Hand and Plastics Physiotherapy: Flexor Tendon Repair

Oxford University Hospitals
NHS Trust
Hand & Plastics Physiotherapy Department
Flexor Tendon Repair
Information for patients
Introduction
You have had surgery to repair one or more of the tendons in
your hand / arm. You have been referred to the Hand Therapy
Department for your ongoing care and treatment. This booklet
gives you important information about your rehabilitation
programme.
Important instructions after surgery
•After surgery your forearm and hand will be in a large
bandage with a plaster-of-Paris splint. DO NOT REMOVE
THIS! Try to keep your bandage clean and dry.
• DO NOT use your hand at all. You may have a small amount
of room for movement within the dressing.
•To minimise swelling you must keep your hand lifted up to
your shoulder level. Keep your hand above your heart at all
times during the first few weeks.
•When sitting or lying you should use pillows to support it,
especially when you are asleep.
•When you are out and about use your arm muscles to hold
your arm across your chest to the opposite shoulder.
Time off work
Depending on your job we would advise:
Type of Work / Activity
Approximate time off
Office based
6-8 weeks
Driving
8 weeks
Manual work
10-12 weeks
Sport
12 weeks
If you need a ‘fit note’ or sick note, please visit your GP.
page 2
Referral to Hand Therapy
You will be telephoned with an appointment for Hand Therapy.
The appointment will be within 3-5 days of the operation. If
you have not heard anything 5 days after your operation, please
contact the Hand Therapy Department on (01865) 231181.
The appointment will be on Level LG1 in the West Wing – follow
signs to ‘Plastics Outpatients’.
What to expect in Hand Therapy
The first appointment will last approximately 1hour. The
physiotherapist will remove the dressings then check, clean and
re-dress your wound.
A lighter plastic splint will be made to fit you and your
physiotherapist will teach you very specific exercises to perform
in the splint (see pages 4-6).
Splint Care (once you have been made a plastic splint)
• Do not place the splint in hot water or near a heater.
•Check your skin regularly for red, sore areas of skin using the
safe technique shown to you by your therapist. Contact your
therapist if you notice any red, sore areas of skin.
•Use a plastic bag over the whole arm when in the bath or
shower (DO NOT take the splint off to bathe).
Scar Massage
You can start this when your stitches have been removed and the
wound looks dry.
•Use a simple moisturiser, e.g. Aqueous cream or E45, over your
scar.
•Rub over your scar to encourage the skin to move normally.
• You can also do some massage without moisturiser.
• Perform this 3-4 times a day for 3-5 minutes.
page 3
Figure to demonstrate healing time of tendons correlating
to Stage of rehab
page 4
Flexor Tendons Rehab Programme
You will be guided through each stage by your physiotherapist.
Do not move onto the next stage without instruction to do so.
Stage 1 (Commence 3-5 days post-op)
Early active movement exercises:
Perform 3 repetitions of the following exercises every 2 hours:
1.Use your good hand to curl each
finger of your operated hand
down to the top of your palm.
2.Repeat exercise as above but try
to keep your finger in the flexed
position using your muscles as
you let go with your other hand.
3.Repeat the flexion movement as
above entirely using the muscles
of your repaired hand.
Try to return your fingernails to
touch the splint.
These exercises help to prevent your tendons becoming stuck in
your scar tissue and ensure that once healed you will have the
best possible function and outcome.
page 5
Stage 2 (4 weeks)
1.Progressing towards Full Active Movement
Sit in a safe environment and remove your splint. Rest your
elbow on a table and let your fingers relax.
a)Allow your wrist to flex
forwards
Note how the fingers relax
into a straighter position,
check yours do too.
b)Then, keeping your fingers
floppy, extend your wrist back.
Again check that your fingers
are relaxing into a curled
position.
2.Hook Grip
Keeping the big knuckles on the back of your hand flat, bend
your fingers to place your finger-tips at the top of your palm.
page 6
3.Flat Fist
Keeping your finger tips straight aim to bend your fingers to
touch the bottom of your palm.
4.Hook into full fist
Perform the hook grip in exercise 2 and then roll your big
knuckles down to make a full fist.
To
Repeat 5 times every 2 hours.
Put your splint back on after these exercises.
Stage 3 (5-6 weeks)
You should now be able to make a full fist.
You may now start to wean yourself from the splint as advised
by your physiotherapist. Use your hand for light activities such as
washing, dressing and eating.
Make sure you wear your splint at night and outdoors.
page 7
Light activities
Medium activities Heavy activities
Using the telephone Painting and
decorating
Handling money
Ring-pull on can
Zips
Using towels
Light clothes
Using fork and
spoon
Personal care,
washing, make-up
Putting on socks,
tights
Dusting
Writing, signing
your name
Light switches
Using remote
control
Reading the
newspaper
Hanging washing
out
Ironing
Hoovering
Lifting children
Lifting boxes,
carrying shopping
Making a bed
Hand washing
Gardening
Washing up, wiping
Driving, cleaning a
up
car
Sweeping
Cooking, lifting a
Reading books
saucepan, kettle
Holding a glass
Using a tin opener
Using scissors
Sports: rugby,
Combing hair,
football, swimming,
shaving
golf
Buttons
Unscrewing jar lids
Holding a pint glass
page 8
Using a knife
Stage 4 (6-8 weeks)
If you have managed all the previous stages, and have been
told to do so by your physiotherapist, you may now discard your
splint.
Start to increase the use of your hand to performing moderate
activities eg. Opening doors, sweeping and washing-up.
(See table on page 8)
Stage 5 (8 weeks)
You may return to driving at this stage if you are able to make a
full fist and feel able to control the vehicle safely.
You should now gradually progress your activities, working
on increasing your strength and function towards unrestricted
activites at 12 weeks.
Stage 6
It maybe that at this stage further hand therapy and / or splinting
is required to regain full range of movement and/ or function.
page 9
Hand Therapy Appointment Record
Your Physiotherapist will be
Day
Date
Time
If you are unable to attend, please inform the department as
soon as possible.
Hand Therapy Department Telephone: 01865 231181
Thank you.
page 10
Directions to Hand Therapy Department
We are situated on Level LG1 of the West Wing at the John
Radcliffe Hospital. Turn right out of the lifts and follow the blue
signs to ENT & Plastics Outpatients.
Any questions you have for your physiotherapist
page 11
If you need an interpreter or need a document in another
language, large print, Braille or audio version, please call
01865 221473 or email PALSJR@ouh.nhs.uk
Hester Bishop, Senior Physiotherapist
Version 1, November 2011
Review, November 2014
Oxford University Hospitals NHS Trust
Oxford OX3 9DU
www.ouh.nhs.uk/patientinformation
OMI 3851P
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