Flexor tendon repair: advice and exercises

Flexor tendons allow you to bend your fingers and thumb. They run from your forearm through your wrist and across the palm of your hand.  They are important in allowing you to make a fist and are essential in allowing your hand to function normally.

Your tendon has been repaired to restore normal movement. You will need to undergo a strict hand therapy programme following this surgery to maximise your recovery and functional use of your hand.

It is normal to have swelling in your hand after an injury or surgery.  Early movement of your fingers as described in this leaflet will help to manage your swelling and prevent stiffness later.

You must not allow your hand to hang by your side. To help drainage of the swelling whenever possible:

Do rest your hand above the level of your heart. Use a cushion to support your arm if this is comfortable.

Do move your elbow, shoulder and neck regularly to prevent stiffness in these joints.

Splints

Within the first week following your repair you will be seen by the hand therapy team.  A splint that covers your hand and forearm will be made to protect the surgical repair.

The repair will be weak and will require protection in a splint to prevent movement and activity that will risk rupturing your tendon.  You should wear the splint 24 hours a day.

While wearing your splint you will need to check your skin on a regular basis for red or sore areas and inform your therapist if you have any concerns.

Your arm and splint will need to be covered with a plastic bag when showering or bathing.   It is important that you do not remove your splint, and you keep your wound dry until fully healed.You must not place your splint in hot water or near a heater as this will affect its shape/fitting and result in the splint becoming uncomfortable to wear.

Moving your thumb and fingers will not stop your tendon healing.  Bending and straightening your fingers will help regain movement and reduce swelling.

You should complete the following exercises wearing your splint:

1. Use your other hand to bend the operated fingers into the palm to make a full fist. 

2. Try to bend your fingers into the palm of your hand. For the first 3 weeks aim to bend your fingers halfway into the palm of your hand.  Aim to make a full fist, 6 weeks after your repair. 

3. Straighten the fingers to touch the splint. If this is difficult then bend the knuckles first and then straighten the fingers. 

Massage helps make your scar more mobile, so it does not limit movement of your fingers. Once the stitches are removed, unless they are dissolvable, and your wound looks dry, you can start to massage your scar.

Use a simple moisturising cream such as aqueous or diprobase.

Massage the cream over your scar in circular movements. As your scar heals you can use firmer pressure over your scar.

This will be demonstrated to you by your therapist, and you should aim to do this 3-4 times a day for 5 minutes.

Do not use your hand for anything other than your exercises unless advised to do so by your therapist.

You can stop wearing your splint but you should continue to avoid heavy activities until 10 weeks after your surgery. Your therapist will advise you when you can gradually resume heavier activities. The tendon repair will not be fully strong until 10-12 weeks after surgery. You are at risk of rupturing your tendon and needing further surgery if you do not follow this advice.

You should complete the following exercises without your splint:

1. Support your forearm on a table. Bend your wrist downwards and relax your fingers. 

2. Support your forearm on a table. Bend your wrist upwards. 

3. Rest your elbow on the table and curl the ends of your fingers into a hook without making a full fist. 

4. Close your hand to make a full fist. 

5. Fully straighten your fingers. 

6. Support the affected finger at the middle joint and then bend and straighten the end joint on its own.

Your hand therapist will be able to advise you, but most people are able to resume:

• light activities such as using a keyboard, writing and dressing between 6 and 8 weeks
• driving a car or motorbike after 8 weeks
• medium activities such a light lifting, opening doors, carrying plates of food after 8 weeks
• heavy activities such as heavy lifting or building work between 10 and 12 weeks
• sporting activities between 10 and 12 weeks

Do not complete any activity that causes pain. Your tendon is not 100% strong until 12 weeks after repair.

Contact the plastics clinic or therapy department immediately if:

• You are suddenly unable to bend your fingers
• Your hand or fingers become more swollen, reddened, or blistered
• Your splint becomes uncomfortable or is showing signs of rubbing or irritation such as redness
• Signs of infection are:
  • increased redness around the wound spreading down your arm
  • pain, throbbing, increased swelling
  • a fever
  • discharge from the wound that is foul smelling or coloured

Plastics clinic on: 01274 364397 available Monday to Friday between 8.00am and 5.00pm

or

The Hand Therapy Team on: 01274 382874 available Monday to Thursday between 8.00am and 6.00pm, or Friday between 8.00am and 3.30pm