometime in February hopefully, although my date hasn't been scheduled yet. Good luck with your second surgery!

    To answer littleloitte's questions from my perspective
    I was in a fair amount of pain for a week or so, when I had Phase 1. I never had an initial tendon repair surgery because the ER completely missed that I had cut my tendons. I was ok like jminus after a week though (pain wise) and was able to passively bend after 1 week. As this is the only/last resort, I also will not pursue another surgery after this is over - although it sucks as it is my right hand. In general, I tend to scar pretty badly, and I have a lot of scar tissue, but it doesn't prevent me from doing the passive motion. Best of luck to you both!

  18. #18
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    I have a lot of empathy as I'm going through the same challenges!

    Sliced through my left thumb flexor tendon by tripping on the stairs with a glass in my hand in early August, 2013. Accomplished this 2 weeks after ordering the brand new 2014 bike

    Primary tendon repair done 8-16-2013. OT was followed religiously, but was not very successful and I was scheduled for a tenolysis 2-5-14. Well, they opened me up and found the primary repair had ruptured so instead of tenolysis, I advanced into phase 1 of tendon graft and got the hunter silicone rod implanted.

    In 6-8 weeks, phase 2 is planned and I've got a good donor tendon in the forearm. Really bummed out that instead of a 3-4 week fast recovery from tenolysis that I'm now looking at late June/early July before I'm mostly back.

    Trying to adjust to 4 months of one handed life with my splint and OT every 3-4 hours.

    Here's results of phase 1 three days ago.

    Finger tendon graft surgery, off the bike for a while-photo-1-small.jpg

    I hope your second phase tendon graft goes well!
    Last edited by Codecruncher; 02-08-2014 at 08:12 PM.

  19. #19
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    Codecruncher,

    I feel for ya man. Thumb seems like a much bigger pain to live without than a finger. I wish you the best of luck in your recovery. I also want to warn you to be _very_ careful with your PT and use of that hand while you are in phase 1... Take a cautionary lesson from me:

    I found out a few weeks ago that my hunter rod detached and my whole phase 1 process was wasted. Basically, once the finger healed up, I was "using" the hand for things, like riding a spin bike and doing dishes, etc. I tried to avoid using my injured finger, but obviously I didn't do a good job. The pre-phase 2 operation x-ray showed that the rod had detached from the finger and moved down into my wrist. I simply didn't understand how fragile the whole process is.

    I was pretty close to just giving up and living with the injury, but after a few weeks off to think things through, I decided to try once more. I am actually having my second attempt at the phase 1 surgery today. If this second attempt fails, then I am definitely done (and I will be out of donor tendons as well). This time around, I am not going to remove the brace, except to dress and shower. I am also going to vastly reduce the amount of passive motion PT I do. I am convinced that I over PT'd.

    It likely means that I will be missing most/all of the 2014 MTB season, but if I can get some finger functionality back it will be worth it. At this point I am used to being off the bike. What's a few more months?

    Let me know how it goes with your healing/PT.

    J

  20. #20
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    jminus,

    Oh man - so sorry to hear about your phase 1 hunter rod situation. Thanks for the warning. I can feel exactly where it ends in my wrist area so I know it hasn't slid down, but not sure if anything is still attached on either end of course. I did get the postop notes and they indicate they rebuilt 2 of my pulleys - the A1 and then some angled one so hopefully those are healing well and I'm growing a new tendon sheath. Feels weird to be growing a new part...

    My third surgery (phase 2 where they take my palmaris longus from the same arm) is scheduled for April 2. I'll keep updating here as the journey progresses.

    Best of luck on your second attempt at phase 1 with the rod. Let us know how you come out of this one in a few days.

    Rehab on tendon crap is just so challenging. You want to attack it and move it along, but this "use it, but not too much" sort of thing is a very fine balancing line for all of us that are into life enough to post on biking forums!

    I so totally wish I would have simply broken the damn thumb instead of slicing the tendon. 8 weeks and follow-up stretching and gentle strengthing and I'd be all good.

  21. #21
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    Hi all,

    I just wanted to update everyone on my progress. I had stage 2 surgery approximately 2 weeks ago. I had two good donor pulmaris tendons that were harvested from both my arms and used for my ring and little finger. The tendons are attached to buttons on my fingertips.

    In terms of pain, I was much better off this time than I was the first time. After two weeks most of my swelling is gone, and I am back in the dorsal blocking splint. I also have been doing the passive motions every waking hour of the day, and have pretty good passive motion.

    Overall I feel hopeful, and fatigued. I'm terrified of popping the new tendons but try not to let it get in the way of PT. I'll keep you all updated as things progress. Here are some pics:Name:  image.jpg
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  22. #22
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    nonbiker - best of luck on your recovery. Your swelling looks fantastic - very low.

    For both of you - what is your surgeon suggesting for time between the first and second stage surgeries?

    For my thumb with the hunter rod, my surgeon says 6-8 weeks. I went with the 8 to be conservative. I had a little reconstruction of the A1 and oblique pulleys so not sure if that determines how long the first stage lasts.

  23. #23
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    Hi code cruncher,

    My surgeon wouldn't do it before 3 months. I had stage 2 almost exactly at the 3 month mark. I have a really good physical therapist who also said 3 months would be about right, and that i needed to regain close to full passive motion before the surgery. I never had an initial tendon repair so I'm not sure if that had anything to do with it.

    Good luck to you also getting your thumb back it is such an important finger....(not that they don't all matter)

  24. #24
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    Thanks. I have full passive motion of the thumb already. Extension (vs. flexion) of the IP joint is pretty frozen, but I'm working on that. The current focus is trying to extend the wrist past neutral so that everything is in good flexible form before stage 2.

  25. #25
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    Maybe because your passive motion is good they have shortened the timeframe....my wrist was very stiff also.

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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

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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.

  28. #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!

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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

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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

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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

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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

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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

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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?

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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

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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

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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  

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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

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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.

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

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    good one Alex You should see the looks I get at work!

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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.

  43. #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!

  44. #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

  45. #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

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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

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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.

  48. #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.

  49. #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.

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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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    I can wiggle a little as well - but if I look carefully I think much of it is extension first and then a natural return to rest. If I carefully block and try to isolate just the IP joint, I get a little - maybe 3-4 mm of flexion. Not much, but it proves the FPL is still connected at least and hasn't ruptured.

    My scars have responded really well to the paraffin baths - the scabs have all sloughed off and the scar massage is going well. My carpal tunnel area at my wrist feels like a rock though - massage loosens and the cycle continues - just need to stay on it. As in the past, I'm a big scar maker so this is a big concern.

    I've started using the silicone sheeting at night to help reduce scar formation. Does your OT have you doing that?

    I have a small, but very solid lump up my forearm where they harvested the palmaris longus; about the size of a decent peanut M&M and just as hard. Massaging that really well also and it has already started to respond, but sore.

    The thumb is very flexed right now and I have little extension of it, but they haven't told me to start stretching it upwards yet. I really hope that comes around, feels like if I had more room to move it back and forth I'd get more movement of the FPL repair areas as well.

    I'm out of the splint at home and the office a fair amount as long as I'm careful not to grab or lift anything with that hand.

    How are you coming along?

  52. #52
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    My wrist is like a rock, too. I bought a massager called a carpalrx to see if that will help any. It hasn't arrived yet, but I will keep you updated as to how it works.

    My scar in my palm was pretty bad - I have been using the walgreens brand of scar cream (similar to Mederma) for the past two days and I am impressed with how much the scar has broken down, so quickly. When I bring my thumb to the bottom of my pinky, that scar now has wrinkles in it and I am gaining my range of motion back with that stretch... before that scar was stiff and wouldn't budge. I recommend trying that scar cream, if you haven't already. I just started the silicone sheeting tonight... hopefully it helps!

    The tip of my thumb seems to be right where yours is at... if I hold it down and stretch it for a while and then let go, I can hold it very slightly bent for a while, so I know the tendon is still there... hopefully the mobility comes back more and more each day as the swelling goes down and it doesn't reach a stand-still. I am trying to keep it moving as much as possible.

    Did they tie your tendon tight making it hard to do a thumbs up, also? I can't even come close to doing a thumbs up right now, but they told me that should come back in time...

