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IU Health Bloomington Hospital

In Good Hands

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March 15, 2019

Ryan Taylor still remembers the horrible pain he felt on that January day two years ago.

He was remodeling his house and tearing down corner bead (metal corner that connects two pieces of drywall).

“The corner bead won that fight,” said Taylor, who serves as Director of Physical Therapy for the Orthopedics and Sports Medicine team at IU Health Southern Indiana Physicians. “I cut my hand in the worst spot possible.”

After removing his work glove, Taylor discovered he had sliced through two of his fingers, right through the flexor tendons. Flexor tendons are smooth strong cords that connect the muscles of the forearm to the bones in the fingers and thumb (two for each finger).

Looking at his hand, he realized surgery was imminent (his first ever), and he had now slipped into the shoes of a patient.

According to Otto Wickstrom, MD, a hand and upper-extremity specialist with IU Health Southern Indiana Physicians, flexor tendon injuries are time sensitive. “The best results happen when the surgery is done within the first seven days,” he said, “but we aim to get these cases in within 48 hours.” Taylor’s surgery was scheduled right away.

“His (Taylor’s) injury is quite common and quite difficult to repair,” Dr. Wickstrom said. “The injury occurred in a zone of the hand called ‘no man’s land.’ It requires absolute precision and must be done perfectly for the repair to function.”

Historically, “no man” would operate on a tendon injury in this zone because the results from surgery were terrible, he said. However, as better surgical techniques and more stringent rehabilitation protocols were developed, results dramatically improved. But patients should still be selective.

“Only fellowship-trained hand surgeons properly trained in flexor tendon repair should attempt to repair these injuries,” Dr. Wickstrom added.

Successful surgery must be accompanied by an appropriate rehabilitation, said Dr. Wickstrom. “If the patient does too much, the repair will rupture. If he does too little, everything will stick together and not work.”

Taylor typically likes to build muscle mass at the gym and hang out with family (wife, Jennifer, and three kids) when he’s not helping others rebound from their own injuries. A fitness enthusiast, he likes to work out at home or at his friend’s gym, but his hand injury left him on the sidelines.

“I was lucky because it was a clean cut,” Taylor said, “which the doctor says, helps with the repair.”

But for three months after surgery, Taylor’s injury forced him to change his routine at work and in the gym.

“With Crossfit,” Taylor said, “almost everything involves gripping a barbell, a pull-up bar or rings.” Taylor admitted he became quite creative while trying to heal and trying to continue some sense of progress in the remodeling of his house.

The expertise and skill of Dr. Wickstrom and his therapist, Chad Royer, OTR, CHT, a certified hand therapist, worked in Taylor’s favor. He was well on his way to full range of motion shortly after surgery, with very little residual pain or stiffness.

“Ryan’s function was nearly full at six weeks, and his grip strength was back to normal at about three months after surgery, which is much better than average,” said Dr. Wickstrom. “In addition, his function currently is absolutely normal. Frequently, patients have very good function, but often do not return to ‘normal.’”

The surgery, albeit an unwelcome visitor, taught Taylor a couple of things along the way.

“It definitely allowed me to empathize more with my patients,” he said. “It also helped me provide guidance on the importance of listening to your providers in regard to when it is appropriate to start progressing, even if you feel you can do more than you’re allowed.”

World-class care, small-town convenience

Patients needing hand surgery, especially a complex surgery like this, should seek out a fellowship-trained, board certified hand surgeon who does a lot of these types of procedures, Dr. Wickstrom advised. “Most of us have spent at least 10 years training after college before taking our first job.” Dr. Wickstrom and Tarek Sibai, MD, both from IU Health Southern Indiana Physicians, work with all types of complex injuries of the upper extremities – trauma as well as elective procedures.

What does flexor tendon recovery look like?

  • Two days after surgery you begin range of motion exercises.
  • Four-to-six weeks after, you are allowed to remove your splint and freely grip.
  • Three months after, you should be back to regular activity.
  • Six months to one year after, your grip strength should fully- or near-fully return.

Featured IU Health Southern Indiana Physicians providers seeing patients for hand and upper extremity issues and injuries:

Otto Wickstrom, MD
812.333.BONE (2663)

Tarek Sibai, MD
812.333.BONE (2663)

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