Flexor Tendon Repair: Risks of Early Movement After Surgery

Flexor tendon rupture of the thumb?

After 32 hours post-surgery for flexor tendon repair of the thumb, I followed the rehabilitation therapist's advice to perform wrist movements.
Initially, the splint was fixed at a 30-degree flexion to protect the tendon.
During the activity, I passively bent the wrist forward by 20 to 30 degrees and then actively returned to the 30-degree position.
Due to removing the splint, I slightly exceeded the return position by about 20 degrees.
Although the movement was slow, it seemed to strain the still-healing tendon.
I repeated this motion five times, and I experienced pain in the thumb's palmar area.

Will this type of movement cause the sutures to pull apart? Will it affect the recovery outcome? Does it increase the risk of a secondary tendon rupture in the future? Thank you.

Wade, 40~49 year old female. Ask Date: 2022/04/30

Dr. You Dianqi reply Orthopedics

Regarding the home rehabilitation exercises following flexor tendon repair surgery, adjustments should be made based on the postoperative timeline or individual recovery status.
Please discuss this with your physical therapist before proceeding.
Thank you.

Reply Date: 2022/04/30

More Info

After a flexor tendon repair surgery, the recovery process is critical, and understanding the risks associated with early movement is essential for optimal healing. Flexor tendon injuries, particularly in the fingers, require careful management to ensure that the tendon heals properly and regains function.
In your case, having performed a flexor tendon repair on your thumb, it is crucial to follow the rehabilitation protocol as prescribed by your healthcare provider. The fact that you attempted to move your wrist beyond the recommended range of motion—specifically, bending it more than the advised 30 degrees—can indeed pose risks to the healing tendon.

Risks of Early Movement
1. Tendon Rupture: One of the primary concerns with early movement, especially if it exceeds the recommended limits, is the risk of rupturing the tendon at the repair site. The sutures holding the tendon together are delicate, and excessive force can lead to them pulling apart, resulting in a re-rupture. This is particularly concerning if you felt pain during the movement, as this could indicate strain on the tendon.

2. Scar Tissue Formation: Early and excessive movement can also lead to the formation of scar tissue, which may restrict the tendon’s ability to glide smoothly within its sheath. This can result in stiffness and decreased range of motion in the long term.

3. Delayed Healing: Engaging in movements that are too aggressive can delay the healing process. The body requires time to repair the tendon, and pushing it too soon can lead to complications that prolong recovery.

Impact on Recovery
The actions you described—moving your wrist beyond the prescribed range—could potentially affect the healing process. If the tendon was indeed strained during these movements, it might lead to complications that could hinder your recovery. Pain at the site of the repair is a sign that the tendon may be under stress, and it is essential to communicate this to your healthcare provider.

Future Risks
If the tendon is compromised due to early movement, there is a risk of secondary rupture, which would necessitate further surgical intervention. This could lead to a more complicated recovery process, including additional rehabilitation and a longer timeline to regain full function.

Recommendations
1. Consult Your Surgeon: It is imperative to reach out to your surgeon or physical therapist immediately to discuss the pain you experienced and the movements you performed. They may want to assess the tendon’s integrity and adjust your rehabilitation plan accordingly.

2. Adhere to Protocol: Moving forward, strictly adhere to the rehabilitation protocol provided by your healthcare team. This typically includes specific ranges of motion and activities that are safe to perform at various stages of recovery.

3. Pain Management: If you experience pain during rehabilitation exercises, it is crucial to stop the activity and consult your healthcare provider. Pain is often a signal that something may be wrong, and it should not be ignored.

4. Gradual Progression: Recovery from tendon repair is a gradual process. Focus on gentle movements within the prescribed limits and gradually increase the intensity and range of motion as advised by your therapist.

In conclusion, while early movement can be beneficial in some contexts, it must be approached with caution following a flexor tendon repair. The risks associated with exceeding the recommended range of motion can lead to complications that may affect your long-term recovery. Always prioritize communication with your healthcare team to ensure that your rehabilitation is safe and effective.

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