Extensor tendon repair (zones 5 to 8) relative motion splint: aftercare advice

We have repaired one or more of the tendons that straighten your fingers. Over the next few weeks your therapist will give you advice about your rehabilitation and the management of your hand and wrist. Getting a good result from this surgery is directly related to the effort you put into your rehabilitation. Please follow the advice and guidance below.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

When can I return to my daily activities?

• It will take 8 weeks for your tendons to heal. It will take a further 4 weeks before you can start normal heavy activities again (see table below). This is to allow the repaired tendon(s) to be strong enough.

• For the first 10 days after your surgery, only use your hand for minimal, very light activities. This allows the swelling to settle and the tendon repair will be starting to heal. After this you may use the hand for light activity (see table below).

• Most patients are able to return to driving 6 weeks after their operation. However, you need to make this decision with your surgeon or therapist.

• When you can return to work depends on the job you do. Please discuss this with your surgeon or therapist.

3 to 5 days after your surgery

• We will replace your plaster with two splints (a wrist splint and a finger splint). These splints must be worn at all times for a further 3 weeks. You may remove your splints carefully each day to wash your hand. Your therapist will show you how to do this safely to protect the tendon repair(s). It is very important to follow the splinting regime, to minimise the risk of tendon rupture while it is healing. You must not try to bend your wrist or fingers without the splints on.

  Do not alter your splints. Keep them away from hot surfaces / objects, or the plastic will soften and lose its shape. Make sure your splints do not rub or cause any swelling or irritation. If they do, please contact your therapist to review the splints.

• Keep your wound and dressings clean and dry at all times. Your dressing should be changed every 3 to 4 days or as advised by your therapist. If you feel confident to change your dressings at home your therapist will provide you with spare dressings. Or, you can contact your GP practice to arrange a dressing change with a nurse practitioner.

• You may have dissolvable stitches. These will gradually fall out and disappear around 2 weeks after your surgery. If you have non-dissolving sutures, these will be taken out around 2 weeks after your surgery either by:

  • your therapist at your follow-up appointment; or

  • by the nurse at your GP surgery.

  If you want your GP practice nurse to remove them, you will need to book this appointment yourself.

• Compared to non-smokers, smokers are more likely to have complications in tissue healing and infections after injuries or surgery. For free friendly support and medication to help you stop smoking, contact One You Kent.

  • One You Kent
    Telephone: 0300 123 1220
    Email

• Elevating (raising) your hand is important to prevent swelling and stiffness in your fingers. Remember not to walk with your hand dangling down by your side. Do not sit with your hand held in your lap.

• Once your wound has fully healed and forming a scar, start massaging your scar in deep circular motions. Do this using a small amount of moisturiser, such as E45 or Diprobase. This helps:

  • prevent hypersensitivity; and

  • the tendons becoming stuck to surrounding structures, causing problems with the movement of your hand.

  For more information, please read our Scar massage leaflet or speak to your therapist.

Phase 1: first 3 weeks after your surgery

The splints we gave you provided support your wrist. They also protected the amount of movement your operated finger(s) can make safely, without putting too much stress through the repaired tendon(s). The finger splint prevents your operated finger(s) fully bending. It is important to start moving your fingers within the limits of the splints. You need to make sure your tendons do not get stuck and your joints do not get stiff.

• These exercises should not be painful, but may feel slightly uncomfortable. Take your normal pain medication (such as paracetamol) if needed. If you are unsure, please contact the Hand Therapy Service team.

• Always exercise gently and slowly.

• Keep both splints on to do the exercises below 4 times each day.

• Aim to do 5 to 10 of each exercise.

• Once your scar is healed, massage it for 1 minute before completing the exercises.

Exercise 1

1. 
   1. Start with your fingers straight.
2. 
   2. Bend the top two joints into a ‘hook’ position.
3. 
   3. Bend your knuckles whilst straightening out your smaller finger joints, to create a ‘table top’ position.
4. 
   4. Make a full fist.

• Keep your thumb, elbow and shoulder moving fully. This help prevent stiffness in these joints and reduce swelling.

• It is normal for these exercises to be uncomfortable, but they should not cause pain. If they do, try more gentler / smaller movements, with less repetition. Build up slowly.

• Do not try to push your fingers into a fist or bend your wrist forwards with your other hand. This could loosen or rupture the tendon repair(s).

• Do not perform any strenuous activities or weight-bear through the hand yet. Weight bearing is leaning through the hand, for example when pushing yourself out of a chair or doing a press-up.

• If you are suddenly unable to actively straighten your repaired finger(s) you must contact your therapist. They are available Monday to Friday, 8am to 4pm. If this happens after 4pm on a Friday, or over the weekend go to the Emergency Department. The on-call Orthopaedic team will assess you.

Phase 2: 3 to 5 weeks after your surgery

You can start to remove the wrist splint for exercises and light activities. You must continue to wear the finger splint at all times. Continue to wear both splint for medium activities. Medium activities include:

• using scissors, a razor, or cutlery

• drying up

• hanging out washing

• putting socks on

• holding a cup

• reading a book

Do not return to driving or sports yet. At night continue to wear both splints. 

