This handout explains follow-up care after surgery to repair your flexor tendons. The splint is there for your protection. It is very important that you do not try to you’re your fingers on your own until therapy begins; otherwise you could rupture the tendons and permanently lose function. Within the first several days it is extremely critical to begin therapy with the correct exercises, to avoid scar tissue formation and minimize the chance for tendon rupture. Please see our pain management form listed below for more detailed information about your postoperative medications, to avoid pain, nausea and/or constipation. If the incision is red or if there is drainage coming out of it, please call us right away at the phone number is listed on the bottom of this page. Go to the emergency room if this occurs at night or on a weekend.

Wound Care:

  • Right after surgery, we put you in a long arm cast that extends from your fingertips to above your elbow. This will help to control swelling and protect your hand as it heals.
  • You can begin physical therapy one to two days after surgery with the cast. This will be a controlled program with the therapist. It is extremely important to follow all the recommendations of the therapist to avoid the possibility of tendon rupture.
  • Do not do any type of gripping or lifting activities that involve the hand because it will put stress on the tendon repair site and can rupture the tendon, which would result in a multistage surgery for correction.
  • Be sure to keep the incision clean and dry. Wear a plastic bag over the cast when showering, until the sutures have been removed.
  • A hand therapist will assess the wound and a program will be implemented that provides for therapy at least three times a week for the first three weeks following surgery.
  • Do not remove your splint or cast without the advice of your therapist or physician.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take your medication as directed, taking the correct dose at the right time. It is important to “stay ahead” of your pain medication and avoid having to play “catch up” for significant increases in pain.
  • Medication for nausea will also be provided. Please make sure to take this as directed.
  • Please check with the postoperative nurses and the office staff at Bellevue Bone & Joint Physicians if you have questions about how to manage your pain medication.
  • If you have uncomfortable side effects from the pain medication, please call us at 425-462-9800.
  • Please see “medications after surgery” information form for more instructions.
  • It is normal to have some pain off and on for approximately one year after surgery, particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medications, as it is not safe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.
  • Once you are no longer taking narcotic medication, you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • The most important concern about flexor tendon repair is avoiding use of the injured hand for any type of gripping. Gripping can cause the tendon to rupture, which would require another surgery. It would also greatly lessen the chances of your hand recovering fully.
  • At your first therapy visit, some of your wound dressings may be removed. This will allow you to start your exercise program.
  • Do not use your hand for any activity for six weeks after the surgery. Hand therapy is very important. Therapy may last for 12 weeks or more after surgery.
  • Please let us know if you need to have a letter of disability for your work or school if you are a student. This will provide you the documentation that you may need to gain help with writing and typing activities.

Follow-Up:

  • The sutures are generally removed in two stages, beginning at 10-14 days.
  • The therapist typically removes the remaining sutures on a gradual basis during the therapy program.
  • After the sutures are removed, we will reset another cast or a splint. This will protect your hand and let the tendon heal. The cast and splint are typically worn until six weeks after the surgery.

Results:

Flexor tendon surgery is one of the most difficult injuries to recover from. It takes 12-14 weeks for the tendons to regain most of their strength. Do not return to full activity or heavy lifting for three months after surgery. Many patients will need a second surgery to remove scar tissue from around the tendons 3-4 months after the first surgery.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD