Hand therapy following extensor tendon repair zones 4-7: ICAM regime

Information for the patient

This is the first phase of your rehabilitation following the repair of your tendons. Once you have completed this phase your therapist will advise you on new exercises to ensure the best long-term results.

What are extensor tendons?

Your extensor tendons enable you to straighten your fingers. They attach the muscle belly which is in the forearm, to the bones in the fingers. Your injury particularly affects the tendon that straightens the joint at the main knuckle, between your hand and fingers.

Why have they been repaired and why is it important to protect these repairs?

If you damage an extensor tendon, you will be unable to straighten one of your fingers. Surgical repair of the tendon aims to restore this function in the hand. The ends of the divided damaged tendon are located and stitched together. The stitches used are thinner than a strand of hair and for the first few weeks are the only things holding the repair together.

The repaired tendon will therefore be very fragile until the ends heal together. It can take up to three months for the repaired tendon to regain its previous strength and during this time you will need to follow a strict hand therapy programme to maximise your recovery. There is a possibility of damaging the repair if the correct precautions are not followed. If you do damage the repair, further surgery might be required to mend it.

What can you expect immediately following surgery?

You will be contacted by the hand therapy team to arrange an appointment within two weeks of your surgery. It may be possible to transfer your hand therapy care closer to home after the first few appointments, depending on the specialist services that are available in your local area.

You might experience some discomfort or pain following surgery. You can take over-the- counter pain relief (e.g. paracetamol or Ibuprofen) or your surgeon may prescribe pain relief before you are discharged.

What to do in the few days before your first appointment after surgery?

Following your surgery it is normal for your hand to be swollen. To reduce this swelling, keep your hand elevated above your heart (for example resting on your opposite shoulder or propped up on pillows).

Until your first appointment post-surgery, do not remove your post-surgery cast or attempt to use your hand at all. Don’t attempt any of the exercises until you have seen or been advised by your hand therapist.

What to expect at your first appointment

Your first appointment will last approximately one hour. Your dressings and cast will be removed and replaced with two lighter weight splints - a wrist splint and a finger yoke splint. Both splints will need to be worn 24 hours a day. The finger splint will be worn for up to seven weeks, and the wrist splint will be worn for up to five weeks as directed by your therapist. In most cases you will start your exercises at your first appointment. We would recommend you eat something and take pain relief before attending your first appointment to make the experience more comfortable.

How should your splints be worn?

1. The wrist splint- to prevent the wrist bending forward and stretching the repaired tendon
2. The yoke splint- worn around your fingers to prevent the injured knuckles bending fully and stretching/stressing the repaired tendon

Straps on the splints should be applied firmly, but don’t need to be tight.

Splint care (once you have been fitted with the splints)

Check your skin regularly for red/pressure areas.

When you remove the splints ensure you keep your hand in the same position it would be if you still had the splint on.

Use a plastic bag over the whole arm when in the bath or shower (do not take the splints off).

If you experience any problems with the fit of your splints, please contact the hand therapy department as soon as possible.

Do not place splints made of thermoplastic in hot water or near a heat source as they will change shape.

Both splints can be washed with mild, soapy water. Dry the splints thoroughly before reapplying and keep the fingers and wrist straight at all times whilst the splint is not in place.

Why is it important to look after your wound?

To prevent infection it is important to look after the wound whilst it is healing. It should be kept clean and dry until it is healed, which takes approximately 10 to 14 days following surgery.

Potential signs of infection and what to do

If you notice that your hand feels hot to the touch, is red, has an unpleasant smell or you have increased pain, this may be a sign of an infection. You should contact the plastic surgery unit (PSU) on: 01223 348507 (Monday to Friday, 08:30 to 16:30), your local GP practice or call 111 if out of hours.

Potential signs of tendon rupture

If you feel a popping or snapping sensation and notice any sudden pain, swelling, or a change in your fingers’ ability to move, this may suggest the tendons have ruptured. You should contact the plastic surgery unit (PSU) on 01223 348507 (Monday to Friday 08:30 to 16:30), the hand therapy department on 01223 216769 (Monday to Friday 08:30-16:30) or call 111 if out of hours.

Why is it important to care for your scar?

Scars are collagen fibres produced as a result of the body’s normal healing process. The amount of scar tissue produced by the body varies depending on the individual and type of surgery/injury. As the wound heals there will be little scar tissue produced but over time the body may develop more.

Initially scars can be firm, thick and red in colour (active phase) but over time they soften and become pale in colour (matured). This whole process may take 12 to 18 months or more.

During the ‘active phase’ you can use treatments to influence your scar recovery. Initially as scar tissue forms it is thick and lumpy and can stick to structures around it; scar care helps to flatten the scar and make it softer as well as reducing the chance of scar tissue sticking to itself (forming adhesions).

When can I start scar massage?

If the wound is healed and dry, 24 to 48 hours after your stitches have been removed.

If you have dissolvable stitches you can start massaging your scar approximately 12-14 days after surgery, providing the wound is healed and dry.

You will need a basic, unperfumed moisturising cream such as aqueous cream or ‘E45 cream’, both of which are ideal for massaging scars and available from High Street stores and supermarkets..

The scar massage needs to be in circular movements, on and around the scar line, to keep the skin moving freely. In the first few days you may only tolerate gentle massage, but you should then aim to increase it to a deep and firm massage to reduce the risk of adhesions.

Please keep your splints on when doing scar massage.

Start date: . . . . . . . . . . . . . . . . . . . . . . . . . . .

Repeat . . . . . . . times per day for approximately . . . . . . . minutes, ideally before your exercises.

How can you help your recovery?

• To help your recovery you should cut down or stop smoking and drinking alcohol .
• Keep your hand elevated as much as practically possible to prevent swelling in your hand.
• Do not use your hand for anything other than your exercises until advised by your hand therapist.
• Do not progress to the next set of exercises unless advised by your hand therapist.

Time frames for resuming activities

If you need a ‘fit note’ or sick note, please contact your GP to arrange this.

Exercises – Why are they important?

Exercise is important to benefit your recovery. It will reduce stiffness and swelling in the hand and fingers and help your tendon repair to move smoothly in a controlled way while protecting the repair from being damaged or rupturing. Your therapist will teach you specific exercises which you must complete throughout the day.

Finger extensor repair exercises

It is recommended that the exercises are done in the order outlined below. Do not begin or progress exercises unless you have been advised by your hand therapist.

Week 1

Both the wrist and finger yoke splint are to be worn when completing exercises.

Further information

Your therapist will check your progress regularly and will adjust your therapy programme if necessary.

It is vital that you attend all therapy appointments as well as any video or phone reviews and complete your home programme as advised in order to improve your chances of a good outcome.

If you require further information please contact your occupational therapist on 01223 216769.