Broken Pinky Finger - Post Surgery Stiffness

I had surgery done on my broken pinky finger on January 1, 2008, which I broke while playing football, and I was in the cast for 6 weeks after that. After the cast came out, the doctor told me to go to therapy for 6 weeks/ 2 times a week to get rid of the stiffness in the finger. Now it is May 5th, 2008 and I have 2 more weeks of therapy left but still the finger is a little stiff. I can bend it but not fully and in terms of going back up it doesn't move at all.

The therapist has told me that doctor's could do another surgery to loosen up the tendons but I will wait to ask a doctor until my therapy is done.

The questions that I had is:

1) What are the chances that I can still gain full momentum in my pinky finger?
2) If I am not able to get the stiffness out, can anyone tell about the surgery the therapist was talking about?

Greatly appreciate your help.

Thanks

[imq]

Hello Everyone,

I would greatly apprecaite the view / comments of someone who has knowledge of this field.

Thanks

[Mdcool]

I had i similar thing done to my finger, i broke it playing footy then had a few screws put in. After the surgery i couldn't straighten it out but i was still able to make a fist. My therapist sent me for another operation to straighten it but it ended up removing all movement due to a build up of scar tissue and the fact that they cut some of my tendons. If i had my time again i would have left it the way it was.

[VG911]

Hi imq

i have the samething right now this is 3 months after my surgery
I can bend it well but could not straighten it up

Is there any improvement in your case , did you go for the second surgery

VG

[DC172]

I broke my pinky finger through the joint playing rugby about 6 months ago.  I didn't have to get surgery but I had like exercises I had to do everyday so I didn't loose movement in that finger.  Just last month I got full movement back...so it could take a while. Hope all goes well! :D

[djmm]

I had a severe PIP joint fracture on my pinkie finger on Aug 17th and had surgery on the 21st.  I have 2 screws holding that joint together now.  

It's about 5 weeks post-op now and have had the cast off for about a week and a half.  I'm in my first week of physical therapy.  

The tip of my pinkie is still numb and the finger itself is stiff as a carrot - very little movement.  I'm very concerned about the lack of movement and the numbness at this point but the doctor and therapists are saying don't worry.  We'll see in another month.  I'm concerned about hearing stories of people that didn't start moving it right away vs. people that did and the significant difference in range of motion later on.

[Olga207]

The same exact thing happened to me a month ago.  I had two pins placed in my bone, and am now going to therapy.  The stiffness is normal.  My therapist told me that I may not get full movement in my pinky for a year, and I am only 16.  Your symptoms are totally normal however.  

[djmm]

Well it's nearly a couple of months later for me.  My pinkie isn't numb anymore, but it's still very very stiff.  My repeated concerns were ignored by my doctor who said "oh it's fine, it's fine" until I went back for the followup and he tells me, "yeah, that's not doing so good" and tells me another surgery is likely to clear out the scar tissue and other blockages causing the stiffness.  

So then I tell my doctor, "But isn't it the first surgery that caused all the scarring and stiffness in the first place?". "Yes" he says.  "And the solution then is to do another surgery to increase the scarring?". "Yes" he says but you'll have to start full range of movement with it right away.  That should be lots of fun with my finger cut end to end.

My pinkie is stuck in the middle range of movement with a few degrees of movement on either side.  That's it.  Otherwise, still feels very swollen all the time and basically immovable.

My recovery from this has been about as bad as it can be.  I hope for the best with the rest of you all.

[djmm]

It's a new year and the physical therapy has been discontinued by the doctor as he says it won't do any further good.  My only option is another surgery and I have so far opted to not go forward with it.  Lesson learned: Don't break your PIP joint!  Broken joint medical treatment is still in it's infancy in 2009 and a broken PIP joint means that joint stays that way for the rest of your life according to the doc and all I've spoken too.  The bone is healed, but big deal - I bump it at least once a day and am reminded of it daily.  

[snappity]

I have been looking all over the internet for info on broken fingers. So far this link seems to be the closest to my situation. I broke three fingers on my right hand about 5 weeks ago. I have three pins in my little finger, three pins in my ring finger, my middle finger is broken also but didn't require pins. They are all broken diagonoly in the first bone right above the knuckle. I'm in a cast to my finger tips down past my wrist. I have the pins removed in a week. I am scared that it is going to take me forever to get movement back in my hand after. If a little finger injury takes so long to recover...am I looking at double or triple the time??eeekkee. I play roller derby and am dying to get back at the sport. If I can't make a fist (not for hitting..but for landing so fingers don't get run over). I won't be able to safely go back.......

[six7damon]

Hey guys, Im just givin input as we all seem to have a similar problem.  Mine is a broken pinky finger (spiral fracture just above bottom knuckle)  I have severe stiffness at knuckle below tip of my finger.  Hand specialist states that people (no matter age) generally NEVER gain full range of motion in broken fingers and also that surgery almost ALWAYS has the chance of causing further and even PERMANENT stiffness due to residual scarring.  I can make a fist but the tip of my finger sticks out, I will try therapy for the initial 30 days but after that if no progress, I think Ill opt for the surgery.  Luckily theres never a need to make a fist playing basketball, however, it is annoying when Im playing Xbox Live....lol  Havent been to OT yet, but so far I try exercising and stretching it (with little progress except just after soaking it in EPSOM salted warm water)

[six7damon]

Read my post.....the chances of you regaining FULL range of motion is minimal at best, I would suggest you try some sessions with an occupational therapist prior to opting for surgery (which is what Im doing).  KEEP IN MIND....surgery could simply make it worse than it already is.

As for the surgery, there is nothing they can really do for the joints, but if the problem is muscular, they can ease some of the tension in the tendons....****but this will DEFINITELY result in scar tissue forming and could POSSIBLY either cause your finger to be permanently straight or bent!!!

[dave914]

This past October i broke my left ring finger right behind the PIP joint.  I had surgery and 3 pins installed to "line up the break".  well im no doctor but when i saw the post op X-rays, i was not impressed.  anyway, here i am 4 months later and i am totally unable to get movement out of my PIP joint.  i have been through PT at least 3 times a week since the surgery, but have gained little to no movement.  like so many other posts, my therapists says another surgery will help...im not so sure... Has anyone had this "second surgery" to clear up the scar tissue that has built up? does it work? or should i just get used to it like i have begun to?  Thanks

[cj9090]

Six weeks ago, I fell and broke my pinky. At first the doctor didn't even think it was even broken. Here we are today, I have had not one, but two operations for my distal avulsion fracture. I have one screw, some wire wrapped around the bone, and two pins in my finger. I get the pins out in two weeks, but I am very worried that this joint will never function again. My doc said I should start soaking it in Epsom salt now, before the pins come out. Has anyone experienced a distal joint fracture? Comments/Suggestions? Thanks

[gres06]

Hey all.  I had surgery on 1/30/2009 for a broken pinky (spiral just above the first joint, the break occured on 1/17/2009, I initially had it xrayed and reset to see if it would heal correctly without surgery)

It is now 2/26/2009.  I began rehab on 2/10/2009 and have been going twice a week, and will continue for 6 more weeks. In between the sessions I have been working the hell out of my finger throughout the day trying to keep it moving and increasing range of motion.  

The swelling is finally starting to go down and I think with it I am able to move a bit more.  Straightening the joints in general is much harder than contracting them and the joint on the tip of my pinky gets maybe 15 degrees unassisted and maybe 45 degrees assisted.  The second joint gets maybe 50 degrees unassisted and 70 degrees assisted.

I am working really hard on the joint at the tip because it feel like that stiffness is really what is impeding my overall movement.  I will keep people posted on the progress...so far my PT hasn't mentioned another surgery but I will bring it up tomorrow and see what she says.  

One thing that I do...is that no matter how hard she works the joint...even if I start feeling nausious because it hurts so much...is that I tell her that it feels ok and have her keep going.  I figure that these first few weeks are critical and I do not want her taking it too easy and ending up with immobile ligaments/joints.

John

[Walker15]

I fractured the proximal phalanx of my pinky in a bike fall.  It was a complex fracture, unfortunately, and couldn't be set without surgery.

The following was my experience:

A week and a half after the break, I underwent surgery that included a bone graft from my wrist and the insertion of four pins to stabilize the bone pieces.

I then spent five weeks in a cast...the first week in a post-surgery dressing, and then four weeks in a cast.

The pins were then removed and the hand bandaged.  From the x-rays the bone looks amazing, perfect alignment - excellent surgeon (Dr. Rebecca Yu). No complications.

It is a day after the cast was removed and I have extreme stiffness in the finger, with virtually no active range of motion (but the passive range of motion isn't very good, but it's still something). The swelling is mostly down at this point.

My whole hand is affected by stiffness, but it is the pinky which is immobile.   I think it is very likely that the tendons are firmly attached to the bone now (the tissue around my proximal phalanx, the bone that was broken, feels like a rock).  I hope I can somehow detach them through PT but the extensive time in the cast,  and the week and a half delay prior to surgery, makes this unlikely I think.  Dr. Yu warned me this might happen so I am not alarmed or depressed, there wasn't an alternative in my case.

If you do suffer a finger fracture, call around to see if you can find an experienced hand specialist who can see you quickly, and who can operate quickly.  Take your anti-inflammatories. Keep your hand elevated above heart level at all times prior to surgery,  and even after surgery if possible, to reduce swelling.  Keeping the hand cool can help.  Let the physician know that you are very concerned about post-surgery stiffness and get advice on how you can minimize this, or if there is anything they can do (special cast or splint?) so that you can engage in finger mobilization therapy quickly.

Your physical therapist should be a certified hand therapist.  

[djmm]

An UPDATE:  It's been almost a year now since my break of my PIP joint on my right pinkie finger.  Since discontinuing PT at my doctors recommendation, the stiffness has not improved.  On the other hand, it hasn't apparently gotten much worse either, so I'm resigned to the fact that I have very limited movement in that finger and it feels like it was injected with cement.  It's got maybe 20 degrees of movement and is stuck at a very inconvenient angle.

Fracture medical science in 2009 is really still little more than medieval at this point.  The best hand surgeons in the SF Bay area have told me "we can get in there and scrape away the scar tissue and release the tendons, but more than likely you'll have worse results" since any additional surgery creates more scar tissue.  

I guess I'll wait for micro arthroscopy or nano-bots that's can go in there and clean up the scar tissue without creating more.  Or maybe some localized anti-scaring injection to allow a surgery to heal without adding scar tissue.  Maybe this stuff will be invented before I die?  LOL.

[Dr Vinod]

You have to understand that the phalanges are very small bones and the tendons of flexors and extensors are intricately attached to them.
This comes with birth and development and no surgery can attach them perfectly as they are very delicate and fine movements also may be lost.
With increase in age the healing of phalanges is very difficult and time taking and this is the case with your proximal phalynx.
With advancement of technology may be there will be robotic surgery which will reduce the scar tissue and a  better way of performing it!
Take care!

[Colnago_Rider]

Think I am in same boat. It's 3.5 months - and therapy and dynasplinting to improve flexion and extension have not resulted in much improvement. Have not had any surgery yet, but am seeing one of the best on east coast who thinks he can get me to 10 degrees which is better than the 45 degrees its bent now.

[Walker15]

Just wanted to update my original post about my finger surgery.  

For about a month after I had my cast off, and after the pins were removed, I had a flexor tendon adhesion.  However, I worked every day, at least 10 min every couple of hours, trying to get that darn tendon adhesion to release.

Well...finally, after so much work, I finally got that tendon to release.  It was a very very bizarre feeling...I could hear and feel some tearing sounds, as the adhesions that were keeping the tendon from moving finally broke.   But I'm very very happy I spent so much time trying to get my "immobile" finger to finally move.  It seemed futile at the time, but I'm glad I didn't give up.  Please try your hardest too, if you end up with an adhesion.  It may take months but it's worth it if you don't have to go for a second surgery.  Try to get the physical therapist to make you a "blocking splint" that can help you isolate the finger so you're getting good flexion.   My therapist also used electrical stimulation to help with contraction but I didn't find this useful at all.  I was able to create much more tension by myself.

Now, 4+ months after surgery, I'm *still* having swelling of my finger joints in my pinkie and wake up with a lot of stiffness in the finger.  I wasn't sure what the problem could be, until I realized last week that the surgery scar was actually still adhesed to the bone at the site where the pin had been placed.   So for the past week I've been trying to get the scar tissue to release from the underlying bone.   I think that may have been what has been slowing down the complete healing of the finger.  However, my doctor also told me that it can take up to 8 months for the joint swelling to go down.  So I'll just keep up with the PT and hope for the best.  

This finger fracture has been BY FAR much more tricky than the time I fractured a bone in my foot.  

[Colnago_Rider]

Followup on my pinky fracture of proximal phalanx -- I'm sharing this so that maybe someone else can avoid my horror story.

FOR THOSE OF YOU WITH A PROXIMAL PHALANX FRACTURE- EARLY RANGE OF MOTION IS KEY ---- WITHIN 7-10 DAYS. HAD 3 HAND SURGEONS TELL ME SAME THING. Casting, or splinting too long makes a contracture nearly certain. The splint had my finger bent at about 60 degrees. Once splint was taken off, guess what happened? Finger remained 'stuck' at 60 degrees. Well, yeah, because the tendons fused to the bone while it was healing - and had no movement.