• Keep your finger splint on, but remove the wrist splint to do the exercises below 4 times each day.

• Aim to do 5 to 10 of each exercise.

• Continue to massage your scar for 1 minute each time you do the exercises.

Exercise 1

1. 
   1. Rest your elbow on the arm of a chair or table. Gently let your wrist bend forwards, keeping your fingers completely relaxed. Your fingers should be quite ‘floppy’ and fairly straight.
2. 
   2. Extend your wrist backwards. Keep your fingers relaxed, so they naturally curl up into a loose fist.

• Continue the exercises from Phase 1.

• It is normal for these exercises to be uncomfortable, but they should not cause pain. If they do, try more gentler / smaller movements, with less repetition. Build up slowly.

• Do not try to push your fingers into a fist or bend your wrist forwards with your other hand. This could loosen or rupture the tendon repair(s).

• Do not perform any strenuous activities or weight-bear through the hand yet. Weight bearing is leaning through the hand, for example when pushing yourself out of a chair or doing a press-up.

• If you are suddenly unable to actively straighten your repaired finger(s) you must contact your therapist. They are available Monday to Friday, 8am to 4pm. If this happens after 4pm on a Friday, or over the weekend go to the Emergency Department. The on-call Orthopaedic team will assess you.

Phase 3: 5 weeks after your surgery

You can stop wearing the wrist splint during the day, but continue to wear it overnight. During the day you must continue to wear the finger splint at all times.

• Remove the finger splint to complete the following exercises 4 times each day.

• Aim to do 5 to 10 of each exercise.

• Continue to massage your scar for 1 minute each time you do the exercises.

Exercise 1: Table top to flat fist

1. 
   1. Hold your wrist and fingers in a straight position.
2. 
   2. Bend all your fingers at the knuckles. Keep your fingers straight.
3. 
   3. Bend the middle joints of your fingers. Keep the tips straight, so they touch the palm of your hand with your nails still visible. Hold for 5 seconds.
4. 
   4. Straighten your fingers back to the starting position.

Exercise 2: Hook to full fist

1. 
   1. Hold your wrist and fingers in a straight position.
2. 
   2. Bend the small joints of your fingers into a hook. Keep your knuckles straight.
3. 
   3. Roll your fingers down into a full fist by bending your knuckles. Hold for 5 seconds.
4. 
   4. Straighten your fingers back to the starting position.

Exercise 3

1. 
   1. Rest your elbow on the arm of a chair or table. Gently let your wrist bend forwards, keeping your fingers completely relaxed. Your fingers should be quite ‘floppy’ and fairly straight.
2. 
   2. Extend your wrist backwards. Keep your fingers relaxed, so they naturally curl up into a loose fist.

• It is normal for these exercises to be uncomfortable, but they should not cause pain. If they do, try more gentler / smaller movements, with less repetition. Build up slowly.

• Do not try to push your fingers into a fist or bend your wrist forwards with your other hand. This could loosen or rupture the tendon repair(s).

• Do not perform any strenuous activities or weight-bear through the hand yet. Weight bearing is leaning through the hand, for example when pushing yourself out of a chair or doing a press-up.

• If you are suddenly unable to actively straighten your repaired finger(s) you must contact your therapist. They are available Monday to Friday, 8am to 4pm. If this happens after 4pm on a Friday, or over the weekend go to the Emergency Department. The on-call Orthopaedic team will assess you.

6 weeks after your surgery

You may stop wearing the finger splint for most activities, but keep it on for heavier activities as guided by your therapist.

You may start driving once you feel safely in control of the vehicle, including being confident to make an emergency stop. Avoid long journeys until you feel more comfortable.

• Complete the following exercises 4 times each day.

• Aim to do 5 to 10 of each exercise.

• Continue to massage your scar for one minute each time you do the exercises.

• Continue the exercises from Phase 3.

1. 
   1. Make a fist at the same time as bending your wrist forwards.
2. 
   2. Extend your fingers at the same time as extending your wrist.

8 weeks after your surgery

• At this stage your tendon(s) will be healed. However, it will take a further 4 weeks to return to normal strength. You may use your hand for all activities, except heavy lifting or contact sports.

• Your therapist will guide you on any specific exercises to complete at this stage, if needed.

• Continue to massage your scar for 1 minute four times each day.

12 weeks after your surgery

• You can return to all heavier activities and sports. Even though the tendon is healed, the muscles in your hand and forearm might still be weak. It may take up to 6 months to return to some heavier activities and sports, but this does vary between patients.

• Your therapist will guide you on any specific exercises to complete at this stage, if needed to strengthen your hand and wrist.

• Continue to massage your scar at least once a day for up to 6 months. This will keep it supple while the scar is still maturing.

Remember that getting a good result from this surgery is directly related to the effort you put into your rehabilitation. Please follow the advice and guidance given to you by your therapist.

Will I have follow-up appointments?

Yes. How many appointments you have and how often you have them will depend on your recovery. You will discuss this with your therapist at your first hand therapy appointment.

Further information

If you have any further questions, please speak to your therapist.

• Hand Therapy team
  Telephone: 01227 783065; option 2

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