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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

  31. #31
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    Vanillat,

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

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

    Best of luck with the surgery.

    Justin

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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

  33. #33
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    Alex,

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

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

    J

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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?

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

    Alex

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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

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


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

  38. #38
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    Nonbiker,

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

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

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

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

    J

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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.

  41. #41
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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

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

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

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

    This was on 4/2 as well!

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

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

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

    My questions I hope you can answer are:

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

    Thanks and good luck with your recovery!
    Last edited by online2; 04-12-2014 at 12:18 AM. Reason: overlooked previous comment

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

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

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

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

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

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

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

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

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

  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.

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



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

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