    Best of luck!

  53. #53
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    Yes, my thumb is very flexed when they decided how much tension to put the tendon under during surgery. Very awkward feeling, more so than with the silicone rod first stage.

    But in the last 2 days I've noticed some improvement in that. I've been starting to rest my thumb tip on the side of my index finger - could barely do that and now I am starting to slide it along my index finger. That little bit of additional stretch has made trying to form circles between thumb tip and finger tips far easier.

    Let me know how the carpalrx works out. The paraffin baths at home 3x a day are awesome.

  54. #54
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    Ruptured tendons do "just happen" in cases where the tendon has gone unused

    Quote Originally Posted by online2 View Post
    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!
    Hi Online2,

    I had my middle finger frozen for a year and, like you, had tenolysis surgery to free up the stuck tendon and frozen PIP joint. The next day we got after it and I did PT every day for nearly 3 weeks. I was not warned to take it easy and had permission to go on a few MTB rides to work on strengthening the muscle and improve flexibility. So on the Monday 3 weeks to the day after my tenolysis and a half hour after my PT session I went home and started eating a doughnut and I felt like my finger had jammed and I couldn't move the tip of my finger anymore.

    Had an MRI 2 days later and it revealed that the tendon had ruptured. The following Monday I went back in for surgery to have a tendon from my leg grafted to the remaining "healthy" pieces of tendon left after the rupture.

    The reason I'm giving you the backstory on this is because when I went to see my doctor he said that a tendons tensile strength goes from 50% (the day of the surgery) and quickly drops to 5-10% at 3 weeks. After 3 to 3 1/2 weeks the strength of the tendon increases quickly to 70%+ at 6 weeks and 90%+ at 8 weeks. Now if I had had this information I would have gone a bit easier on the tendon leading up to that 3 week mark.

    However, I did have a lot of trauma to that tendon when I got the injury that froze my finger in the first place. (Dislocation at the PIP joint at 20MPH, opened up the skin, scar tissue from previous injuries was stuffed inside the joint when it was put back together, a 12 day infection that caused me to nearly lose my hand, harsh PT, and a year of non-use. All that probably caused the tendon to be in poor condition going in to the tenolysis.

    In a nutshell, don't blame yourself. Your tendon was weak from 10 years of non-use. Just keep in mind the timeline, get PT, do not take off the brace until 6 weeks and do not hyper extend your thumb until after 8 weeks. In fact don't do that at all, it causes arthritis. If you want it straight from a surgeon read this excerpt from an ebook (http://www.msdlatinamerica.com/ebook...9.html)...skip to the Complications section to see the pitfalls for yourself.

  55. #55
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    Hello All,

    Quick update. Had tendon graft from my leg to replace my middle finger's FDP tendon. I'm at 4 weeks and 2 days from my surgery. Been in a splint since the surgery, have less than two weeks left in the splint. Transitioning from passive only motion to place-and-holds. My passive flexibility is good due to the latest surgery removing more scar tissue from the previous tenolysis surgery and keeping my hand elevated 100% of the time day and night. I got a "Sponge Bob" cube to put my arm in at night. The place-and-holds feel good to move my limp fingers but no noticeable motion from my repaired finger at the PIP or the DIP. Going to take it slowly and try not to work it too much. Just passively stretching every hour and a half and then place-and-holds starting at the position with my hand closed just tighter than the position where I can hold for 5 seconds. I do place-and-holds for 2 seconds, then extend to straight, then place my fingers in position again and repeat until my injured finger is too tired to hold at that position any longer. I am using my other fingers to help the injured one by sandwiching it between them. My PT said that I should move them together and wait for a week before isolating the injured finger in a place-and-hold.

    So a few thoughts/questions for our little group:
    1. Does it seem like your PT and surgeon give you valuable information only after you have an incident, instead of before it happens, when you could have made a decision based on that information?
    2. Does intense PT make it harder to gain back flexibility due to the irritation it causes?
    3. Do you know of a website that caters to people with our types of injuries?
    4. Would you find it valuable to have a website that provides a community for people who could use emotional support, tips and tricks and just good advice?

    I'm considering creating a website where we as patients can pool our collective knowledge to make better decisions and get things right the first time.

    Your thoughts as always are appreciated.

    Alex

  56. #56
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    I'm 3 weeks post second stage tendon graft surgery today.

    I've noticed that my surgeon and PT people are generally more aggressive in their approach than any of yours. Maybe that's because my injury was thumb vs. fingers - or maybe he just moves faster. Examples:

    1. My hunter silicon stage 1 was only in for 8 weeks (and he was suggesting a range of 6-8 so I was on the long side). Sounds like all of you are closer to 12-16 weeks. Bonus: I got to keep the rod to see up close what was in me for all that time.

    2. At the urging of my surgeon since I scar quickly, PT had me doing place and holds on the thumb after stage 2 the very next day after surgery.

    3. My surgeon considered buttons "old school" and rarely uses them unless there is almost nothing left to connect the tendon to.

    4. They have me getting out of the splint for periods at my desk - like typing. But typing doesn't use my left thumb at all (I took formal classes way back in high school). I find I do a lot more PT a lot more often when in meetings or just at my desk if I'm not in the splint.

    I hope this approach works for me - not sure at this stage if it is better or not; just different.

    Like any health related issue, I find that I need to research outside of my doc and PT visits and come to them armed with lots of questions. I get the feeling that other patients don't take that much effort/investment in their own recovery.

    I don't think lots of PT makes it harder to gain back flexibility so far. I do take Ibuprofen afterwards to try to minimize swelling and irritation.

    I continue to see small improvements so I'm quite positive and just trying to remain patient with the 3-4 month recovery time.

  57. #57
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    Codecruncher that's great that you're seeing improvements, it will make your recovery period pass much quicker.

    I have super turbo charged scar tissue because of a disease called Dupuytren's Contracture, so we got after my therapy after my tenolysis. But then my tendon ruptured and I think my PT is being extra cautious about putting too much stress on my new tendon. Which leaves me with the very real possibility of needing another tenolysis. Which I can't bare to think about.

  58. #58
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    Hi all,

    I am 2 1/2 months post phase 2. I actually had my post-op appointment today. I am out of the splint completely now. And, my buttons were removed today. Currently, my two fingers are bending slightly when I attempt to make a fist. My little finger appears to be doing better than the ring. I am still no where near close to making a fist but can see some movement of those two fingers which previously didn't move at all. Unfortunately, my middle finger (which previously was not injured) will no longer move at the tip. The doc says that I may have developed some scar tissue from when she intertwined the tendons from my two fingers with that one. But that she is hopeful that it will come back in time.

    I have been told that I cannot ride a bike, or grip a steering wheel for at least two more months. I should only use the hand for light activities like eating.

  59. #59
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    CodeCruncher,

    How is your movement in your thumb? Are you seeing any improvements from 2 weeks ago?

    I just went in for a visit on Monday for a follow up with the doctor and he said that the tendon seems to not be gliding (getting scarred down again) and suggested I do not wear the splint AT ALL anymore and try to move it and exersize it as much as possible. They also made me a new splint to wear only at night to flex the thumb out, so I am able to do a proper "thumbs up"...

    I did my first round of ultra sound on that visit on Monday as well and started to actually feel the tendon glide (it was almost making a friction feeling) under the scar in my palm area. The part right under the tip of my thumb (not sure what that is technically called) seems to be really scarred down and hard and I am pretty sure that is where it is getting caught up... No matter how much I massage that area, it doesnt seem to do anything... Massaging it almost seems to make it worse unless I do it extremely light.

    I am very optimistic that the ultrasound is going to be the way to go to break the tendon free from the scarring... they asked me to come in 3 times a week to do this... at 25 bucks per co-pay, plus the time off work it seemed more beneficial to buy an at home ultrasound. I bought one online for $100 - I am going to start doing that at least once per day at home... it should be arriving tomorrow. I will still probably go 1-2 times a week to have them do it as well as hand therapy sessions. I would definately recommend asking to do ultrasound over the scarring if they haven't started that already and see if it helps you. I noticed an immediate difference!

