Hand flexor tendon laceration-Post surgery range of motion issues

[drock580]

Hello,
I filleted my left middle finger on an oyster when I fell into the water about a year and a half ago. I cut the tendon (60%), and had surgery to repair it. I have a limited range of motion now, which I understand is because of the combined effects of scar tissue that forms around the tendon during healing, and also the fact that the tendon will not be as strong after repair. (The scar tissue inhibits the ability of the tendon to glide smoothly through its sheath along the finger).
My issue is not with the limited motion of the finger. The surgery went well and that is pretty common for that injury. What's been difficult is that I'm having range of motion problems with my arm, shoulder, and posture because of it, which I didn't expect. I'm an athlete (mostly soccer, basketball, surfing, but am into it all, played a little college soccer), and that stuff is an important part of my life, and my body is just not working the same. Feels like I got chicken wing arm or something, and my balance is off. I've talked to a couple physical therapists, and both seem to think it should be mostly back to normal, which isn't how it feels. What I'm feeling also makes sense to me as well, because the finger tendons run from your fingertips to the forearm muscles and attach at your elbow. Like having five rubberbands that work together, but one is shorter.
Anyway, I'm posting because I'm wondering if others with the same injury have experienced anything like this, or what people thought. Do I need to just workout hard? I try to stretch my arm and stuff out all the time, but it doesn't seem to help. Mostly I"d like to talk with people who have had similar injuries...but anybody really. I've been kind of frustrated after the talks with my physical therapists, and to be honest the whole thing has me pretty bummed.
(sorry for the long post)

[Zaynah]

hi..

So sorry to hear about your injury.. i'm in a cast right now, immobilized... so i know what it feels like after surgery.

After the operation your hand, wrist and forearm was probably put in a splint/cast for the immobilization (removing strain on the tendon). If movement exercises weren't started early or you didn't recieve proper rehab for all the structures and joints involved, this could be the reason for your problems.. With immobilization your entire arm from your shoulder moves differentely because of the injury to it distally in the forearm/hand. So many structures stiffen up due to the inflammation process and keeping the limb relatively still.

You can do stretches (fingers and wrist pulled back with a straight elbow) for 30sec-2min 3times daily, do massaging techniques to break down connective tissue bands that have formed in various structures, apply heat to help increase blood supply for healing and removing toxins, and do hand-finger exercises. If your elbow and shoulder bothers you, you must sort it out. A good physio should be able to examine each joint and pin point the problematic structure. There is a condition called shoulder-hand symdrome that occurs often after wrist fractures or shoulder injuries, where the person complains of discomfort in the shoulder, down to the hand. It's very complex and often misdiagnosed, but treatable.

Someone must be able to help you. if you have discomfort, there must be something wrong, and a trained professional must be able to fingd the problem and give you proper advice.

[drock580]

hey Zanyah....thanks for the reply, I really appreciate that because it seems like you might know what I'm talking about, where I don't think my therapists do. I've only been here a few days, and seen you replies to people...Are you in medicine?
Anyways, I'm in a rush right now, but will send a bit more info about my situation, and would like to see what else you have to say....as well as anyone out there who has had this injury. It would help alot to know if others have experienced something similar.....Thanks alot....Merry Christmas or whatever (Happy Holidays)

[Zaynah]

Yes, I'm a qualified physiotherapist from South Africa. I have a interest in sport and pediatrics.
I have had many injuries and operations being a competitive sports woman all my life (stopped now for the longterm due to major hip injury), so I know what people go through.

Happy holidays ;)

[drock580]

Hello Zaynah,
I think my rehab went pretty well, at least the doctors were pretty pleased with how things went. There were times when I wouldn't do exercises and stuff for a few days, and kinda of stopped the last two or three months towards the end of the one year therapy time, when they say healing and rehab usually plateaus, but they said that wouldn't have mattered much. The thing you said that I'm indentifying with is the shoulder moving differently because of the injury to it distally (distal means farther away from the main joint or shoulder in this case....right?) in the forearm/hand. Like a tight rubber band in my forearm keeps the hand and forearm from "stretching out all the way", and so the rest of the arm and shoulder will not move properly or like it used to. I don't really have discomfort or pain...its just the range of motion thing. I'm always trying to stretch and move my hand and forearm around, but it really doesn't do much...I'm planning on starting strengthening exercises again, but don't know if that will do much either (for the range of motion problem at least).
I massage the area occasionally, but I don't know if the scar tissue will breakup anymore, because its been a while. I asked my surgeon about a second surgery to remove scar tissue, but he advised against it, saying it would probably do more damage, which kinda makes sense.
I don't know much about shoulder hand syndrome, but its not a discomfort or pain issue. So, I don't really know. The only thing I can think is to get on a workout program and see if that helps. Its just frustrating because when I explain whats going on to my therapists, they just kinda look at me at say....no, your movement is fine, it should return to normal. If that was the case, wouldn't it just happen naturally?...its been about a year and a half. If they would say stuff like, yeah...you may experience some of these other effects, but you got to work through it or something...I'd be cool and could move on with it.
But they're saying it should be fine, and that I worry about it too much, and that's not whats going on. I don't know, I feel what I feel. I've lost strength in my upper body because things aren't working right.
Any ideas? I'm going to research shoulder-hand syndrome a bit. It would also be great hear from anybody who has had a similar injury, whether you have or haven't experienced some of this...it would help...(has what I've explained made sense, I can ramble)....Thanks

ps-Zaynah, Hope your wrist is doing better, good luck with surgery

[Zaynah]

hey.

stiffness is a big issue. i'm batteling getting my wirst motion back. It's very difficult if you have therapists that aren't very experienced with these types of injuries. You must remember that not every health professional in the world is of the same calibre and they only do the things the know... not very helpfull it they have to give 100% for someone, as it's about money most of the time.

