What is a flexor tendon?
Your child has injured one of the tendons in their hand called a flexor tendon. A flexor tendon is responsible for bending one or more of the small joints in the fingers or thumb. The flexor tendon is also attached to a muscle in the forearm. When the two act together, they work as a pulley to allow our hand to grip and to hold.
With a flexor tendon injury, the tendon has become unattached from its muscle in the forearm in one or more places. This means that the muscle in the forearm is not able to move the affected finger or thumb in the way that is normally expected.
The finger(s) and the tendon(s) that have been involved are: ___________________________________
Who will I meet?
Your child’s recovery will be managed by a team of health-care professionals that include a plastic surgeon, a physiotherapist and an occupational therapist.
Your plastic surgeon will discuss with you the course of your child’s surgical treatment during your clinic visit. The surgeon will review with you the associated risks and the benefits of the surgery.
Your physiotherapist will help your child with the exercises that are needed throughout their recovery to ensure the best possible outcome from the surgery. They will teach you and your child what to do at home, so you feel comfortable doing all the exercises together. The physiotherapist may see your child prior to surgery and then when it is safe for your child to move their finger after the surgery.
Your occupational therapist will make sure your child is fitted with a thermoplastic splint to help position their hand for the best possible recovery. They will teach you about when to take the splint off and how often to wear the splint. The occupational therapist may see your child prior to the surgery and they will see your child after it is safe for the post-operative splint to be taken off.
Why is the rehabilitation after the tendon repair important?
After a flexor tendon repair, there needs to be a balance between time needed to heal and movement to have the best result. If your child moves their hand too much too soon, there is a risk the surgical repair will come undone. If your child moves their hand too little, there is a risk there will be too much scarring in the surrounding tissues that will prevent your child’s hand from moving in the expected way.
Your hand is made up of a lot of small parts, including 27 bones, that exist together in a small space. You need all these different parts to move your hand in the way that you do. Because of this, there needs to be a balance between allowing the tendon to heal and preventing scar tissue from acting like glue between all the small parts. Your health-care team, which includes you, will help guide this balance.
Once the tendon is repaired by your surgeon, your child’s hand and arm will be in a post-operative splint for up to several weeks. This helps your child’s body to heal the tendon. The time that your child’s finger will remain completely immobilized in the post-operative splint will be dependent on several factors including, their age, the structures involved in the injury and the type of repair that was possible at the time of the surgery.
Once it is safe for your child to move their hand, there will still be a balance needed between allowing the tendon to heal into a solid structure and preventing the tendon from being stuck to all the surrounding parts such as other tendons and bones. The occupational therapist and physiotherapist will guide your child’s exercises to make sure they are not doing too much or too little.
How long will my child have to wear a splint for?
Your child will likely have to wear a splint after the post-operative splint is removed to protect the tendon repair. Your child will likely be required to wear the splint both during the day and while they are sleeping. Your child will continue to wear the splint for all or part of the day as the weeks progress. The wear schedule of your child’s splint will be determined by your child’s health-care team. Your child will likely not be wearing any splint by eight weeks after the repair.
When can my child move their hand?
After the surgery, your child will be guided each week by their health-care team. To begin with, your child will be unable to move their hand and it will be secured in a splint that will protect their hand and arm. It may be challenging for both you and your child during the recovery process as the type and number of activities they are permitted to do will be very limited. Your child may need help getting dressed, bathing and doing other tasks they were doing independently prior to the injury. It will also be important for your child to restrict any physical activity that may result in a fall. Your health-care team will guide your child back to return to activity.
How long will my child’s tendon take to heal?
The timeline of recovery for your child will depend on several factors such as their age and the structures involved. A typical timeline for recovery may look like this:
0 to 3 weeks: Little to no movement of your child’s hand. They will remain in the splint or cast full time. Your child may be given exercises to complete in the splint. Your child may be required to see a therapist weekly.
3-4 weeks: Progression of some of the exercises your child is prescribed. They may be allowed to remove the splint to complete the exercises. Your child may be required to see a therapist weekly. They may be required to see a therapist multiple times a week if other treatments are needed.
4-5 weeks: Continued progression of your child’s prescribed exercises. They may be allowed to remove the splint when they are seated for light activities, such as mealtime or homework.
5-6 weeks: Continued progression of your child’s prescribed exercises. The splint may be removed during the daytime and changed to be fitted overnight. Your child’s activities will continue to be restricted to light functional activities. Most outdoor activities or sports should be avoided.
6-8 weeks: Continued strengthening of your child’s hand will occur. Your child will be encouraged to use their hand for more gripping activities to increase movement. Outdoor activities and sports may continue to be restricted depending on your child’s recovery and the risk involved with the activity. You can discuss your child’s activity level with your health-care team.
8-12 weeks: Continued strengthening of your child’s hand will occur. Your child may be back to most of their activities including sports. Your therapist will be able to help you determine which activities may continue to be unsafe for your child.
What are the types of exercises my child must do?
Your physiotherapist will prescribe exercises depending on the time frame and stage of healing of the repaired tendon. It is important that you and your child follow these instructions and repeat the exercises throughout the day as suggested by your physiotherapist to make sure of an optimal recovery. The appropriate exercises will be reviewed each week so that you and your child feel comfortable to complete them at home. You will also receive a handout describing all the required exercises.
Will my child have any scars?
Your child will likely have a scar that is related to the injury and a scar that is related to the surgical repair. With appropriate scar management, both incisions will heal well but your child will likely have a visible scar. It will be important to keep both incisions clean as instructed by your health-care team after the surgery. You will be provided with instructions from your health-care team about the management of the scar. They may suggest strategies such as cleaning with soap and water, massage and silicone to assist with the healing of the scar.
Please contact your health-care provider:
- If your child has had a fall or injury that may have caused damage to the repaired tendon.
- If your child is showing signs of infection or excessive bleeding at the incision site.