    As far as not wearing a splint at all times, like I was told to do, at this point (4 weeks out), I am not sure I agree. It seems as if I have way more flexibilty in the morning right when I take my splint off after wearing it for 8 hours... I think it allows that imflammation to calm down. When I have no splint on throughout the day and try to bend the tip and hold and constantly excersize it, it gets stiff and seems swollen... to the point that I am unsure if the tendon is still attached because it doesn't seem to be moving at all. There really seems to be a fine balance... I was told to push the therapy/excersizes hard, but my personal opinion is to go real light, but constanstly excersize and massage the area until the swelling seems to subside - then push it hard.

    I hope yours is improving nicely...



    Quote Originally Posted by Codecruncher View Post
    I'm 3 weeks post second stage tendon graft surgery today.

    I've noticed that my surgeon and PT people are generally more aggressive in their approach than any of yours. Maybe that's because my injury was thumb vs. fingers - or maybe he just moves faster. Examples:

    1. My hunter silicon stage 1 was only in for 8 weeks (and he was suggesting a range of 6-8 so I was on the long side). Sounds like all of you are closer to 12-16 weeks. Bonus: I got to keep the rod to see up close what was in me for all that time.

    2. At the urging of my surgeon since I scar quickly, PT had me doing place and holds on the thumb after stage 2 the very next day after surgery.

    3. My surgeon considered buttons "old school" and rarely uses them unless there is almost nothing left to connect the tendon to.

    4. They have me getting out of the splint for periods at my desk - like typing. But typing doesn't use my left thumb at all (I took formal classes way back in high school). I find I do a lot more PT a lot more often when in meetings or just at my desk if I'm not in the splint.

    I hope this approach works for me - not sure at this stage if it is better or not; just different.

    Like any health related issue, I find that I need to research outside of my doc and PT visits and come to them armed with lots of questions. I get the feeling that other patients don't take that much effort/investment in their own recovery.

    I don't think lots of PT makes it harder to gain back flexibility so far. I do take Ibuprofen afterwards to try to minimize swelling and irritation.

    I continue to see small improvements so I'm quite positive and just trying to remain patient with the 3-4 month recovery time.

  60. #60
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    Hi Online2,

    Glad to hear things are progressing for you and that you have not re-ruptured!

    What area of the country are you? I'm in Madison, Wisconsin. My OT person is really curious - I've shared all these other experiences with her - she thinks people have this perception that the midwest is lagging in progressive treatment plans, but when she has compared at conferences, she has concluded we are often pushing the envelope more than the coasts.

    Do you have a link to your ultrasound device? I'm very interested. I purchased my own paraffin bath unit to maximize my therapy (Amazon link is back a few posts) - maybe ultrasound is another good option. I use the bath 3x a day.

    Your experience of flexibility is opposite to mine. I'm the most stiff right away in the morning and get better throughout the day. My OT person thinks you are correct - you are probably over doing it a little and pushing things into inflammatory areas.

    I did my first ultrasound for this round on Tuesday 4/29 and again today. I have seen slight improvement, but have not felt friction or more freeing as you indicate yet. I also have not been wearing my splint much at all the last week, but have been very careful with that hand. I find I do OT a lot more throughout the day when the splint isn't an immediate obstacle (10 minutes here, 5 minutes there, sitting in a meeting, etc.). And the continual slight movement has got to be helping avoid total scar down I figure.

    After paraffin, massage, and exercise my thumb tip range of motion is about 2 centimeters total (more of that is extension than flexion, but it clearly is still connected - I had zero before).

    I am fairly aggressive at scar massage, stretching, and exercises. I don't find that anything I do so far has caused me to swell up.

    I also have a little very sensitive pressure point just past my IP joint in the pad of my thumb - almost the opposite side of where my thumb nail is. That sucker is pressure sensitive. That was where my hunter rod ended and where the sutures must be to attach the transplanted tendon to my remaining FPL stump distally. Light massage has helped, but I think it is going to be pressure sensitive for a long time.

    Today my OT reformed my previous splint into a night time stretch one that sounds identical to what you have now (pics below).

    In addition, I discussed stretching during the day with my OT and we came up with a new idea using a foam roll to try to restore thumb extension vs. flexion ("thumbs up" as you call it). See the pics of my red foam roll below. I stick a small ball point pen inside it to add stiffness so it continues to stretch and not collapse in the middle. But the foam softness really helps against that pressure "point" in the tip of my thumb - it doesn't aggravate it like a hard surface does.

    My scars have healed very well - same as previous surgeries. The thumb scar you can't even see anymore, the wrist is still a little more dramatic.

    My wrist extension is responding well. I could barely get to neutral 2 weeks ago and now I'm doing much better - maybe 1/3rd of the way to normal range of motion by the end of a therapy session.

    The wrist is loosening a little also - not quite like a rock. The incision line itself is still very stiff, but to the right and left it starts to be pretty pliable quickly.

    Best of luck. Sounds like we are both progressing about the same.

    Finger tendon graft surgery, off the bike for a while-img_1355.jpgFinger tendon graft surgery, off the bike for a while-img_1356.jpgFinger tendon graft surgery, off the bike for a while-img_1359.jpgFinger tendon graft surgery, off the bike for a while-img_1361.jpgFinger tendon graft surgery, off the bike for a while-img_1360.jpg

  61. #61
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    CodeCruncher,

    Thanks for sharing those photos - your scar in your wrist seems to be doing MUCH better than mine... Mine is still red around the incision and a bit swollen (I will try to get some pictures up here soon). Those parrafin baths look like they work!

    I bought the US PRO 2000 portable ultrasound machine off amazon.com - not too sure if it is helping, or not, but I figure it cant hurt. I am using it once to twice per day for 10 minutes. I have not felt a significant change at home with that device or at PT with their device since my initial ultrasound treatment where I felt the friction feeling of the tendon gliding in the palm area. That friction feeling has also gone away.

    I have not been wearing the splint (except at night to get the extension back) as instructed and have been finding myself trying to do PT excersizes any chance I get during the day as well....

    I am only getting maybe 1-2 centimeters of movement when I try to wiggle the tip of the thumb... I haven't gained much movement since the surgery.

    When I do a place and hold, I can hold it for 5-10 seconds at around 2-4 centemeters, but then it goes back up without my control, no matter how hard I try to keep holding it there. Does that happen with you?

    PT has been going OK - they have told me they don't want to start getting "aggressive" until 6 weeks, which is next week.

    When you make a fist, does your thumb bend in at all, or does it stick out straight? What has your doctor told you about possible recovery time and possible range of motion to expect?

  62. #62
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    Hey all, thought I would jump in with a quick update of my situation.

    I am now 11 days away from phase 2 surgery on the 21st (can't come quick enough!) and as of now things are going fairly well. My "custom" Hunter Rod job is still holding up and I finally remembered to grab a photo of it:

    Finger tendon graft surgery, off the bike for a while-img_20140508_112757.jpg

    The only cause for concern is that there is an internal suture that somehow got trapped partly exposed out of the skin when they sewed the incision shut and the skin hasn't healed fully around the area. My doctor says as long as its not infected, it should be fine, but I haven't been allowed to get the hand wet at all for the last two months!

    Other than that, I have been taking it easy and just sitting around on the couch. Starting to pack on a few pounds because my beer drinking hand is still fully functional

    Hope you all are doing well.

    J

  63. #63
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    Great to hear from jminus and online2!

    jminus - at least your 12oz and 16oz curls are maintaining muscle tone in your unaffected hand . Bummer to hear about your suture exposure - that sucks. We both know how awesome a real shower is after ~12 days and you're still having to do the garbage bag dance every day - I feel for you! I hope that area of non-healing doesn't present any complications on the other side of stage 2 for you.
    Best of luck on your upcoming stage 2 surgery! It will be your last one - just like us!

    online2 - my OT people freaked a little when I told them you bought your own ultrasound. They were concerned you'd use it too much and there are a lot of different time and frequency settings they choose to aim at different results. Hope it works out for you - be careful and keep your OT informed on what you're doing. Buy the paraffin bath - you'll love it. It is awesome for just general OT and you can always sell it later on craigslist. I think I'll keep mine as it will really help with finger cracking during our dry Wisconsin winters.

