About a month ago I had surgery to repair a tendon laceration. I'm concerned because I'm not getting my motion back. What can be done about this?
The first step is to find the cause for the loss of motion. It could be skin or joint contracture or tendon adhesion. Each of these problems has its own treatment. In both cases, the patient loses active motion but with adhesions or scarring, there is usually some active motion left. With joint contracture, the joint is stiff and stuck and doesn't move past a certain point (if at all).
Imaging studies may be needed to identify the cause of the joint motion problems. MRIs or ultrasound help show if the loss of motion is from tendon re-rupture versus adhesions.
Once it's clear what the problem is, then hand therapy with an occupational or physical therapist is advised. Splinting and exercise are the focus of treatment for these problems. If there's no progress or very little change, then a second surgery may be needed.
If there are adhesions keeping the tendon from gliding, then the surgeon performs a tenolysis. Scar tissue around the tendon is carefully cleaned out. The tendon is released inside the sheath so that it will slide and glide again freely. The patient is sedated but awake enough to actively move the hand during the surgery. This is the only way the surgeon can tell that the tendons are gliding properly for normal motion.
If there is a joint contracture, then the method of splinting must be reviewed and changed if needed. Finger "buddy" taping (one finger is taped to another to move together) and active-assisted exercises are performed. If conservative care doesn't help, then surgery may be needed to release the joint.
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