Flexor Tendon Rupture in Hand

[TBS]

Did a search and couldn't find anything

I managed to rupture the flexor tendon in my right thumb this AM while trying to cut a piece of 8lb monofilament tippet with Swiss Army knife scissors. Heard a pop and thumb would not move at the knuckle. Prior to that I was keyboard warrioring here. So not exactly severe stress on the joint.

X rays say no avulsion fracture. Appt with hand surgeon in two days

Interestingly I was prescribed Ciprofloxin for an infection last week. One of the side effects is tendonitis and tendon rupture, esp. the Achilles and especially with "seasoned veterans" like me.

The prescribing doc knew I ruptured my Achilles while skiing two years ago. She also knows I'm an aging athlete who skis, mountain bikes, hikes uneven ground and sometimes forgets he's getting old.

I took a few days off from skiing late last week and early this week, until I could talk to the doc about risk of injury given known side effects. Guess I have my answer. Happy I didn't ski.

Oh yea, there won't be a followup with this doc.

Will chronicle my surgery and rehab.

[splat]

Jeezus Fuck, TBS. Just wow. I honestly believe it took a long time for the cipro to catch up on me. I just don't think my left shoulder tendons would have splintered and my bicep tendon all but severed for any other reasons, especially given the shoulder exercises I've been doing pretty solid for the last 40 years. But a thumb tendon. Wow. My cream, and I attribute the Chinese circulation herb formula in the cream to the rapid healing (cbd only for symptomatic pain), has been a blessing. Growing my torn labrum back together was incredible and the tendons only bother me if I sleep on that shoulder on a hard surface.

[NW_SKIER]

Gonna have to lay off the furious masturbation for a bit. Vibes

[TBS]

I do that with the other hand

[TBS]

@splat, I also had a bad reaction to Ciprofloxin half way through the five day course. Dizzy, nausea, puking, ended up in ER. Switched me to something else on Monday.

Will see what surgeon sez re: causation.

[stealurface831]

I do that with the other hand

if you rupture the tendon in that one, ya always got yer feets.

[TBS]

You may be that flexible but I’m not

[splat]

@splat, I also had a bad reaction to Ciprofloxin half way through the five day course. Dizzy, nausea, puking, ended up in ER. Switched me to something else on Monday.

Will see what surgeon sez re: causation.

When I finally became allergic to cipro, I broke out with sores in my mouth.

[TBS]

Spoke to the surgeon Friday
He sez there's no way of knowing whether the Cipro was the last straw, but suspects the rupture is likely due to "attrition", caused by the tendon rubbing on this


Which was necessary due to this - that's what you get for skiing over barely covered rocks

Well you also get a cracked sternum and a dislocated finger too.

And in the small world department, that plate was installed by his mentor during his residency.

He's ordering up an MRI to see if there's enough tendon to do a simple repair
He isn't optimistic

So the likely options at this stage appear to be
1. Harvest a tendon from one of my fingers to graft on the ruptured one and remove the hardware. Recovery time is 12 weeks. A review of the literature I can find sez about 20% get full range of motion back and the standard appears to be about 45 degrees. And in about 15% of the cases the repaired tendon ruptures again and thumb won't ever bend again.
And my middle or ring finger won't bend at one of its joints.

2. Live with a thumb that won't bend at the end. This isn't my dominant hand.
Tests performed since rupture
- I can hold a ski pole just fine
- I can tie a surgeons knot, single & double uni knot, cinch knot and nail knot (with a jig)
- I can fling a fly line (this is my rod hand) without pain
- I've ridden my MTB twice. The thumb pad is a little tender, which I attribute to a pissed off tendon end, but otherwise my right hand does what it needed to do
- I've lost some pinch strength, don't know about grip strength. Will test at next appt

Thoughts? WWMD?
Any experience with either option? Any football or rugby players with jersey finger?

Will follow up after MRI

I'm also talking with my Achilles surgeon and PT this week to get their view on my risk of rupture due to Cipro.

[pfluffenmeister]

Can you still furiously masturbate?

[::: :::]

Dang, man, those are rough options...
Not sure #1 is worth it for limited use & less movement in another digit

[grinch]

Ive got nothing on this injury other than docs seem to always give the worst possible scenario. Wish you the best tbs. Your active so that jumps your percentage up quite a bit from average

Sent from my SM-G950W using TGR Forums mobile app

[TBS]

Can you still furiously masturbate?

As I explained to NW Skier and others, I use my other (dominant) hand for that. Along with help from Ms TBS of course...
But thanks for y’all’s concern

MRI is tomorrow AM and meeting with surgeon is Thursday PM

[pfluffenmeister]

As I explained to NW Skier and others, I use my other (dominant) hand for that. Along with help from Ms TBS of course...
But thanks for y’all’s concern

MRI is tomorrow AM and meeting with surgeon is Thursday PM

Good luck, I hope everything goes well.