    My place and holds were best right after surgery. But in the past 5 weeks I am not able to keep it in place as well. But the behavior is different. As soon as I release my hold, it pops up a little and then I can sustain the position indefinitely.

    I'm clearly scarred down some as my extension is still hampered, but my MP joint works fine if I put the tendon on slack and bend it. I've been trying to keep on the scar massage and watching lots of youtube videos on myofascial release, scar tissue massage, etc.

    My night splint and the red "spacer" rod are working, but very slowly. I get a little bit more, but it feels like it is approaching plateau in a battle against scar tissue.

    In contrast, my wrist extension backwards has been progressing fantastic. Once all warmed up, I am within about 20% of normal I'd estimate. That should get me out road biking in a couple of weeks as wrist extension ability was the primary problem preventing gentle riding.

    Next week (week 6) I expect my OT will start iontopheresis for 5-6 sessions. Have either of you had that previously? I had 6+ sessions of that last fall, but that was after I was unknowingly ruptured so of course it really had no positive result.

    Here are a few pictures of wrist and as much tendon excursion as I'm able to after a home OT session.

    What area of the country are you folks in?

    Finger tendon graft surgery, off the bike for a while-img_1368.jpgFinger tendon graft surgery, off the bike for a while-img_1369.jpg

  64. #64
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    Hey everyone, I finally had my phase 2 surgery yesterday so I thought I would check in.

    Everything went well. The doctor tried to use the plantaris tendon (Plantaris muscle - Wikipedia, the free encyclopedia) in my right leg for the autograft, but it wasn't long enough, so he used of my toe extensors instead. Unfortunately, the only way to check the plantaris is to remove it! Kind of strange to have a body part "wasted", but I knew that was a possibility going in. I haven't seen it yet, but I had the button installed on my finger. I will try and get some picts at my next appointment. I will start PT on sunday.

    I did get some good news. Apparently the original muscle belly for one of my index finger flexors was intact enough for my surgeon to use. This means I will hopefully retain more independent motion for that finger once recovered. I have my fingers crossed (har har).

    So, here I am, with my hand AND my leg in splints, laying on the couch typing with one hand for the 4th and hopefully last time. Hope you all are doing well.

    Justin

    PS - just ordered a slew of bike parts as a reward!!! My shopping/beer hand is in fine shape.

  65. #65
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    Best of luck jminus! Did you not have an extra palmaris longus in your forearm to use? My doc said about 85% of people do, but maybe you fell into other group? Or perhaps those are not long enough for your finger need vs. my thumb.

    I hope your surgical site heals well and that you have no complications from your suture exposure that didn't close up well from previous surgery.

    I'm 7.5 weeks after the final graft surgery. My PT continues, but I'm starting to worry that I'm plateauing in function. I actually had more range of motion when the FPL was ruptured between surgeries 1 and 2 because I could extend fully. Now I'm in this middle range where I cannot extend fully because it is attached, but I also cannot flex fully because of scar tissue. I continue aggressive stretching and PT, but I'd love to see some stronger results to encourage me in a positive feedback cycle.

    Best of luck and please continue to update on progress.

  66. #66
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    I do have the palmaris longus, but the doc said it wasn't long enough. I guess he needed about a foot of graft.

    I have been doing the place and hold exercise since friday 4x a day for 10 minutes (2 days post op). I can feel the tendon moving inside the new pulley system... it is sort of sticky, like it doesn't have any lubrication. Not sure if that is expected at this stage or not, but at least I know it is moving and still attached.

    Leg and hand are both pretty sore and I can't really walk. Still taking some PKs at this point, but only a few each day.

    Sorry to hear you progress has stalled a bit. Maybe with continued PT you will break through some of that scar tissue. Do you have any power in flexion? I could live with less ROM if I at least have some strength back in the finger. I already have about 20 degrees of contracture post surgery. The doc said that he intentionally hooked it up tightly because he expects it to stretch.

    J

  67. #67
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    I do have some power in the flexion. I just unloaded the dishwasher for example and can finally grasp a mug or cup from the bottom up side down and pull it up with just the tip of the thumb used (vs. the "lobster claw" sandwich move I used to have to do).

    I started strength exercises with putty about 1.5 weeks ago. Those are definitely helping, but at this stage only 7.5 weeks since surgery my grip is nowhere near what it was pre-injury of course.

    Glad to hear you're moving it passively already and are out of the surgical dressings enough to do that. I think that was a big hindrance on my first surgery where I was stuck in the dressing for 4.5 days with zero movement.

    How's the swelling? Are you still icing it?

  68. #68
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    There really hasn't been much swelling. I never iced it as I wanted to encourage as much blood flow as possible. Instead I just keep it elevated most of the time. Today, I'm trying to take ibuprofen instead of the PKs in the hopes that some anti-inflammatory meds will reduce the stiction in the tendon sheath.

    I have a bit more extension this morning as a result. I'll see the doc on Friday to get an official status report.

    At 7.5 weeks, what are your restrictions? I assume you aren't allowed to do any heavy lifting right? What kind of timeline have they given you?

  69. #69
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    Sounds like you are in a good place. Hope your leg heals fast - that has to be a huge obstacle compared to the previous surgeries where at least you could walk around easier.

    I have no restrictions basically - I avoid lifting anything heavy or really, really straining it, but I'm so concerned about the scar down that I've been stretching it pretty aggressively for at least a few weeks now - and I stopped wearing the day splint after 2.5 weeks. Timeline is pretty open now. They are hopeful continued iontopheresis and ultrasound and OT will break up the scar tissue and get me more excursion and ROM. Surgeon said it would be a year or two before I really know where I end up in terms of function. But if I'm dramatically impaired to where a tenolysis is a possibility I'm sure that would be about 6 months or more after the April 2nd surgery - so Oct or Nov at the earliest. I really want to avoid that so I've been hammering OT hard.

    The site up my forearm near the elbow where they took the palmaris longus ended up with a large hemotoma - felt like a large solid peanut M&M under the skin. For the past 7.5 weeks I've been really aggressively mashing on it with a plastic massager tool and it has really responded. I'm confident I'll be able to get rid of the entire large rock lump completely. If you have something similar in your leg, might want to do the same.

    The plastic massager tool I have is great. My wife got it for a hip labral tear she had repaired. My right hand (the good one) gets soooo tired trying to constantly massage and exercise the injured left hand. The massage tool helps me from trashing the right hand and getting tendonitus. Below is a quick picture of it.

    Hey - the upside of the paraffin bath you bought is you can use it on your foot! That will help those scars heal much quicker.

    I hit a huge milestone tonight - one that I'm confident you will enjoy soon. I went road biking with my large group of regular Wed night riding friends. Did 30 really hilly miles on a gorgeous night. Super happy. Boy does my ass hurt (10+ months off the bike).

    What state are you in? My OT keeps bugging me on where you are - she wants to "compare" to the coasts I think. I'm in Madison, Wisconsin.

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

  70. #70
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    While I am from the west coast (Washington), I am currently in NYC and my doc/ot are from the Hospital for Special Surgery in Manhattan.

    Congrats on the bike ride! 30 miles seems pretty good for a first ride after that long off the bike.

    I'll look for a massage tool like that, although it just occurred to me that I could probably use a metal bike tire lever to do the same job

  71. #71
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    Just had my doc appointment. Everything on track, no real concern about the "stiction" in the tendon glide, but they do want me to back off on the amount of place and holds. Also told me to minimize/cut out the ibuprofen, as it can hurt the soft tissue healing. I didn't know that.

    Current timeline is:
    - Stitches out two weeks post op (next thurs) and I can take a (bag over hand) showers again and hopefully wear a shoe on my right foot.
    - Button comes off after 6 weeks post op. (Yay garbage bag showers)
    - No two handed typing and splint stays on for three months post op (not 100% sure this is what he meant)

    Here is a picture of the foot carnage.

    Finger tendon graft surgery, off the bike for a while-img_20140530_111540.jpg

  72. #72
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    Wow, you picked a good adjective on that one. That is a few more stitches on the foot than I would have guessed. Hopefully it heals quickly and the swelling reduces.

    Is the back side of your calf on the same leg also opened up that much where they tried for the plantaris tendon that ended up being too short?

    re: Ibuprofen - I've heard concerns if bone is involved in the healing, but not on pure soft tissues before. But a few google searches do indicate definite questions around it.

