Nasser Hyder - Orthopaedic Hand, Wrist and Trauma Surgeon Your Practice Online
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Meet Nasser Hyder
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After Care and Therapy

Two Stage Flexor Tendon Repair for Old Tendon Injuries

Sometimes flexor tendon injury is not detected early or for some reason repair has not been carried out. Sometimes the repair has been done but failed. In these situations, a two stage flexor tendon operation is required. In the first operation the left over bits of the old tendon are removed and tendon bed is recreated. A silastic (plastic) temporary tendon is left in place. In around 3 months, a nice tendon sheath and bed forms around this silastic tendon. The second stage operation is then performed, when the silastic tendon is removed and replaced by a tendon graft taken from your forearm or more commonly the leg.

First Stage Operation

The operation will be done under General Anaesthesia and you will be discharged home on the day unless there are other reasons to keep you in hospital for longer. On discharged your hand will be bandaged from forearm to the fingertips. You will attend the OT (Occupational Therapy) within a few days and the bandage will be changed and you will be instructed to start stretching the finger. The stitches will be removed at about 2 weeks.

You will stay under the care of therapist for swelling control, scar management and to continue passive stretches for the next 3 months. It is important that swelling is completely down, scar has settled and full passive movement is possible before the second operation is undertaken. 

Second Stage Operation

This operation will be carried out at about 3 months from the first operation. It is done under General Anaesthesia as a day case procedure. On discharge you hand and arm will be in a half plaster extending from below the elbow up to your fingertips. You will be asked to keep the hand elevated in a sling to keep the swelling under control.

You are likely to require some pain killers for a few days.

 0 – 4 Weeks

You will see Occupational Therapist within a week of the operation and the plaster will be removed. A thermoplastic splint will be made for you to keep your wrist at neutral extension and finger knuckles (MCPJ) at 30 degrees of flexion. This splint will be on the back of hand allowing you to bend (flex) your fingers gently and straighten (extend) them up to the splint (30 degrees). You will be asked to do active gentle flexion and extension several times in the day. Some passive stretching will be undertaken by the therapist. At night time your fingers will be strapped by Velcro so that no inadvertent movements take place. You may also be seen by a physiotherapist at this point.

You will be seen in the clinic at 2 weeks for removal of stitches and general check on your progress.

4 – 8 Weeks

At four weeks it may be necessary to adjust the splint depending on your progress. Active and passive exercises are continued. No resisted exercises are allowed at this stage.

8 – 12 Weeks

Day time splinting is discontinued but continued at night time for another 4 weeks. You can start doing active extension and flexion outside the splint but with minimal resistance or force. You will be encouraged to make full fist, half fist and hook fist. Passive movements and stretches will continue as before under the guidance of the therapist.

12 Weeks

All splinting can now be discontinued. . You will be advised to start using your hand for normal use. Even at this stage there will be less that full movements in the finger and the scar may feel hard. With continued use and exercise, the finger will continue to improve for the next 12 months.

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Hand & Wrist Elbow After Care and Therapy