Tendon Rehab

[blandrick]

A couple weekends ago, I had an accident with my axe while camping. I hit my hand just behind the knuckle for my left index finger. I severed one of the tendons that attach to my index finger, and nicked the other one. I was sent to the local trauma center, metal detectors and armed guards type ER, where they sewed the severed tendon back together. I've been in a hard cast since then, from about mid-forearm all the way down to the ends of my fingers, keeping all 4 fingers on that hand extended. Supposedly, I will start "rehab" this Friday when my cast is taken off.

My thoughts were to start deadlifting the empty bar from the safeties for a few sets of 5 every other day, adding 10 pounds each time until I can pull from the floor with bumpers. Is there anything else I should do, or should be aware of when working back from this? Given that it has been in extension the whole time, I'm not terribly worried about regaining strength for extending that finger, but I am worried about grip strength/flexion.

I can get more specifics Friday, when I go back to the hospital and I get copies of the ER report, if those are necessary or helpful.

[Tom Campitelli]

Hands are really complicated. I am sorry to hear about your accident. My general recommendations are the same as for any injury - give it as much work as you can without making it worse. I don't have any experience with this particular injury, so your guess is about as good as mine. I like your approach. Start with something light and move up as pain allows. Also, you may want to see what pressing a light bar feels like. You will be able to judge when you are ready for what, most likely. We'll see if any of our more knowledgeable readers have input.

[blandrick]

So I have the ER report in front of me now. I severed the EDC just behind my knuckle, they labeled it as an extensor tendon. They took me out of the cast and have me in a splint, no wrist movement, and minimal flexion of the injured finger due to the splint they put me in. My question is this: they don't want me lifting anything remotely heavy (and this coming from a physical/occupational therapist...) until 12 weeks post-injury, when the tendon should be fully healed. She explained that right now, while it's still held together mostly by sutures, that flexion can/will work those sutures apart, and can cause the thing to rupture. I like using my hand, so obviously that's something I want to avoid.

That said, as of right now I'm scheduled for an all-expense paid vacation to A Much Warmer Place Than This at roughly 13 weeks post-injury. Assuming I don't get disqualified for this, I have to assume that I need to be strong in order to not be a useless fuck out there. How the fuck am I supposed to balance needing to get stronger with "DEAR GOD YOU'RE GONNA EXPLODE YOUR HAND"? If I do what they want, I'm looking at basically not using my left hand for 3 months, and then being expected to carry equipment and don body armor/etc in an efficient manner when necessary, which seems suspect at best. I'm not even worried about being able to pull a respectable amount, because I know I can fix that. I'm worried about being strong enough to perform basic tasks.

I can go by feel to some extent, but it's not like it's guaranteed that it wouldn't be a sudden thing if the tendon is going to rupture. Do I cut it somewhere in the middle, say at 6-7 weeks, to minimize risk to the tendon? Am I correct in feeling that they're being hyper-conservative with the treatment plan for this?

Hope I didn't ramble too much. I appreciate the advice you've already given.

[Tom Campitelli]

I think your concerns are very justified. I also know that doctor's recommendations are often made for the least active, most slowly recovering demographics. They may not fully apply to you. You have a number of circumstances in common with a professional athlete. Keeping your hand immobile for 12 weeks is probably not good for it. Nor is causing it to unravel after two weeks because you pounded on it. I would not be surprised if the answer lies in the middle somewhere. I don't know enough to make a definitive recommendation, but given your imminent change in climate, rolling around with an atrophied hand is probably not the best option.

[John Petrizzo]

This is a tough situation to comment on as I do not deal with many hand injuries, but I have worked with plenty of other tendon repairs (pec, rotator cuff, biceps, quad, achilles, etc.) and in my opinion, Tom is right. Most of the tendon repairs I have worked with have had to wait about six weeks prior to any significant loading due to the increased chance of re-injury during the initial weeks immediately post-op. 12 weeks is a very long time and only something I have seen a few times in cases where the surgeon felt the risk of re-injury was particularly high. However, your doctor was correct in that too much flexion of the fingers right now during the early phases could over-stretch the tendon and cause you to re-injure yourself. As Tom said, I think common sense usually prevails in these situations and you will have a feel for when you are ready to do more, but for right now, I would not push things too much.

Good luck with your recovery.

[Marenghi]

I´d perceive that the other way round: If your doctor´s recommendation is what it is and leads to you being not fully prepared for the future tasks - then you wont be able to do those future tasks. Have that certify by your doctor and youre safe. Dont risk your long-term health.

[Tom Campitelli]

Have that certify by your doctor and youre safe.

Neither doctors, nor anyone else, can certify that anything is safe. Going into a location where people might shoot at you is the exact opposite of safe.

[Marenghi]

oh, what i meant was that he should have his doctor certify that hes ill/not able to fulfill his duties atm (i dont know the exact medical/insurance term for that in english) . going handicapped into combat surely is not safe.

[blandrick]

Fortunately (unfortunately?) I am no longer being sent across the planet, so I can afford to be more conservative in my rehab. Thank you for the advice, all.

[JimtheConquerer]

From a combat readiness perspective, I have to think there won't be a negative perception towards you since...you know you almost lost a finger if you wave off this deployment from a medical perspective.