    My thumb extension stretching is progressing a little more. I got a little too aggressive the other night with the dicem anti-slip patch in trying to pull around any scar tissue and managed to inflame the incision line a bit. But backing off on that has let it heal again.

    Best of luck - later this week is stitches out for you - always a great milestone day.

  73. #73
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    Wow Justin! Your foot made me greatful that I had the spare tendons in my arms. I wish you a very speedy recovery!

    I just wanted to provide an update, I believe that I am the farthest out from Phase 2 surgery. I had phase 2 approximately 4 months ago, and I'm nearing the end of my PT sessions as well. It has been a huge adjustment for me mentally, as I did not receive the results that I expected.

    My little finger on my right hand now bends when the other four come down, but unfortunately I am still unable to make a fist because my fingers do not work in tandem. Apparently the new tendons are shorter than the old ones significantly, so that the tips do not all curl over at the same time. I can bend the tips of my unjured fingers separately, but they all do not bend together in the correct motion that would allow me to make a fist - which is very disappointing. My pinky finger is also bent in an awkward position, the tip is really stiff - even with using the night time splint so I am unable to lay my hand flat. Its a very uncomfortable feeling that I'm hoping I will notice less in time.


    I didn't really want to update because I didn't want you all to compare your results to mine, but it feels relieving talking to others who are going through the same thing. I've attached some pictures of my progress.
    Attached Thumbnails Attached Thumbnails Finger tendon graft surgery, off the bike for a while-image.jpg  

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

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

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


  74. #74
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    Quote Originally Posted by Codecruncher View Post
    Is the back side of your calf on the same leg also opened up that much where they tried for the plantaris tendon that ended up being too short?
    Fortunately, the back incision is much shorter. A week on from my last post, I am walking much better and things are starting to feel closer to normal. I have all the stitches out now, but I am dealing with a few minor skin issues related to healing that are annoying but not very serious.

    Haven't started working on extension yet, looking t my finger now, I'm guessing that it is going to be a challenge to get it to straighten out.

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    Nonbiker,

    That must be frustrating to be so close to "normal", but not quite there. Does your doctor/OT expect any progress in the future?

    I may be dealing with a similar situation, as my tendon is "tight" as well. My doc said that he expects it to stretch out over time. I am also seeing some minor bowstringing in the base of the finger at the A1/A2 pulley area. I almost feel like it has stretched a bit. Basically, I can see/feel the tendon through the skin, though I don't know if it is going to be an issue. It could simply be that my rebuilt pulleys are looser than the original.

    I also had another exposed suture! For some reason my body wants to spit them back out. The doctor trimmed it off, but if the skin doesn't heal, I may be in for yet another (minor) operation to close it up! Ugh. Hopefully, it heals on its own.

    Here are a couple of shots of the current situation. The second photo is where I can "hold" the finger when I fire the muscle.

    Finger tendon graft surgery, off the bike for a while-img_20140613_092656.jpg
    Finger tendon graft surgery, off the bike for a while-img_20140613_092807.jpg

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    Wow jminus - that looks great (save for the exposed suture part). Your flexion with the hold looks good to me and the swelling doesn't look to bad. How's the extension so far - I don't suppose they have you trying much of that yet so it must be pretty tight still.

    Nice that they didn't have to open your finger and palm up again - looks like it was just at the top two joints and then down past the wrist.

    How's the foot and calf healing up? I suppose in NYC you aren't driving much anyway?

    When do you get the button removed? I assume you still can't get that portion wet?

    This Wed will be the 12 week mark (3 months) for me and the thumb. I'm still getting iontopheresis with the potassium iodide on both the thumb near the MP joint and that pulley and the wrist tendon bundle. Both I think have responded well to it - they are definitely much softer and more pliable and I think I'm getting slightly more movement. The night splint really didn't do anything for me anymore and they've got me using a little spring single finger splint for an hour or so at a time throughout the day for a gentle, but long continuous stretch at this phase. I think my 12 OT visits covered by insurance run out this Tuesday so might be on my own after that; we'll see what Tuesday's visit brings. I feel I can do all the same OT on my own; the only thing I really think the appts were needed for the last 3-4 weeks was the ionto treatments.

    I've gradually gotten a little more extension and it feels like the tendon is catching or starting to loosen a little more in my wrist (feels different the last week or so) - maybe the ionto is finally busting that rock of scar tissue and adhesions up more.

    I've been able to bike for 3-4 weeks; did a few 35 hilly mile most-of-the-day casual road bike routes and the wrist and fingers tolerate all that well.

    Day to day life is fairly regular - I don't think about the hand that much - except my pinch strength and grip strength isn't anywhere near what I'd like yet. But I've just started in the last 2 weeks on major strengthening exercises so I think that will come around a little more - obviously if the tendon glided as good as it originally did it would be better at transferring the forearm muscle strength contraction to the finger tips for increased pinch/grasp strength. I'm hopeful that continues to gradually improve with daily work the coming 4-6 months.

    Wow - am I tried of doing OT every day. I'm sure you are burnt out at times on it also. Will be so nice to just go back to regular life and get back that 90 minutes or more a day of messing around with your hand.

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    Had my final OT checkup today at 4 months.

    Pinch strength is very close to normal and the grip strength continues to improve with exercise. The IP joint has some contracture compared to before when it was very hyper extendable. I can do a pretty decent Fonzi thumbs up move and continue to work on that stretch.

    I'm just spontaneously using the hand normally for just about everything and continue to try to do OT, mostly stretch and strength - and a little scar massage still - but I'll skip a day or two if I'm too busy with life.

    Best of luck to everyone. Life does get a lot better. August 6th will be my 1 year injury anniversary.

    I even got to hike up to the top of Mt. Fuji in Japan earlier this month with hiking sticks and had no issues!

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    Codecruncher,

    Good to hear from you! I'm glad to see things have been going well. Sounds great to be back to full activity level! I'm really looking forward to that for myself.

    I have been meaning to give an update on my situation:

    I am exactly 10 weeks out from phase 2 surgery today. I had the button taken out several weeks ago and I am back to taking showers without a bag! The suture issue seems to have healed up, though there is a little "thin" spot in the scar tissue there and I am having to monitor it closely.

    My doctor and OT have been very conservative with my OT program due to my history of failures/complications, so I am still wearing my brace when in public and at night, though not while in the office or at home. I am also wearing a brace to straighten the finger at night and a ring to support the A2 pulley area during the day. I am also allowed to use all my fingers for typing again (yay!) and things feel pretty normal form a work perspective.

    My OT protocol currently involves active motion: trying to straighten the fingers with wrist flexed backwards and then closing the fingers into various bent positions. When I try to make a fist, I can get pretty close, though I can't quite get the finger down to the palm. My ROM there has been pretty static for several weeks, though I am happy enough with it. I have some bowstringing through each rebuilt pulley, so I probably won't get too much improvement here due to the lack of mechanical efficiency.

    For extension, I have about a contracture of about 25 degrees at the second knuckle. I am still seeing continued improvement in this area with the night splint and daily OT stretching. Even so, I am pretty happy with the current ROM.

    My only real issue with the finger is that the tendon does not glide smoothly across the pulleys in certain positions. I hope this resolves itself in time. We will see.

    I will be finally starting resistance exercises tomorrow in my next OT session. Should be interesting. I think they will have me in the brace for a full 12 weeks.

    On the more negative side, I am having some complications with my foot where they removed the graft. I actually was cleared to start running last week, which felt great. Within 4 runs I was getting close to my pre-injury mileage. But after my run on Monday (4.9 miles!) I noticed that something didn't look right with my anterior tibialis tendon. Basically it is bowstringing out pretty severely when my foot is in dorsiflexion. It could be related to over compensation from losing part of my EDL (which is still scarred down and not moving) but I'm not happy about it either way. It doesn't really hurt (yet) but I'm quite frustrated to have my previously healthy foot now being a source of problems.