[splat]

Personally, I'd get the hardware removed that caused the rupture and see if it can heal on its own. Was that option mentioned? Give my cream some time and see how you feel. Just keep slathering it on.

[TBS]

Reviewed MRI with surgeon this PM
- tendon is torn in half and retracted with a gap of about 5cm. Ain’t gonna reconnect on its own.
- can’t tell if the plate caused the rupture, or the Ciprofloxin, or both or neither.
- cartilage where thumb meets the hand (CMC joint) is pretty messed up and arthritic. Yup, having it bent back so thumbnail touches the wrist many times over the years will have that effect.
- all other tendons, cartilage and ligaments show no signs of damage

Options still the same
1. Do nothing (aka “Perpetual Stiffy”). Will lose some grip strength and a lot of pinch strength.

2. Repair the tendon and remove the hardware. No way to know whether they can sew tendon back together directly or need to take tendon from elsewhere until he opens up the hand. Probably a four hour procedure. Three month rehab. There’s a small chance of reattaching without grafts if done in next 10 days. After that it’s gonna be a graft.

Surgical outcomes appear kind of mixed. Adhesions can occur that can’t be loosened up. Tendons re-rupture 15-20% of the time.

So far the only drawbacks to the Perpetual Stiffy is:
- harder to type on a phone
- need a pair of pliers on occasion to overcome lack of pinch strength

All in all I’m leaning toward a perpetual stiffy.
Change my mind

[::: :::]

Future chairlift conversation starter: “would you like to see my perpetual stiffie?”

[NW_SKIER]

Future chairlift conversation starter: “would you like to see my perpetual stiffie?”

I like where your head's at there.

[splat]

I severed the tendon on top of my hand for my middle bird finger on my way through a windshield in a car wreck when I was young. It was sewn back together the same evening. I have a tweak with it that matters not. Other than that, it works fine. I'd advise getting the best usage you can with a graft, which would obviously (in my mind) be a stronger repair and thumbs and fingers are kinda convenient to have when needed, like ACLs in knees. I wish you the best with your decision, TBS.

[old goat]

I severed the tendon on top of my hand for my middle bird finger on my way through a windshield in a car wreck when I was young. It was sewn back together the same evening. I have a tweak with it that matters not. Other than that, it works fine. I'd advise getting the best usage you can with a graft, which would obviously (in my mind) be a stronger repair and thumbs and fingers are kinda convenient to have when needed, like ACLs in knees. I wish you the best with your decision, TBS.

Extensor tendons (top of the hand) do much better with surgical repair than flexor tendons like TBS'. Not comparable.
Personally, I'd be inclined to have it fixed--there's a reason for the expression "sticks out like a sore tumb. Even 45 degrees of flexion would make a significant difference. This is not a professional recommendation btw, I'm no hand surgeon.

[TBS]

Spoke early this AM with a Physical Therapist I trust about this
First question after I explained what happened, the Cipro and the plate was: "What's your A1C level?"
"Uhh, about 6.4"

Then he took me through a bunch of literature from NIH showing a really big correlation between tendinopathy and A1C >5.7. Like the risk is 3-4X higher in diabetics. Apparently (in terms I could understand) diabetes impairs the ability to make collagen lay down properly.

OTOH, getting A1C below 5.7 and moderate exercise will strengthen and remodel tendons.

Then we went through the DASH (Disabilities of the arm, shoulder and hand) test that Hand Therapists use to measure impairment and subsequent improvement during therapy.
https://www.myoptumhealthphysicalhea...Forms/DASH.pdf

Per the test, I have no measurable impairment. Well, OK I can't knit (per Q 17), but I couldn't do that before the injury. I do struggle tying surgeon's or uni knots with 4-5x tippet, but that's because I need magnifiers to see what the hell I'm doing.

There was also a question "Have you had difficulty playing your musical instrument or sport as well as you would like?" The answer is yes regarding sports, because even though I Used To Be Good, I'm getting fucking old.

There was no question on the test about impaired ability to furiously masturbate.

Grip strength for right hand is 5-10lbs less than left (dominant) hand - normal.

Surgeon told me there's no real rush to have the repair surgery. However, if I don't get the surgery in the next week (three weeks from rupture) the need for a tendon transfer goes from "Probable" to "Certain".

Then I got a second opinion by phone from another hand surgeon. Went through the above, the MRI results and especially the DASH test. Basic answer was since there's no practical impairment at present, the cost/risk/benefit of surgery doesn't really stack well.

So...
I'm not getting the surgery done now.
Gonna get my A1C below 5.7 to help get tendons strong again.
Then, after some more time to consider cost/risk/benefit of surgery, maybe I will get the surgery.

In the meantime, I have a perpetual stiffy...