Greater Washington Plastic Surgery Associates | Vineet Mehan, MD, | Earl M. Johnson, Jr., MD,

What to Do When You Cut Your Finger and It Won’t Bend

Did you just cut your finger trying to slice an avocado? Can you no longer bend it? Are you bleeding on your keyboard right now? Drop the avocado and carefully put down the knife, you may have cut your flexor tendon…

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A flexor tendon is like a puppet string connecting the muscle of your forearm to the bones of your finger.

If you cut the string the puppet no longer moves or no longer moves well. It’s a little bit more complicated than that, but you get the idea.

So now what?

You need to get your finger fixed because it’s your hand, you use your hands every day. And, people we will look at your funny if you’re fist looks like this.

The first step is stopping the bleeding. Hopefully you’ve done that already. If there is a puddle of blood in front of you, stop reading this, call 911 and go to the ER before you pass out.

Once you are not bleeding out, you need to find a surgeon. Your surgeon will carefully examine your hand to evaluate all of your tendons that move your fingers, blood vessels, nerves that give sensation and make sure nothing else has been injured.

The video below shows how we can determine exactly which tendon has been cut. Generally speaking each finger has 2 tendons that will cause it to flexor or bend. The muscles that move these tendons are in your forearm.

If your finger is not bending, then it needs to be repaired.

Flexor tendons are repaired by finding the 2 ends of the cut tendon and suturing them back together. Sounds simple, but make sure your surgeon knows what they are doing, there are a few things that can go wrong.

If your surgeon tells you he is going to make a zigzag incision on your finger you are on the right track. Not only is making zigzag incisions fun, but it also allows your surgeon to carefully expose all the delicate structures inside your finger. It also reduces scar formation.

I cut along the lines and then open the finger like a book. Once everything is exposed, it is time to go hunting for flexor tendon. One cut end is usually right where the skin was cut.

Sometimes the other cut end retracts or recoils. Think about what would happen if you stretched a rubber band and then cut it. It would snapback, right? That is kind of what happens with a flexor tendon.

Once we have the 2 ends of the tendon, we suture them together. There of lots of fancy techniques, but the main goal is to have a strong repair that has no gapping or bunching.

If there is anything else that is cut, that will be fixed as well. Your skin will be closed with sutures and you will have a big ugly splint like below.

 

 

So that was the easy part. No for real, that’s the easy part. The hard part is the therapy. Fixing the tendon is only half the battle. Soon after surgery you should see a hand therapist who will guide you to regaining not only motion but strength.

A lot of smart people have figured out that you need to move the tendon while it heals. It makes the tendon stronger and reduces scar formation. But if you move it too much, the sutures can fail. And if you don’t move it at all, your finger can be permanently stiff. You will see your therapist a few times a week and continue to see your surgeon as well.

Eventually, you will have a beautiful splint and you will only need to wear it at night. It will look something like the photo below but probably bigger.

Your surgeon and therapist will continue to work with you until you’re making a perfect fist and you are back to normal activities like cutting avocados.

Take a look below at some of our patient’s frequently ask questions. Feel free to contact our office with any questions. 703-544-8971.

 

 

FAQs:

When will I be able to go back to using my hand normally?

After surgery you tendon will be repaired but only healed together by sutures. The tendon is not very strong at this point. Most of the strength is back around a month after surgery. It can be 6 months before full strength has returned.

If both your surgeon and therapist agree you may be able to start simple activities (ie writing, light housework, using a keyboard) 8 weeks after surgery.  You will not be able to play contact sports or use your hand for any heavy activities for at least 16 weeks.

It is very important that you follow the instructions of your surgeon and hand therapist to avoid rupturing your repaired tendon.

 

How long will I be in a splint?

You are splinted for 6-8 weeks.  The splint must be worn 24/7 and cannot be removed except by your doctor or hand therapist for the first 6 weeks.  The following two weeks you will be allowed to removed your splint for hand therapy exercises, however you will continue to wear it while sleeping and during the day while doing other activities.

Do not attempt to alter your splint. It is made to protect your tendon.  If you have concerns with how it fits please contact your hand therapist.

 

Do I have to go to hand therapy?

Yes! Yes! Yes! It is extremely important to go to hand therapy when instructed to by your surgeon. How well you recover after surgery is based on following instructions from your hand therapist.

If you do not go to hand therapy you put yourself at risk for stiffness, repeat rupture of your tendon and further surgery.

 

Why is it important to do hand therapy exercises?

Proper exercise of your repaired tendon is an important part of the healing process. It actually makes your tendon stronger as it heals. Although it may be slightly painful, when done properly it will help you regain the proper motion and function of your injured finger.

The specific exercises given to you by your hand therapist will reduce stiffness and swelling in your finger. Too much or too little exercise is dangerous as it increases your risks of rupturing or scarring your tendon repair.  You will need to carefully follow the exercises given to you by your hand therapist.

 

How do I know if I re-injured my tendon?

The tendon is weakest 3 weeks after surgery which is when the risk of rupturing your tendon repair is highest. Ruptures often happen when patients remove their splints or attempt to do too much activity too soon after surgery.

Accidental trips, falls or sudden catching of your splint can also cause injury to  your tendon. You may feel a sudden snapping sensation to your finger. If your repair has ruptured you will no longer be able to move your finger.

If you think your tendon has ruptured contact the your surgeon immediately.

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Posted in: Hand Surgery, Reconstructive Surgery

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