    I ordered an ankle brace and I will back off on the running and see what happens. I am pretty determined not to have another surgery, so I am hoping it is something I can manage with therapy. At least walking feels

    I'll check back in once I have some more news.
    Here is the current state of affairs:

    Finger tendon graft surgery, off the bike for a while-img_20140730_094858.jpgFinger tendon graft surgery, off the bike for a while-img_20140730_094906.jpg

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    I want to thank jminus for starting this thread, and everyone else for participating providing insight that I can apply to my very slow healing process after crushing a middle fingertip in a door seven months ago.

    As a guitarist, I know I was very lucky; I lost no function (only the nail). However, the bone is still quite tender, and playing normally is impossible for more than a few minutes a day. So I understand the challenge of having to wait seemingly forever to get back into action, much less full performance.

    I'm also a swimmer. If any of you have done triathletics, you may know the benefits of swimming, even if it isn't your favorite sport. While it's not much of a weight-reducer, it might help balance the 12- and 16-ounce toning mentioned earlier and help regenerate both stamina and upper body strength lost during the long recuperation process - all this while being easy on bones and soft tissue.

    Of course, you have to be sure that suture points are pretty well sealed, as even the most chlorinated (yechh) water poses risks to deep wounds.

    Anyway, I wish each and every one of y'all the best results possible, and thanks again for making my journey a little easier.

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    That's great progress jminus!

    Your index finger contracture is just slightly more than my thumb and you haven't really started aggressively stretching it so I'll bet it improves a bunch.

    Bummer to hear about your potential calf complexities, hope that is a short term reaction as your body figures out what new muscles need to be toned up in order to deal with the re-configuration of things.

    Aren't normal showers grand?

    You hit a low point on the first failure of the hunter rod, but seeing you be able to flex all your fingers into a fist is fantastic. It sounded like you were close to just living with it ruptured, but despite all the challenges, having even the function you have today is so much better.

    Best of luck!

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    Hi everybody, I had been in this forum back in Feb/Mar 2014 as I had 2 FDP ruptures from an incident at work (Sheet Metal). I had planned on it anyways but my Surgeon also asked me to join some forums and share my story with people.

    In February I had cut all 4 fingers on my right, dominant hand. I was on a remote worksite but was rushed to the small town hospital. I was checked out and was assumed to not have any tendon damage and that my loss of motion was due to pain so I was stitched up and sent home to follow up with a specialist. 2 days later I went to the hospital and got referred to the specialist the next day (order of operations in the health system). So naturally with the other doctors opinion he didn't think know for sure if there was a problem so he wanted me to get an ultrasound. So I went to OT right away and they put me in a brace to keep tension off incase they weren't ruptured and so they could heal. Ultrasound took 2 weeks to get into and found that my index and middle fingers had FDP ruptures. So followed up with my surgeon and between him and Ot they said its too late to try a repair so I got booked in for surgery 2 months later- April for the 2 stage hunter rod. I did lots of warm water soaking and passive motion the whole time and my fingers were passively moving great. I stayed off the beer and ate as healthy as I could to give my body the best chance possible. I went in for surgery and the surgeon was able to feed my tendons back through the sheath and reattach!!! I was so excited and my OT was very surprised! I started Physio two days later doing passive motions in a mobile splint to restrict my movements. I went through this process for about 6 weeks, starting place and hold about halfway through, and then started very light strengthening. The soaking and suture stage sounds about the same as everyone else. I was working my way up through the strengthening levels and at week nine my middle finger re-ruptured on a pinch strength excersise. I was Devastated. Still not sure why, may have been pushing it too hard, may have done something at home that pushed it too far? But so I had now planned to do a hunter 2 stage on my middle finger. This time I got in 4 days later (would've been 2 but they could not find the rods or ran out). I asked my surgeon if he could work his magic again PLEASE. He was very doubtful and so was I then. But then I woke up and asked if I have a rod in my finger.. he smiled and said no. He was able to do it again! So we co-ordinated with physio and I started a slower cycle. I was bound to my brace and 0 active or place and hold for 3 weeks. I had a follow up with my surgeon and he recommended starting active motion, so my OT started my on place and hold for about another 3 weeks and finally some straight active motion. I was being very careful and limiting the amount of any movement I did outside of physio. at about 2 1/2 months I started strengthening again and also doing passive and active motions. I was doing modified work 8 weeks after my second surgery and it was amazing watching my progress as I could lift more and more. and I am just now, 10 months later, going back to my normal duties. I do have a lag in my middle finger that I will continue to work on and a slight lag in my index and I also have some loos of sensation in my index finger. I know this is a different scenario than any of the posting on this site already but I figured it could give hope to anyone who comes across it. For a guy who was never to do construction again ive already been swinging a hammer, squeezing snips and wire cutters and using power tools. My strength is great and is still coming back as I proceed with everyday life. Im not suggesting to fight for re-repairs as I did, I'm just trying to let people know to do as much as you can to help the healing along, don't neglect it.. but don't push it too hard! I know its a fine line and can be difficult, but just do what you are comfortable with. As much as it doesn't seem like things will be at the beginning, everything will be ok and you will get better/adjust and carry on with life!

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    hello, I just had a rupture of my fdp tendon (jersey finger) of my dominant hand and was told because of the tear the tendon is now much shorter, the tendon ended up in my wrist. I went thru the procedure to reattach it to the dp joint with a hole drilled thru the bone and sutures. the tendon was cut shorter because of how much it was shredded. Now he wants to open me up again and do a tendon lengthening procedure because I now have a condition known as quadrigia. he wants to do this procedure in the bottom picture, I wanted to ask others this as well, no one mentions pain that much , I am now 5 weeks into this and the pain is still intense and the surgeon said its because of my shortened tendon is pulling more than usual, I know about pain I ruptured my achillies and after 5 weeks I was wearing both of my shoes and not much pain at all and this is much worse . what do you think
    Attached Thumbnails Attached Thumbnails Finger tendon graft surgery, off the bike for a while-img_20141123_134058_351.jpg  

    Finger tendon graft surgery, off the bike for a while-img_20141123_133535_660.jpg  

    Attached Images Attached Images  
    Last edited by jdh022764; 12-20-2014 at 04:01 PM. Reason: attachment

  83. #83
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    jminus, which tendon failed? fds or fdp? are hunter rods designed for both or only one of the tendons? and why couldn't the surgeon just reattach it again

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    Quote Originally Posted by jdh022764 View Post
    jminus, which tendon failed? fds or fdp? are hunter rods designed for both or only one of the tendons? and why couldn't the surgeon just reattach it again
    Both the FDS and FDP tendons were initially severed when I cut my hand. My first surgeon was going to try and reattach both, but told me after the surgery that the damage was to extensive and he could only get one re-attached. It didn't matter, because the primary repair ended up failing, hence the need for the hunter rod.

    I don't think it is possible to replace both the FDP and FDS using the hunter rod procedure. By that point, they will just do the FDP since it can perform most of the work of the FDS as well.

    As far as your situation, it never hurts to get a second opinion. I have read about the tendon lengthening procedure, but I don't know anyone who had it done or what the consequences are in terms of tendon strength. I would probably opt to have it done rather than live with a severe contracture. I have a mild contracture (10-15 degrees) and I think it is really annoying. Probably not annoying enough to have it fixed, but if it was much worse, I would.

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    I have a severe contracture but the quadrigia is the main reason we are talking about the lengthening procedure. when I ruptured my tendon my adjacent fingers worked perfectly now they do not and he said its because of the quadrigia from pulling the 5th digit tendon to reattach it and now the other fingers have slack in the fdp tendons, what a pain in the butt this turned out to be.

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    Quote Originally Posted by jdh022764 View Post
    I have a severe contracture but the quadrigia is the main reason we are talking about the lengthening procedure. when I ruptured my tendon my adjacent fingers worked perfectly now they do not and he said its because of the quadrigia from pulling the 5th digit tendon to reattach it and now the other fingers have slack in the fdp tendons, what a pain in the butt this turned out to be.
    Hi sorry to hear what you are going through. I also had the hunter rod replacement surgery. My second surgery was in Feb 14. I have contracture in my finger that really bothers me - its more than just annoying its painful, and while I have good passive motion, my action motion is not great, and my two fingers that were fixed surgically move at a completely different pace than the three that weren't. I went to see another specialist who said that the fix could be worse than the problem - meaning that I should essentially live with it. Its had me pretty down in the dumps. I'm not sure I'm better off from where I started. Anyway, wish I had better news - wishing you the best of luck!

