Extensor Tendon Repair
Extensor tendons are the cords that help straighten the joints in each finger. There is one large tendon down the top of each finger to the middle joint and then it merges with additional tendons to help straighten each finger. When these are cut, they do not heal on their own. Surgery is needed.
After surgery, therapy helps get the tendons moving in a controlled fashion. Too much movement and tendons may rupture. If there is not enough movement, a scar may form and movement can be limited.
Therapy will start within one week to 10 days after surgery. Your therapist will make a splint and go over exercises to start right away.
With this injury, the location of the tendon repair determines how much or little you can use your hand during recovery. Plan on being in a single finger splint (for injuries further out to the tip of the finger) or a splint that fits like a ring across all of your fingers for 6-8 weeks.
- DO NOT TRY TO MOVE YOUR FINGERS AND/OR WRIST IN THE SPLINT
- Do not remove your post-operative dressings/splint. Keep your dressings/splint clean and dry. Cover your dressings/splint with a plastic bag for bathing.
- Your dressings will be removed during your first post-operative visit or during your first occupational therapy visit.
- You may use Tylenol (acetaminophen). DO NOT EXCEED 3000 mg of Tylenol in 24 hours.
- You may also alternate ibuprofen (NSAID’s) with Tylenol to supplement pain control.
- It is recommended to use narcotics ONLY as needed (and directed) for additional pain control. Take it with food to prevent nausea. Extended use of narcotics can lead to dependency/addiction and cause severe constipation and GI complications.
- Please keep the area elevated as much as possible for at least the first 5 days or until the swelling improves. You are using gravity to help assist fluid movement out of the area.
- Please refrain from full-body exercises or activities that increased blood pressure and heart rate to prevent increased bleeding from the wound.
- Keep the dressing/hand dry. Cover for bathing.
- Use of the hand/finger(s) will depend on the location of the tendon repair. Occupational therapy will evaluate your hand on a weekly basis and will give you further directions on daily activity and work-related modifications and/or restrictions.
- You will be instructed to NOT use your hand/finger(s) for any work or self-care tasks for about 6-8 weeks depending on the type of work you are returning to. Too much activity too soon may cause the tendon repair to fail.
- NO DRIVING while under the influence of narcotic pain medication.
- NO SMOKING. Smoking interferes with circulation and wound healing and may cause serious complications such as wound infections. It is in your best interest to refrain from smoking.
First Post-op Visit
- Often 8-10 days post-op unless directed otherwise. This visit is scheduled during the scheduling of your surgery.
- Your first Occupational Therapy visit is often scheduled at 5-7 days post-op. Therapy will transition you into a removable finger splint depending on the location of your tendon repair.
- Sutures are often removed between 8-14 days depending on the extent of the wound and your past medical history. Uncontrolled blood sugar (diabetes), smoking, certain medically conditions and some medications can delay healing. Sutures are left in longer in situations of possible delayed healing and you may be directed to return at a later date for suture removal.
- You will be directed on continued wound care. At this time, showers are often permitted out of the splint and uncovered. DO NOT SUBMERGE the wound until fully healed. No bathtubs, hot tubs, pools, and/or dish water. This type of environment is often unsanitary and can lead to possible infection.
- Scar Tissue Massage
- Post-operative wounds/incisions heal with scar tissue. The network of fibers that make up scar tissue changes and improves over time. Massaging a healing wound causes the fibers to align themselves to the directional stress you apply making the skin more pliable like normal skin. This action also desensitizes the wound. The best way to see it is to “move the tissue around and over the scar in all directions like kneading dough.”
- Occupational Therapy will guide you through this process.
- Time-frame for post-operative recovery
- Everyone recovers from surgery at their own pace. You can anticipate a return to activities “as tolerated” without restrictions about 2-3 months following surgery.
- Returning to activities as tolerated without restrictions does not mean there is an expectation you will be pain/symptom free. The hand will need time to develop muscular endurance as you expose it to increasing activity much the same way an athlete develops endurance to run 10 miles.
- Your post-operative pain, swelling, range of motion and overall function will depend on how proactive/compliant you are with your post-operative care, activity modifications/restrictions, therapy and home exercise program.
When to Call?
Please call the office if you have any questions or concerns regarding your post-operative care. If any of these symptoms are present please call:
- Persistent fever greater than 101.5 °F or 38.5 °C
- Increasing pain or swelling not controlled with medications
- Excessive drainage or bleeding on the bandage
- Chest pain, difficulty breathing, nausea, vomiting
- Cold fingers, or painful fingers that are not normal in color
- Increasing redness beginning 7 days after surgery