The best thing to do with discomfort, impaired range of motion or stiffness is to use heat (hotpacks or hot bathc). It relaxes muscles and ligaments and lubricates joints, as the heat brings bloodsupply to the area. After the heat (10-20minutes) you should do the stretches. First start with the muscles near the shoulder, as many muscles run over 2 joints. So stretch your shoulder in all the directions you could think off (keeping your elbow bent). Hold each 30sec-2min. Then go to the elbow and stretch it in both directions keeping your hand and wrist relaxed. Then the forerarm. keeping the elbow straight turn your forearm so that your palm faces the ceiling and then down to the floor. Now move the wrist in all possible directions, keeping the fingers relaxed. Then only the fingers and your thumb. Now straighten your elbow and turn your palms up to the ceiling and open your hand. Now turn your palms facing down and make a fist. These last to stretches stretch the mucles running over the elbow and wrist, as well as the nerves. If you get a tingling or discomfort feeling in your vingers, this indicates the nerves.... they can shorten just like muscles. If you do exercises (strengthening your grip and stretching the muslces) everyday every few hours, this will lengthen the soft tissues... it will take a few months, but you will gain back range of motion and strength. It is very important to stretch the muscles at your shoulder.. The pecs (that brings your arm across your body) shorten and gives you rounder shoulders and then influences your entire spine curvature (if the spine between your shoulder blades curve more, then the neck part will compensate and have a pronounced S shape and so with the lowerback). its such a pity that you cant' find a therapist willing to check everything out, your posture, the nerve lenghts, the joints, the mucles etc. Good luck with everything.

[drock580]

Hello Zaynah,
Haven't had my PC working in a couple of months, but I wanted to reply and tell you that I appreciate your advice. You didn't even evaluate me, but you described exactly what I'm feeling is going on with my posture and everything (effects from shoulder, pec muscles, influences on spine curvature, lowerback, etc.). You're the first therapist who didn't think it would just go back to normal. Anyways, I'm still working on getting into a routine to work everything out, and am trying to incorporate the stretches and things you suggested. I'm still feeling a little pessimistic about things improving, but I'm going to see what I can do. Never expected this finger injury to have these other effects, but I have lost quite bit of upper body strength and flexibility because of it....crazy. How much of an improvement do you think I could see...alot...almost back to normal?
Thanks again

[Zaynah]

hi

thx for the update. it's such a pity that many health professionals out there only do the bare minimum and that they don't see the bigger picture. i'm just glad to help. because i've had many injuries and operatons, i understand all the small things no one tells you, and i know how important it is to be informed about your condition. many health professionals don't take the time and effort to explain in detail the diagnosis, treatment and post operative rehabilitation with reasons, cause they think the patient wouldn't understand the complexity of the case and it's a waste. i am all about educating and informing... cause if you know, you understand and then you can make informed choices.

If you incorporate the proposed exercises for the stiffness, posture and ranges of motion, you condition will improve. it's impossible for me to give you a definite prognosis about how much you will improve and how long it will take as i haven't had my hands on you! but, usually it can take months to a year. with any injury, you never achieve 100% healing and recovery, never. even with a ankle sprain, those ligaments will always be a bit lax or a bit stiff and prone to another injury. this is because the composition (elastisity vs strength vs viscosity) of the injured tissue changes and it's never the same. but we aim for function and painless function at that. the most important thing to remember is to not 'forget' about that arm, by rather using the other arm for compensation. always use the arm as much as possible like you would normally, but out of pain and discomfort. Take babysteps to progress in your rehab, for example, if you hold a stretch for 30sec, progress every week/ second week with 10seconds untill 2minutes. a good idea is to sit infront of a mirror when doing posture correction exercises, stretches etc, so that you can see how your body is compensating, and then you can correct it yourself. if unsure, do it with the other unaffected side and see what you should be doing.

do this for your posture in front of a mirror: tuck your chin it (dubble chin) to correct a head forward posture that puts strain on the upper neck. then pull your shoulder blades backwards to the spine and downwards, as this corrects the rounded hunch back and the forward shoulders thanx to pectoralis muscles shortening. now slightly contract your tummy muscles (pulling in the navel to the spine lightly and making the tummy hard as if someone is about to puch you in your stomach). turn sideways in the mirror and slightly tuck in you pelvis, so that you dont arch your lowerback too much. keeping all the above positions, breathe deeply a few times trying to feel how a correct posture should feel. You are thus activating the stabilisers in the neck, chest, upper and lower back for a normal postural alignment. If the spine is corrected, the upper and lower limbs usually follow. the above posture exercises, are from the Pilates exercise method. it is all about correcting postural imbalances and re-educating the muscles in balance.

If you can, swimming is a good exercise for the entire body, as this exercise uses the muscles in the correct movement patterns, and will help increase strength and the water helps relax the muscles.

It will take time to lengthen and loosen tighten musles, tendons, joints and re-educate the correct muscles (stabilisers) to ensure good postural alignment. Keep faith. i know, there will be days when you feel like giving up and that it's such a waste of time and energy, but in the long run, you'll see the results and be thankful you pushed through. Good luck.