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    Quote Originally Posted by nonbiker View Post
    Hi sorry to hear what you are going through. I also had the hunter rod replacement surgery. My second surgery was in Feb 14. I have contracture in my finger that really bothers me - its more than just annoying its painful, and while I have good passive motion, my action motion is not great, and my two fingers that were fixed surgically move at a completely different pace than the three that weren't. I went to see another specialist who said that the fix could be worse than the problem - meaning that I should essentially live with it. Its had me pretty down in the dumps. I'm not sure I'm better off from where I started. Anyway, wish I had better news - wishing you the best of luck!
    Nonbiker,

    Have you been wearing a night brace to straighten the finger out? I have found that it seems to really help. My contracture has definitely improved over the last few months. I still wear the brace every night. My whole hand and wrist is weak and has lost a lot of flexibility, so I think this will improve over time as I return to regular use.

    My biggest issue now is that the finger doesn't feel "right" when I grip things or move it. Lot's of twinges and little pangs, sensitive skin, etc. I'm paranoid that the repair will fail as soon as I do anything strenuous, especially given the track record I have with complications and failures. I've already made the decision that if it does fail, I'm not going to get it fixed again and either get it removed or just live with it.

    I've come to accept (and appreciate) the level of functionality that I have now, but I don't want to have to baby my finger for the rest of my life.

    I'm slowly phasing in heavier activities. I've been using the hand in the gym with light weights and I plan to go on my first (easy) bike ride this weekend. The doctor said I am to have no restrictions by Feb 25th... 9 months after my stage 2 repair.

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    Just a quick visual update for anyone who comes across this thread.

    My finger gets pretty close to straight and I have pretty good active motion. I'm fine with the current state of affairs, IF it holds up under heavy activity We will see, I'm starting to ramp things back up.

    The best part is not wearing the damn brace. I got SO TIRED of explaining what happened over and over again for a year. It has given me a new appreciation for what somebody with a visible disability must have to live with.

    Finger tendon graft surgery, off the bike for a while-img_1015.jpgFinger tendon graft surgery, off the bike for a while-img_1016.jpg

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    Quote Originally Posted by jminus View Post
    Nonbiker,

    Have you been wearing a night brace to straighten the finger out? I have found that it seems to really help. My contracture has definitely improved over the last few months. I still wear the brace every night. My whole hand and wrist is weak and has lost a lot of flexibility, so I think this will improve over time as I return to regular use.

    My biggest issue now is that the finger doesn't feel "right" when I grip things or move it. Lot's of twinges and little pangs, sensitive skin, etc. I'm paranoid that the repair will fail as soon as I do anything strenuous, especially given the track record I have with complications and failures. I've already made the decision that if it does fail, I'm not going to get it fixed again and either get it removed or just live with it.

    I've come to accept (and appreciate) the level of functionality that I have now, but I don't want to have to baby my finger for the rest of my life.

    I'm slowly phasing in heavier activities. I've been using the hand in the gym with light weights and I plan to go on my first (easy) bike ride this weekend. The doctor said I am to have no restrictions by Feb 25th... 9 months after my stage 2 repair.
    I have not been wearing the brace at night anymore. At this point I am 11 months post phase 2 and my doctor said that its not necessary anymore. Sometimes I wear the finger splint with the spring (can't remember what its called) to straighten it out a bit, but as soon as I use my finger it bends back.

    I'm happy that your finger turned out well. Looks like you have great active motion from your picture below. I know what you mean about your finger feeling foreign. Mine does too as well. I don't think that you tendon will pop again. From what I understand it is very strong, and the likelihood of that is very low at this point unless perhaps you fall directly on top of it.

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    Thank you jminus for the response, I had my second surgery January 14, 2015 to release the FDP tendon with the Z-Plasty technique and 12mm was added in length. when I got out of the cast two weeks later the only difference I saw was the finger being slightly straighter and it does not work still. if anyone out there can tell me what I can expect from this please let me know, I did some therapy after my first surgery but my hand and finger was so swollen that it didn't do much and because of the over advancement of the tendon the pain was intense for the two months after. One thing that the 2nd surgery helped was the pain was gone except for the incisions again.

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    Figured I should follow up now that I am FINALLY back on the bike. I moved from NYC to Washington State last week and the weather here was already in full-on spectacular MTB mode. I am currently living out on the Olympic Peninsula and working from home which means I can hit the trails every day at lunch!!!

    So far I have been on 5 MTB rides (and one ride with the roadies) and things are feeling pretty good. I can actually do one-finger braking as well. My hand still feels weak and sore, but I think it is starting to improve.

    I can't even describe how great it feels to be riding again. Looking back on my original post makes me cringe. 1 year and 5 months off the bike. LAME! At least I stayed in decent shape by running and hiking.

    Hope the rest of you have your lives back as well.

    Take care,
    Justin

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    Hi Justin,

    Man, i read through your story.....You are warrior!!!

    I tore the FDP in the ring finger of my left hand on 3/3/15 (6 weeks ago). it was a complete rupture.

    The surgeon operated 3 days after initial injury on 3/6/2015

    I am now 5 and 1/2 weeks post-op

    Been doing hand therapy 2X/week

    I'm concerned.....not much flexion in the DIP of the repaired finger.

    The therapist keeps telling me that i've adhered/scarred and thats why the tendon is not pulling through.

    Can you offer any advice? This whole ordeal has been very difficult emotionally like you I'm an athlete who's weekly regiment incorporated bike, swim, hike, yoga, cross-fit.

    The only thing i can do now is spin inside.......

    thanks for your input,

    Eric in Oakland

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    Quote Originally Posted by bankstoneric View Post
    Hi Justin,

    Man, i read through your story.....You are warrior!!!

    I tore the FDP in the ring finger of my left hand on 3/3/15 (6 weeks ago). it was a complete rupture.

    The surgeon operated 3 days after initial injury on 3/6/2015

    I am now 5 and 1/2 weeks post-op

    Been doing hand therapy 2X/week

    I'm concerned.....not much flexion in the DIP of the repaired finger.

    The therapist keeps telling me that i've adhered/scarred and thats why the tendon is not pulling through.

    Can you offer any advice? This whole ordeal has been very difficult emotionally like you I'm an athlete who's weekly regiment incorporated bike, swim, hike, yoga, cross-fit.

    The only thing i can do now is spin inside.......

    thanks for your input,

    Eric in Oakland
    Ouch, ring finger. I'm sorry to hear that. My only advice, other than following the doctor's and therapist's advice to the letter, is to try and keep your mental state in check. By far the hardest part for me was trying not to be depressed. I practically defined my identity by mountain biking and rock climbing and to have that taken away was tough.

    Try and keep your focus on the future. Even if your finger doesn't get any better (though I truly hope it does), you WILL be able to do ALL the activities you love again. Even rock climbing can be done with 9 fingers, Tommy Caldwell is one of the best climbers in the world and lost his index finger years ago. Here is is free climbing el cap: .

    In the meantime, run and hike and keep your endorphin withdrawal at bay.

  94. #94
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    Hi Justin and everyone else!!

    It's been good to hear all the stories on here - especially Justin - its been really insightful and good to hear from someone who's had a similar experience.

    I lacerated my FDP tendon in right middle finger (dominant hand), back in January this year with a piece of glass - lucky not to injure my FDS!! I had two failed primary repairs (both ruptured however waited 4 weeks after the first rupture due to my physic not detecting the rupture which was extremely frustrating making the second attempt less likely to work well as the tendon had retracted).

    I have now been through the two stage Hunter process and am 11 weeks post second stage. Like everyone else its been a difficult process and has been hard to stay upbeat and motivated but have tried my best. I am a huge tennis player as well climbing and other sports and for tennis it is vital I get a good range of motion/flexion at the dip joint to hold the racket properly.

    I saw my doctor and physic yesterday and despite them thinking I have a good gliding tendon (as when i isolate the movement of the dip when putting pressure on the middle joint when my hand is straight - i get good flexion). However when my hand goes into fist position, I am only getting around a 20 degree flexion at the dip joint which is not sufficient when holding small objects or a tennis racket.

