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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
    what the quan?!
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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!

  16. #16
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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 07:12 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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