    My surgeon now believes it is a tendon length issue/ tendon being too loose and says my only option would be to tighten it if I wanted more flexion at the dip in a fist position.

    This is good/bad news for me as after 4 surgeries and 8 months since initial injury, the idea of another op is a killer, and also feel I should be careful going into this finger again after the amount its been through already - I wouldn't want to make things worse.

    I also have slight contractures at the dip joint and an even more slight at the pip.

    Anyway wanted to ask you if you've heard about tightening the tendon when its too loose ( I also don't want to worsen the contractors). My doctor says its actually the best of the problems to have, as I have a free gliding tendon which doesn't seem to be scarred up so tightening it should have less risks than the whole two stage procedure I've been through but I am def gonna try and get some second opinions before operating again.

    Anyway any advice would be amazing and I am hear if anyone needs advice on the process as I have been through it!!!

  95. #95
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    Finger tendon graft surgery, off the bike for a while-photo-11.jpgFinger tendon graft surgery, off the bike for a while-photo-10.jpgFinger tendon graft surgery, off the bike for a while-photo-6.jpg

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    I attached a few pics above, I am getting only 20 degrees flexion at the dip joint when in a fist and 30 degrees when my fingers are semi flexed as in the last photo.

    From what I've read considering i only tore my fop and therefore only lost motion in my DIP joint, that these results are mediocre.

    Thanks for your help!

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    Quote Originally Posted by S21 View Post
    Hi Justin and everyone else!!

    It's been good to hear all the stories on here - especially Justin - its been really insightful and good to hear from someone who's had a similar experience.

    ....

    Anyway wanted to ask you if you've heard about tightening the tendon when its too loose ( I also don't want to worsen the contractors). My doctor says its actually the best of the problems to have, as I have a free gliding tendon which doesn't seem to be scarred up so tightening it should have less risks than the whole two stage procedure I've been through but I am def gonna try and get some second opinions before operating again.

    Anyway any advice would be amazing and I am hear if anyone needs advice on the process as I have been through it!!!
    Hey S21,

    Sorry to hear about what you are going through. I know exactly how you feel, especially in regard to the undetected rupture and the effect that has on your final prognosis. You are pretty darn lucky to still have the FDS intact (and the pulleys I assume).

    I have read about shortening and lengthening procedures and my totally uneducated opinion is that it is much better to have to shorten a tendon than lengthen one. I would think to shorten the tendon they just cut it down at the muscle end and re-attach it the same way the did the initial repair. Hopefully that would only involve opening your wrist up and not messing with the finger. If it did involve going into the finger I would be more hesitant. Contractures suck and is one of the more annoying issues I live with now post-op.

    Definitely get another opinion and also find out if you need to act soon or if you can wait awhile and see if things get better. I know that ~1.3 years out from my last surgery, my hand has gained a lot more range and strength.

    I'm riding my MTB more than I ever have and you will get your life back too! Go read some of the other posts in this forum to put things in perspective.

    Stay strong!

  98. #98
    S21
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    Thanks for the reply Justin

    Out of interest what did your doctor/ physic tell you to do regarding your contractures - did they continue to improve post 3 months after stage 2? I am simply doing stretching exercises where i put the joints back - my physio hasn't given me anything else but would be good to seek a second opinion.

    Thanks!!

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    Quote Originally Posted by S21 View Post
    Thanks for the reply Justin

    Out of interest what did your doctor/ physic tell you to do regarding your contractures - did they continue to improve post 3 months after stage 2? I am simply doing stretching exercises where i put the joints back - my physio hasn't given me anything else but would be good to seek a second opinion.

    Thanks!!
    They were very conservative with stretching my finger because of the previous failures. I had a brace to wear 24/7 that kept the finger bent for the first three months or so. Then I ended up getting one that slightly straightened the finger. I used that for over a year, but I would say the contracture stayed about the same as it was at month 3. Never really had any exercises to do. Like I said, they were very paranoid about another rupture.

    These days I stretch my finger/hand every day. With some stretching it loosens up, but it doesn't stay that way.

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    ... and if we just ...

    " Thanks Justin and everyone for initiating this thread, it helped me through out the surgeries to keep myself motivated"



    Hi guys, my name is sai.. I am a software developer..i had a cut on my tendon(left hand index finger) on feb 17th .. i went through a two phase surgery(hunter rod technique).

    My doctor is Jason k Haslam(Nashville).. He is a great doctor

    /*I thought to give brief updates for every two weeks(hope it will be helpful to someone)*/


    First surgery was performed on March 17th. A silicone rod is kept in my finger. Exactly after two weeks the stitches came out.

    Below are the pics after the removal of stitches on march 31st.
    There is lot of pain for first two weeks and i was taking pain killers.
    I took 12 pain killers for first two weeks(i thought these pain killers might create side affects so i thought to handle the pain myself)
    Finger tendon graft surgery, off the bike for a while-img_2688.jpgFinger tendon graft surgery, off the bike for a while-img_2690.jpg

    I am not able to move my fingers for two weeks. Slowly i got my motion back after two months(may 17th)...

    Doctor suggestion
    Stop overdoing the OT(just repeat the exercises 5-6 times a day)
    Massage everyday gently
    No physical activity with the "left finger" and no heavy activity with the "left hand".

    I was performing physical therapy myself. My doctor suggested me some exercises(your doctor might recommend a therapist after 1st stage). My finger remained tight for 20 days after the removal of stitches.
    This is how my fingers look April 1st 2016
    Finger tendon graft surgery, off the bike for a while-img_2695.jpg




    On april 9th 2016
    my finger still got some swelling and it is tight.
    Finger tendon graft surgery, off the bike for a while-img_2726.jpg
    Finger tendon graft surgery, off the bike for a while-img_2727.jpg

    --------------------------------------------------------------------
    On May1st this is how my finger looks(below picture)... there is no swelling and got 90% of my flexion back....

    Finger tendon graft surgery, off the bike for a while-img_2809.jpg

    -----------------------------------------------------
    On may15th this is how it looks with full flexion...
    I started using my left hand for typing(but not the left finger).. I started to learn typing without index finger...
    I started typing fastly and accuratley by using my three fingers..
    my pinky finger for 6 buttons on key board(q,a,z,w,s,x) ...
    my ring finger for three buttons (e,d,c)....
    my middle finger for 6 buttons (r,f,v,t,g,b)...
    I dont know how i am gonna adjust back to my original style of typing after the full recovery...

    Finger tendon graft surgery, off the bike for a while-img_2863.jpg



    I had my second stage on june 20th(exactly after 3 months)
    This is how my hand looks on the same day after surgery.
    There is no pain this time... i didn't take single pain killer(weird)...
    Finger tendon graft surgery, off the bike for a while-img_3041.jpg

    Stitches come out after 3 days or one week
    This is how my hand looks on july 18th
    Started hand therapy(this time i was suggested to use therapist)
    Only passive motions till my button is removed.


    I can make a fist(with the help of other hand), but i cannot extend all my fingers... There is no swelling but tendon is tight.. so are all the fingers..
    Finger tendon graft surgery, off the bike for a while-img_3140.jpg
    -----------------------------------------------------
    A button is used to hold my tendon(below picture)
    the button comes off after 6 weeks from surgery

    Finger tendon graft surgery, off the bike for a while-img_3141.jpg

    -----------------------------------------------------------------
    wrist is kept bent at a certain angle using the split...
    The split below is a custom splint
    Finger tendon graft surgery, off the bike for a while-img_3142.jpg

    This is the angle i was talking about.. the hand will be in this position for 3 months....
    Finger tendon graft surgery, off the bike for a while-img_3143.jpg


    --------------------------------------------------------
    I am scheduled to visit the therapist two times a week.
    In the below picture the palmers Cocoa butter formula cream is used to soften the skin and remove scars upto some extent and massage the scars two times a day(only after the wound closes or heals up),,, and the silicone strips(brown colored strips in pic) are used to break the scars... I was suggested to stick these silicone strips to the scars when i sleep at night ...
    Finger tendon graft surgery, off the bike for a while-img_3144.jpg



    Yesterday(26thJuly), my button is removed. My finger feels tight. I have good active motion in my other fingers.
    Last edited by sai12367; 07-27-2016 at 09:44 AM.

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