Also make sure if you are splinted, do not have your DIP splinted as well. If you can move your DIP while MCP and PIP are immobilized at least you have tendon gliding.

My incompetent doctor insisted I remain splinted for 40 DAYS!! Then he refused to write script for occupational therapy cause he didnt want 'anyone breaking it again'. When I finally started - IT WAS TOO LATE. So.....

I needed surgery done after 4 weeks of agressive dynasplimting yielded no increase in ROM. Fixed at 65 degrees with max flexion at 85-90. Surgery - he went from top and bottom multiple incisions and also put wire in there to stretch tendon. Needed to cut into my palm to finally release the tendon from all the scar tissue. Last three days have been pure no holds barred agony. Most painful experience of my life. Finger is now about 20 degrees. Codeine did nothing. .

You don't know the meaning of pain til you have hand surgery. Making a grown man close to tears. Excruciating.

UPDATE: So now, 2.5 months after surgery, Looks like surgery only got finger straighter (now is about 25 degrees). Very rough Occ Therapy 3x a day, flexion splinting during day and extension flexing at night. I have 10 degrees unassisted, and maybe 45 degrees assisted at DIP and maybe 5 degrees unassisted and maybe it goes from 25 degrees to 90 assisted (after warming at OT) at PIP.

Have really tried hard to do all my exercises, splinting and OT 3x a week.

Surgeon says scar tissue has tendons locked up, but the looser I can get PIP, the better chance for second surgery. So it's tenolysis, and perhaps capsillectomy. First surgery went slightly into palm before tendons freed up, second one will be the same complete dissecting of the finger. he said might have to go to wrist to pull tendon and make sure it pulls through.

Not sure I will go ahead.  While the thought of 'giving up' now is not exciting knowing that I have permanent disability, neither is the agony i went through with first surgery.

Im finally getting feeling back on the finger... still swollen though, the scars hurt....

[GotRugby]

I fractured my right 5th metacarpal behind the PIP joint and had surgery to re-break the bone and pin it after wasting a month in a hard cast in an attempt to avoid surgery.  The pins stayed in for 4 weeks and when they were removed I could barely open or close my right pinky finger due to it being extremely stiff and losing a lot of muscle strength.   I went to my PT only a couple times. The only benefits were the exercises (which I later found online for free) and convincing my PT to give me the exercise putty in advanced (I had to lie that I wouldn’t start using it for another two weeks for the more rigorous exercises).  He did mention something about possibly needing a second surgery and to take my time with the recovery.  Honestly I didn’t listen to him because I know my own limits and I knew I needed to get my finger working or live with the consequences.  

Luckily, I was able to use my left hand as a model for bending and stretching my injured right hand.  I preferred creating my own exercises with more range of motion and used my left hand to somewhat forcibly stretch the various parts of my pinky finger.  My biggest problem was the PIP joint locking up, which the stretching really helped (I did it to the point of pain with my eyes closed so I could focus on not re-injuring myself).  I also found that beginning these exercises/stretches in a hot shower to be very effective.  It has been 3 weeks since I last visited the PT and I have regained 90% of the movement, and hope for a full recovery considering I still have lots of swelling and muscle loss around the area.

My advice would be to stay on top of the exercises and not be afraid to really push your limits.  I also drank a lot of milk and upped the protein intake, even though the PT said it wouldn’t really help.  Since I did a lot more rigorous exercises and stretches then recommended, I limited my workout to 3-4 times a day at the most and even took entire days off.  If you can’t take a shower before every workout try microwaving a pillow case with some uncooked rice for 2-3 minutes and use it as a hot pack (it works amazing for deep penetrating heat and is also cheap/reusable).   These techniques have worked for me, but I’m not a doctor so use common sense. Good luck!

[jupiterpolice]

so i have my index finger broken and have had 3 pins placed inside to keep straight????? and if i do the surgery there is no guarentee i will get full mobility back??? can anyone answer this question for me or is it too early to tell yet!! im in law enforcement and this happens to be my trigger finger in question! right now my finger is completly stiff straight ! i got about 20 percent movement in the middle but no movement at all in the lower bend!! anyone got any advice thanks

[jupiterpolice]

i would also like to add that the first surgery,the placement of the 3 pins was extremely painfull,,and i do mean extremely! am i being paranoid too early that i will or will not ever regain full mobility as to pull trigger on a handgun??,,once the pins are removed ,will that make it easier to start moving ? do the pins limit mobility or should i still have some movement since its been almost 2 weeks since they were placed in?? finger still very swollen! shoild i be trying to move this finger on my own??  if the mobility does not come back,,will getting that second tendon stretchin surgery that everyone seems to talk about work???

[Colnago_Rider]

Make sure you are constantly moving the finger at all joints - mcp, pip and dip. I know it's painful. What did me in I think was after my surgery the finger was all bandaged up because of the pin and I couldn't move it therefore the tendons scarred down. I am scheduled for second surgery next month. I cannot bend my pinky at pip at all. The time is now to make sure you are seeing an OT that specializes in hands. You didn't mention any OT or PT or where your fracture location was. That also makes a difference. Was K wire used in your surgery?  My finger is still swollen and my surgery was in September, and my initial fracture was in late April. Pins may restrict your movement but if it were me I'd load up on codeine and try to bend it assuming the bone is sufficiently healed. Few surgeons said I should have started OT  a day or two after surgery unlike the incompetent Doc who splinted me and insisted I remain splinted. Do not wait to seek multiple opinions. I can't stress enough how important early intervention and agressive OT/PT.

Is your finger immobilized now, or had it been after the surgery? Also, how soon after the fracture did you undergo surgery?

Since you're in law enforcement, obviously maintaining good range of motion is critical- especially that finger . I am righty, and my injury was left pinky. But having no use of it still impacts so many daily tasks, which I would never have imagined.

[jupiterpolice]

thanks for your response, i believe the proper term for the break is called middle phalanx fracture,in laymens terms ,its broke just below the second nuckle and the tip bend! ,as per the doctor ,ther was no ligament damage and he inserted 3 pins in the finger to keep in straight,the injury happened on dec.21, had surgery on the 28th,large cast was removed on jan 5th,i now have a smaller removable spint just covering the index and middle finger,doctor told me to start tryin to move finger now on my own,( showed me some exercises,the bad thing is ,he wanted me to start physical therapy that day,,had a death in family so im actually not gonna see the therapist until monday,tommorrow! my doctor was in fact very insistant on me starting therapy to get movement! i guess ill see how this week goes and if the therapist can get any movement! i just dread having to do another surgery in the future to get mobility!,just seems real silly to me how much is involved in a broken finger,guess im old school,thinking you just splint finger and in a few weeks everything is normal,,is your advice to me to keep on trying to move finger for mobility?? if i dont move it enough will it stay frozen and immobile?requiring a second surgery and is there a chance that second surgery will not work?? thanks for your your input  also can u explain to me wha you mean by the PIP, AND dip and mcp! hate to sound stupid but this is a little new to me ! thanks

[Colnago_Rider]

LOL. Instead of saying you were in LE, I was going to say you were OTJ, but between DIP, MCP and PIP, there were too many abbreviations in the thread. (have family OTJ, NYSP).

Anwyay, back to your finger.

Yes, all this does seem silly. When I fell, I had a ligament tear in my other hand's thumb, and thought very little of the pinky. Little did I know....

I did not have surgery on the pinky initially, only splinted at an angle. It was this improper splinting, and the duration of which, which was responsible for ruining the finger.

You had surgery quick, which is good. The cast after is unfortunately, a necessary evil unless they had been able to stablize the fracture with wires, which in turn allows for earlier range of motion. You didn't have it, so you're working against the clock.

The location of your fracture is probably a better location than mine which was proximal phalanx (or between 2nd and third). Mine was all the way up the pinky where it connects to the palm. The bone sits right under the flexor tendons, which in my case fused to the bone while healing, simply because they were not moving. HAd they been moving, there's no opportunity for them to fuse, thus, the need for early ROM (range of motion)

Are you supposed to remain splinted all the time? Is your DIP (first joint) immobilized? Hopefully its not, and you can move that joint, either unassisted or with your other hand. Best thing to heat the finger with warm water for a while before working the joint. So, I would work your DIP, then move to your PIP joint (Middle joint), and again, slow, steady stretches on it.

Therapist tomorrow should teach your excercise. Don't blow them off. She tells you to do em 6x a day, do em 10. (Make sure they are certified hand therapist or occupational therapist - If you can, do not go to a general physical therapist) I've gone to both and the difference is HUGE. CHTs and OTs are specialized in hands.

So keep on moving it - as much as possible. Be careful about leaving it splinted too long, consider buddy taping index to middle finger. Also - how is your middle finger? You also need to be careful about damaging that finger by prolonged immobilization. ALthough my pinky finger was busted, after my prolonged splinting, I lost about 70% movement in my ring finger.

Yes, my Doc was a total moron. But like you, I'm thinking - it's a pinky - whats the big deal.

Just continue to ask a lot of questions, but from Doc and OTs.

If all goes well, hopefully you wont need second surgery.

I can't wait for my surgery, although the thought of super-agressive OT the day after its split wide open, is not something I'm entirely looking forward to.

I would also say, that as long as doc thinks bone is solid, the OT needs to push you until you are basically crying. For the first few sessions, the pain was excruciating. Then again, my surgery was a capsillectomy plus tenolysis, and both top and underside of my finger was cut end to end plus about an inch into my palm.

Next surgery should only be underside of my finger, palm, and perhaps into my wrist if the flexor tendons that are responsible for bending remain scarred down.

Fun stuff.... :)

[jupiterpolice]

yes ,had the surgery pretty quick and this doctor is supposdly one of the best in the country!! i appreciate the talk and will keep you updated as i hope u will do same!,i just dread doing another surgery for immobility!.  im not going to a certified hand therapist but an occupational therapist! a friend of mine used this guy for a hand injury and swears by him,my doctor told me to also go with a hand therapist but it felt like a scam due to him telling me to use HIS therapist which happened to be an hour away from home! so i stuck to a reccommended therapist closer to home! ill see what he says in the morning!,my finger is in a removable splint which covers middle and index finger!,i was told by doctor to do exact ly what u said about moving it several times a day! it hurts!!! percocets are like pez to me now!!  i cant use the warm water method due to pins sticking out of my finger and was told that i canot get finger wet due to infection risk!,my real question to you is this, if my finger is not moving 10 days after surgery and all the signs of stiffness are there and after weeks of therapy i dont get movement back enough to pull a trigger< is it worth tryin another surgery to get movement? i know your not a dr. but just wanted your opinion! thanks again

[Colnago_Rider]

Occ. Therapist is fine - you'll be in good hands with them.

OK - you can't get it wet yet. When are pins coming out?

See if you graduate from the percosets to the codeine once the pain settles down. Very easy to get hooked.

After my first surgery, I had the hard cast thing as well, for like 10 days. When everything came off and he pulled my pin, I wasn't initially worried about no movement. It hurt so bad, I figured my brain wouldn't move it cause it hurt so much.

But after 6 or so OT visits (3x a week, 1 hr) it gradually became clearer that my flexor tendons were scarred down.

If you can move your first joint unassisted (the one closes to the tip - DIP) that a good sign. If you can move on your own the PIP (second joint) about 90 degrees, thats also a good sign. If you can't do any of that unassisted, how much can you do assisted?

If you don't get movement, not sure if you really have a choice about 2nd surgery. I stopped OT, and do it on my own but only because we reached a max, and then that was it. So the goal now it to have swelling reduced, and he'll go back in there.

One thing to keep in mind - you can't have a second surgery for a minimum of 3-4 months, at earliest. You need to wait until all the trauma settles down, edema, etc. Thats why although I want the surgery right now, I have to wait to hopefully have it a month from now. So just something to keep in mind - if this OT doesn't work, you may be without the use of the finger for another 4 or 5 months.

Keep moving it. Lets see what your OT says tomorrow.

[jupiterpolice]

so the therapist says i got about 25% movement in my dip and maybe 5% in my pip,its still very swollen and basically therapist says due to the 3 pins ,its very difficult to get movement,she did alot of stretching excercises and electric sten machine along wih ice! going again today,hand was really sore when i left yesterday and seemed to have stiffenned up again ,guess time will tell

[jupiterpolice]

got the pip and dip mixed up !!lol,, i can move the dip very little ! unassisted as well as very little assisted,,the pip ,or middle flexor i can move about 25% unassisted ,maybe a little more assisted !!  still very swolen and sore! hope thats not a sign of scar tissue forming or the beginning of permanent scaring! i try to take it out of this removable splint as much as i can ,but being the pins are exposed im afraid of nicking on something causing more damage! so the splint remains on most of the day! can wait to get these pins out!

[Colnago_Rider]

When are they pulling the pins...
Its good that you have 25% at PIP. How much assisted range you have at DIP?

[jupiterpolice]

pulling the pins on the 29th!!  i have mininmal range of movement at the dip , 5-10 percent at best! do u think that has alot to do with the pins! therapist says still very swollen ,very stiff ,! the pip is getting a little better! you can see the difference if i dont stretch on my own for a few hours how it stiffens right up!, i refuse to do another surgery if i cannot get full movement at dip! guess time will tell after pins come out

[jupiterpolice]

pins are out ! what a great feeling!! i can honestly say ,you really dont feel it when he pulls the out,although later in the afternoon ,finger did swell up like a balloon!! i have limited movement at the dip (but i can move it) and some pretty decent movement at the pip! therapy starts monday so guess ill see how well she gets it movin! time will tell!!

[bcirrin]

I broke my middle finger in three places had a titanium plate put in only to find out I was allergic to titanium in 2007.  I had three surgeries on one little finger and would never do it again.  My middle finger is still immobile, scar tissue set in.  I was constantly at the PT with no results.  I give up.  I have to face it that I have a deformed middle finger that doesn't bend.  

[Colnago_Rider]

My second surgery is in two weeks. No capsillectomy, just tenolysis - from pinky tip to inch down into the palm. If tendons arent freed from that, then he goes into the wrist.

PT starts the following day, which should be a lotta laughs.

This better work, cause there won't be a third try.

[steve890]

i hope someone can help me with this.  On Jan 25th i broke the shaft of my fifth metacarpal. i saw a doctor who advised me to have surgery in order to assure the return of a proper range of motion for my pinky finger. i went for the surgery on Feb. 1st, a week after the injury. ( i was splinted up for that time). screws were placed in my metacarpal to hold it together.  following surgery i was not placed in a split becasue my doctor felt that since the screws are holding the bone together that i should take advantage of this and return as soon as possible to using my hand in order to avoid accumulating scar tissue, etc. its been 2 weeks since my operation and my surgical scar is healing up. the stitches have dissolved.  but i cannot bend my pinky at the joint. its not an issue of pain, it just stops and springs back up.  i can bend the tip and the middle joint of my pinky. just not the one attached to the knuckle joint.  its my dominant hand that is broken. im a career musician and artist. i cannot play guitar and cannot paint and hence cannot work/tour. im really scared that its going to remain locked like this and ill never go back to those things again. my doctor has not been helpful at all. during my post o visit he asked how many days it had been since the operation. then proceeded to tell me i have bad scar tissue built up and thats why i cannot move it.  he proceeded to bend my fingers forward without any kind of prep. to me knowing. it hurt like hell and i thought my finger was going to break again. i thought it was pretty shady of him to do this without at least x raying the hand first to see how things were holding up.  all he did was write me a persciption for loratab and percocets informing me that i was going to need them. when asking why he said because its going to hurt. i understand that. but he didnt even show me what to do to break up the scar tissue. he got up and left unceremoniously after 5 minutes of face time with me.
i went home not knowing what to do to break the scar tissue up and called their office back to get some more answers.  i then got referred to a OT who i will be seeing on tuesday and was told i may or may not get motion back. that its up to me.  the doctor had promised if i went through surgery i would get range of motion back. now this.... looking at my hand now, there are NO discernable knuckles on my fourth and fifth metacarpal. its just eerily flat and deformed looking.  my hand is hard around the scar. i have no feeling (numb) on the inside bottom  half of my pinky and the inside bottom half of my ring finger.  none in the dip between the knuckles.  has anyone had this experience before?  can anyone offer me any hope or advice?  im really terrified at the thought of not playing music or painting again.  i feel completely alone in this and have not been given ANY sort of indication of prognosis from my doctor. please help!

[Colnago_Rider]

Get to the OT as soon as possible. Take codeine before you get there.

The surgeon should have shot you up with lidocaine before bending it.

I think it's a good sign you can move PIP and DIP, but not your MCP. That means you only have scarring at MCP.

I am going for my second surgery this Friday.

Make sure your OT is a certified hand therapist. Dont go to just a regular PT.

Was your surgeon a hand surgeon or a regular ortho?

Why was their a lag from when you fractured the finger to when you had the surgery? I'm not a Doc, but the first few days are very important. The reason I'm in my position is my hand was splinted for too long. The screws are generally good as they allow for earlier range of motion.

Perhaps get second opinion from a hand surgeon. My pinky injury was not dominant hand, and as a graphic designer I can still get by without being able to bend or use it. You have a different scenario. Time is of the essence though.

[jupiterpolice]

just wanted to see how your surhery went?
i had my follow up with my specialist friday!, its been 7 weeks since my surgery and 6 weeks since they removed the 3 pins in my index finger,,i still have no movement at my dip( maybe 5 percent assisted ,still very painfull/sensitive and swollen!,i have about 25 % movement at the pip and almost full mobility at the mcp-although sometimes stiff and painfull
i sometimes get swollen inside the palm just below the index finger??? have you ever gotten that?? was told by doctor that this is due to the ligament getting stretched and iritated? doctor put me on predisone for 10 days in an attempt to get rid of the swelling! which comes and goes!! i have been sleeping with a drug store bought splint at nite due to sometimes banging or twisting the finger at nite in my sleep causing me to hit ceiling,,therapist says i should not be restricting the movement at all but shes not in bed with me holding it!! lol,,i do get up in the morning and stretch it out as best i can!  doctor stated to me that ligament could have stuck to the bone during the healing process and that there is a procedure to go in and loosen up the ligament so as to get mobility!! i believe this is what you got done??  i really do not want to do any other surgery,ill have to see what the next step is for my job!! as i said before ,iam an active mos and no movement out of my dip could restrict certain needed duties!!
never thought a broken finger could be so involved!! so its ack to therapy on monday for 4 weeks till i see the specialist again!  hopefully i will get a little more mobility in the weeks to come but didnt really like the look on the doctors face when he saw  the mobility i had along with the swelling! any insight would be appreciated! thanks and hope your surgery went well!!!

[Colnago_Rider]

Had surgery friday afternoon. was so excited in recovery, seeing my finger move at pip and dip for first time in 10 months... doc said to keep flexing it making fist, etc, so we dont get the scar tissue forming, etc. surgery was big, as pinky sliced tip to end, palm opened up about 3 inches, and wrist also opened up to pull tendon through.

extensive scarring on one of the flexor tendons rendered it non-operable for tenolysis, so it was removed. remaining tendon lysed.

all was looking good, but sadly it was short lived. got home, was still flexing it gently, when heard and felt a pop, and unfortunately i ruptured the flexor tendon., presumably beneath mcp. called surgeon, and he says:

its probably ruptured below mcp joint (1st knuckle from palm) since i cant move finger tip / pip at all. said it was pretty beat up due to second tenolysis, original scarring, etc, and he had removed one tendon, but that profundus tendon was intact although badly scarred, and that PT would have probably ruptured it monday, and that this was nothing i did wrong, it was just very weakened/frayed to begin with.

said three options:
1: do nothing, live it with, still have movement at mcp joint, but i'll never again move dip or pip
2: try and repair tendon with surgery next week, 25% chance might be able to reattach ruptured tendon although cant say wont rupture again since whole tendon is pretty badly scarred
3: flexor tendon reconstruction/graft with hunter rod, which means surgery next week, then two months from now a second surgery to do a tendon graft from my forearm, and then lot of occupational therapy. that would make a total of 4 surgeries.

wish i had better news for you from my surgery.

i would say to be careful about immobilizing hand at night. u always should want constant movement, even in your sleep at joint. during the day your should constantly be working it, assisted or unassisted. how much can you do assisted?

my biggest concern i'd have is that your flexor tendons have scarred down, thus resulting in your loss of rom at dip at pip. mcp stiffness is probably more a result of not using it enough. thus, its critical that tendon is always moving.

prcedure your doc is talking about is presumable a capsillectomy, which i had in first surgery... very painful... even after about 30 stitches on this surgery, its actually not as painful as my first finger-only surgery which had capsillectomies of pip and dip.

i just wish i had known that tendon rupture was possible outcome of tenolysis. not sure that would have changed things though, and if it didnt rupture it by now i surely would have ruptured it in PT.

so at your pip, you can bend from 180 degrees straight to what - 120? 90? can you reach your palm from you finger?

anyway, good luck. obviously, i'm not a doctor, and judging from my luck, i obviously don't know the subject matter as well as i had thought! just keep asking questions, and try and research as much as possible. your career is obviously dependent on fully functioning, make sure your medical team understands that....

[jupiterpolice]

at the pip i probably got about 10 percent unnassisted and maybe 25-35 assisted movement!
i do not even come close to reaching my palm!!
at the dip ,i got no movement unassisted and about 5 percent assisted,although it is still swollen and sensitive to touch so therapist kinda backs off ,i guess when the swelling goes down ill know for sure just how stiff it will stay
my question to you is ,in your experience,if my finger is stiff like this now,,are the chances of physical therapy helping get mobility back slim???
is it true the longer it stays immobolized after surgery the harder it will be to ever get mobility back??
i really dont plan on doing another surgery without any type of good guareentees that i will get better mobility< especially after hearing your stories!!
i can say im getting very used to not doing anything with that index finger utilizing my middle finger instead(that includes the typing im doing now!!
thanks again,

[Colnago_Rider]

getting to the palm was sorta a milestone for me, but it took about 20 pt appts before it happened. im surprised about the level of stiffness at dip.

i would say yes, the longer immobilized after surgery, the harder to get mobility back.

remember, this was my second surgery, and second tenolysis. thats a lot of trauma for a little tendon. apparently tendon rupture occur in 8-15% of the cases.

u have to decide if a surgery will make it worse, and based on what you say, not sure it will or could since you have such limited use now.

i think after 8 OT visits, it was clear that i would need another surgery. but my first surgery got my finger straight from bent and locked at 65 degrees to about 20 degrees. i had joint capsilectomies on both dip and pip.

just make sure your OT is taking periodic benchmarks do measure improvements...

im wondering if you have joint contractures on pip and dip based on your very limited ROM there...

u need to get swelling under control. are you wrapping the finger up with coban tape for the swelling? ask your ot for it.

sorry for not typing with caps, etc -- hand is throbbing. cant wait to get this bandaging off to look at the mess..

[jupiterpolice]

therapist was able to get finger to touch palm<<very painfull though,,alot of stretching,although afterwards (that nite) It seemed that it was stiff again,although able to move unassisted,(the pip) she did move the dip a little more ,but im still unable to really get any good movement myself!
i have 3 weeks of physical therapy before i see doctor again,so i guess ill see how she does with the stretching!! hope your feeling better

[Colnago_Rider]

ask her if she thinks maybe you have a joint contracture.... you will be really stiff after a hard OT visit, but i think its great you can get to palm. huge. make sure u keep swelling under control, and that you also during the day are continuing to work it. your 1 hr visits with her 3x a week is worthless if you dont do your own work after----

i went back to the surgeon today, with a written list of 30 questions. i'm convinced he's capable of doing the job, im just not convinced i want to go through with a two stage surgery which means surgery friday, then in 3 months a flexor tendon graft. He took off all my bandages. Looks like about 25 stitches. Wrist incision hurts more than finger dissection, and palm he only went down about 1.5 inches. When flexing MCP, wrist incision hurts like hell.

i dunno - i'm waffling. one minute i want to do it, next, i just want to give up. i race bicycles (not for a living of course) but I've been training my butt off, and this has me losing most of the season. after second surgery i have to be casted for 4 weeks also (open cast with extension protected, but flexion free). Which, as a graphic designer, ***** cause I can't type or use keyboard I guess for 4wks. It's my own company, so the boss won't fire me at least, although he thinks I'm an idiot already. As does my wife.

So with the surgery, of course no guarantees. Have lived with no use of pinky for 10 months, what's a lifetime I guess? He says great outcome is 90 at pip and 30 at dip, and poor is 0 dip and 45ish at dip. But seriously, 45 degrees at DIP is close to worthless. Hell, its already contracted 25 degrees, so thats getting me another 20?

Of course, I also rarely back down from a fight.

Dunno. But I can tell you this, I know pretty much all there is to know about tendon graft surgery using Hunter rods. So I got that going for me, which is nice. :)

Dan

[jupiterpolice]

therapy this morning got me about 45% assisted at the dip and 75% assisted at the pip,,unassisted i really have about 5% at the dip and maybe 25-45% at the pip.,therapist seems like she is getting frustrated, finger was still swollen,im actually thinking about changing therapist and going to a HAND SPECIALIST THERAPIST,was told that it could really make a difference!!
just wondering<<did you get alot of movement at therapy assisted  and not so much on your own???
or did you not get movement either way??
i get movement by the therapist but i really still cant move on my own??  will that get better or am i pretty much screwed?? lol
thanks  jay

[Colnago_Rider]

you need a CHP for sure.... i thought you were seeing one all along. makes big difference...

they will push you more than solo, and givr u proper home excercises....

get appt with one asap.... surprised your doc didnt insist on one....

[jupiterpolice]

i thought my therapist was a chp!!!  WTF did i know? i called therapist and asked her if she did hands!,,they said yes! i took that as she was a HAND THERAPIST!!  this **** is all ****** new to me!! just recently i asked her if she was and she said no! so i know my doctor will probably be pissed off but **** him,he should have made it clear to me that there was a difference!!  well i see him friday so ill finish the week with this PT,AND GET THE NEW PRESCRIPTION FOR A HAND THERAPIST~~ maybe this could explain why i still have swelling and no movement!! and its been almost 2 months since surgery!! like i said b4 i have been stetching on my own but it stiffs up immediatly after along with swelling!
doctor said he will do a cortizone shot directly into finger next time if swelling has not gone down!!,,anyhow you are definatly right about going specificly to a hand specialist !! thanks

[Colnago_Rider]

yeh, that *****. my first PT person said same thing - then later I found out she wasn't CHT - like you said - what do I know? You prolly don't need a scrip to see CHT though; they're classified the same basically as far as insurance is concerned I thought.

never heard of cortisone shot in the joints, which doesnt mean anything, but no one ever suggested that. do you have a flexion splint to wear? you should have that during the day - basically you put the tip of finger in it, and then it velcros to your wrist, and as you get more looser, you can then make it tighter. my pt person never did that, but my cht did.

tomorrow my stitches come up. finger is incredibly numb. i hope i made right decision not going through with the other 2 surgeries. guess time will tell---

research your area for chts - there are not a lot of them around...

ask your doc if you've built up scar tissue on flexor tendons and if you need second surgery for tenolysis. hopefully you don't - but two months out, yeh, i might have thought better movement.

generally protocol will be to keep with aggressive OT until you plateau. You can't go back in for 2nd surgery for usually 3-5 months after first.

i really think that velcro splinting should be used. i will try to look it up online so you can buy one.

[jupiterpolice]

whats up brother? just out of curiosity(and i know your not a doctor,but seem to be more experienced in this than me) if i had scar tissue buildup or tenolysis(whateve that is),would i be able to move the joint at all?? meaning the dip or pip?
the therapist today was able to move the dip today ! it seems like she is moving the pip more and more and today she got flexon in the dip!!!  i thought that if i had scar tisue or tenolysis, it would be sorta LOCKED and unable to move?? is that the way yours was? or did you have a little movement ?? i still cannot move the dip on my own and probably have about 45% unassisted in the pip!!  the therapist does get more out of the pip with stretchin and pain!!!!  she gets about 5-10 percent at the dip
i guess what i wanted your opinion on was if im getting this movement does it neccessarlly mean that i do or do not have tenolysis or scar tissue buildup??
hope you kinda know aht im asking ,,thanks

[Colnago_Rider]

Being able to move your joints DIP and PIP passively is great. You say 45% active ROM at PIP. Is that about 90 degrees for you?

Tenolysis is the surgical procedure to remove scar tissue off of the tendons, which glide through sheaths in your finger. As your forearm pulls the flexor tendon, it needs to glide freely through the sheaths. The end of the tendon is just above your DIP. If there are obstructions within the sheath, or the tendon has scarring, it usually then cannot pass through the sheath well, and you end up with limited or no movement at DIP or PIP.

Again, not being a doctor, but the fact that you have limited ROM at DIP suggest some scar tissue on your flexor tendon. Can physicaly therapy 'break' the scarring? Some post earlier suggest that may be possible. Before my last surgery, I was able to passively get 90+ degrees at PIP and probably 30 at DIP - but all passively. Actively, I was only able to get 5-10 degree at PIP and 15-20 at DIP. Its a bummer now, cause I have zero active, and my MCP is weak now, and my ring and index finger are also a bit messed. I had my stitches out on Tuesday and went back to therapy yesterday.

Since my wrist was cut open, I guess you get scarring there too, cause now when I flex ring and index finger, the scar on my wrist pulls up about half an inch with it. Looks lovely. :)

Anyway, doc says I can actually still do a graft down the road; he was trying to get in now to avoid having to wait now again for all this stuff to heal up. So I guess I can decide in a few months if I want it, but if I think I might, I have to get back to passively working the hell out of the DIP and PIP again, which now have severely stiffened up (not to mention hurt, and are completely numb).

Please ask your OT about that velcro flexion. Heres one thing, althogh its not as strong:
http://www.supportsusa.com/bort/finger/mobidig_flexion_finger_splint.htm. Can wear at night---

Actually, this is the one--
http://www.sammonspreston.com/app.aspx?cmd=get_product&id=97554

[jupiterpolice]

yo thanks bro! you actually cleared a few unanswered questions for me! it seems like im going through the same sh*t you went through! i have the same amount of movement in my finger as you!!
although i havent seen a HAND THERAPIST YET! ,i have to see my doctor to get another prescription,which ill do on wed of next week!
thanks for the info on the velcro splint! i will check with doctor/therapist next week!
for a guy who is not a doctor ,you sure use big words! lol,,,explain to me what you mean by moving the finger passively ??  you mean assisted and unassisted right??

once again,,thanks ! you should be billing me for this info lol

[Colnago_Rider]

As you're resident online finger advocate, I must insist that you see a CHT immediately! Yes passively means using your other finger or hand to move the broken one.

I can't believe in a month it will be a year since I crashed. My racing season starts in a few weeks. Although I raced last year, I was only in PT and didn't have my 1st surgery til late Sept. I'm actually pretty worried about breaking it again if I should wreck, although I guess I shouldn't be, cause it doesn't work. If I go to do a palm-plant, i think the pinky will hit first since I can't straighten it!

Oh well, I can't spent too much time focused on what-ifs, or I'll never be comfortable racing again.

[jupiterpolice]

30 percent today unassisted  at dip ,nothing at dip ,,passive 60 percent at pip maybe 5-10 at dip!!  will see my doctor next week and get new prescription for hand specialist

[HappyMeanie]

I broke my pinky 4 weeks ago.  The doctor thought it might heal w/o surgery, but she had to put in 3 pins Monday Aug. 2.  I never realized the complications that could arise from this.  Needless to say, I am quite worried about what will happen in 5 weeks when the pins come out.  I will see her for post op follow up on the 19th.  I'd greatly appreciate suggestions on what to ask at this visit.

Also, how are you guys doing now? Almost a year later...

[Colnago_Rider]

Check your inbox---

So during the last 4 weeks before surgery what did you do? Were you splinted? DId you have any physical therapy? What was your range of motion at mcp, dip and pip before surgery? Where was actual fracture point on pinky?

I never realized the complications, either, unfortunately until it was too late to realize how the original treating ortho had permanently ruined my finger, and two surgeries later to try and fix his mistake didn't work.

Your biggest issue is early range of motion. Unfortunately you are already 5 weeks into it. If you research pinky fractures on the ortho sites you'll note that usualy 5-7 days is standard protocal. My doc had my immobilized for 5 WEEKS! And when splint came off, it was locked at about 80 degrees.

Don't mean to alarm you unnecessarily, and I'm obviously not a doctor. Let me know the answers above and I can try and share with you advice.

[jupiterpolice]

hes not a doctor but does know his ****!!! and should start his own website for medicalo advice on hand injuries!!  all those questions he asked you are right on!!  you had 4-5 weeks without range of motion??  thats pretty bad! i had about 9 days of no movement with pins and had alot of trouble getting movement and also had to get a tenolysis done!!  fortunatly i had great results on my pip joint(thats the middle joint<cologn rider had to teach me the lingo),,but my dip joint(the tip) is fused straight due to a combination of no movement and the injury itself,,i agree with his advice ,movement early and often is critical, and MAKE SURE YOU SEE A HAND THERAPIST ,NOT ANY OLD PHYSICAL THERTAPIST!!! THEY ARE NOT THE SAME!!   JUST ASK YOUR THERAPIST IF THEY ARE"A CERTIFIED HAND THERAPIST AND ONLY DO HANDS!!!!!!

[jupiterpolice]

PS. If your doctor inserted three pins in your finger,THAT IS A SURGERY,YOU WILL HAVE SCAR TISSUE AND STIFFNESS,,AND ARE YOU SAYING THE PINS HAVE BEEN IN YOUR FINGER FOR 5 WEEKS????

[HappyMeanie]

The pins have been in for 9 days.  I broke it & have been immobilized for 4.5 weeks.  I will be immobilized for 5 more weeks before the pins come out.  The fracture is just above the MCP joint.  It was expected to heal w/o surgery, but after 2 weeks moved out of alignment.  3 pins went in to straighten & stabilize. I am finally off painkillers & see my surgeon on the 19th.

[jupiterpolice]

just think its a LONG time to have that finger immobolized!!, the pins that were inserted cause scar tissue which eventually will siffen the ligament/tendons! it will happen, trust me it happened to me and my finger was only immobolized for a few days!! you might want to get a second opinion before its too late!  cologno rider would probably agree with me, but dont take our word, get a second opinion!! i was VERY lucky and think i had a great surgeon which got me full movement back out of my pip joint,but my dip joint is shot(probably from the type of crushing injury it took!  alot of people dont always have great success with that tenolysis surgey, alot of risks,,ask cologno rider!! well good luck bro

[Colnago_Rider]

I'm confused. You say you broke bone above you mcp? You mean in your hand then - not your finger. Regardless, the flexor and extension tendons sit directly above that. Like Jupiter says - the pins MAY be keeping the tendon off the bone at that location - but you've got the rest of the finger also immobilized which will not help as far as tendon scarring goes.

Is doc a hand surgeon or reg ORTHO ? I'd seriously consider a second opinion. Don't wait. You are already very late for ROM -

I'm shocked that if bone was unstable they didn't use K-wire to stabilize it so you could have early ROM.

Do you have your Xrays as JPGs? Would like to see em.

[bradley892]

Thank you...You saved my pinky... I broke it three weeks ago same place as you at the PIP really close to the knuckle...  The doctor wanted to do surgery (as they always do..its their job)... I have always been a fast healer so I said fine give it a couple weeks and we will re-evaluate because the fracture looked stable.. He gave me a cheap splint and some pain pills and told me to keep it immobilized for 4-6 weeks... I left it completely immobilized for the first week and because i couldnt play xbox i finally took it off and was able to slightly bend it with a lot of pain. After two weeks I was looking online and found this forum. I now basically have full range of motion actively with pain and stiffness. I definitely already had the beginning of an adhesion in my flexor tendon. I massaged the areas between the metacarpal bones and that also seemed to help with ROM.. Bowstringing as i called it. Thanks again your info was very valuable and saved a finger!!!!

[Colnago_Rider]

Thats awesome news. Yeh, had you immobilized for 4-6 weeks you'd have been totally screwed, as I was.  You doctor and mine went to the same school apparently!

I am so glad my horror story helped another person out.

So I helped save two fingers - yours and Jupiters.

[rockyfire]

It seems like I have the same fracture as colnago rider did. I fractured my pinky finger at the PIP, right at the joint. I broke it on Aug 23, had it splinted the same day at an ER. I saw a Ortopedic hand specialist on Sept 2nd. The x ray shows a small piece of bone floating right at the knuckle. He told me that he typically likes to do surgery within 2 weeks of the break, if needed and of course it is my choice. What he said is that first of all, he would splint it, then schedule the surgery for Sept 6. He went on to explain that his first option is not to cut open, but to insert a wire or wires to attach the bone. He went on to say that if that as not possible due to soft tissue then as a last resort he would have to open the finger up and use a pin or screw, which a screw would probably be permanent. I am concerned about losing my mobility in my pinky. I am  a
firefighter and I cannot afford to lose that. After reading what you guys been through I would appreciate your guys opinion and experience in this matter .

Have any of you heard any results from just letting it heal naturally as opposed to surgery?

Thank you

[Colnago_Rider]

Sorry to hear about your fracture. Your timeline has me confused. September 6 has passed, but yes, is 2 weeks post fracture.

Wires are good, but in my opinion, wires should have been discussed on Aug 23, or a few days post fracture. The benefit of the k-wire for a non-stable finger fracture is that it allows for EARLY RANGE OF MOTION.

Here's your challenge as of today. You are already 2.5 weeks post-fracture. I'm assuming you've been splinted and immobilized for this period of time. You've got to get that joint moving as soon as possible. Why wasn't the bone fragment picked up on xray sooner? It was either there from the beginning or not.

PIP joint fractures are especially difficult. If the bone is not stable, at initial fracture time or within a few days, you would do open reduction, and secure bone via K-wire or perhaps screws. I consulted with the best hand surgeon probably in the world, who said he'd have had me moving the finger 3 days post surgery IF I HAD SEEN HIM FIRST.... Unfortunately, I saw him 6 weeks later -- too late for me. Now, you're in a different mode - trying to fix scarring.

AT this stage, you can still do that surgery - but it seems a little later than normal standard of care.

I imagine your ER doc really doesn't know much about the complications of finger fractures, thus the reason for not getting k-wire recommended at onset (not uncommon, although googling pinky fractures would tell you it should be common knowledge among orthos). When he did his closed reduction, did he re-xray the joint? Tell me about your splint. Is your DIP also immobilized?

As far as letting it heal naturally, ironically, had I not seen a doctor and had him splint me for as long as he did, I'd probably be able to use my finger today. Or even buddy-taping might have saved my finger.

In your case, the bone fragment throws a monkey wrench into the mix. What size is the fragment? Is it off the shaft of the bone or right off the joint?

The longer the joint doesnt move, the more scarring. Some people are more prone to scarring of flexor and extensions tendons than others. But in all my research, most sources state that range of motion (ROM) is needed with 5-15 days of fracture or tendon scarring likely. You're beyond 15 days already. Not sure if you've been fully immobilized during that time or not.

If you are still splinted, make sure your DIP is not as well. At least you can get movement at that joint and get the tendons gliding across your PIP.

Don't sound the panic button yet, but you've got to get a plan - like NOW. Each day that joint doesnt move, more and more scarring is likely to occur. You not only risk the flexor tendon scarring, but a joint contracture as well, which I had as did JupiterPolice.

I think the doc you consulted with was probably offering good advice, but the surgery time he wanted to do has come an gone. So I guess you're either not going to do the surgery, or are still thinking about it. I would say the longer you wait, the less viable an option that becomes, and less likely a good outcome. Jupiter had pins, and then second surgery, which did fix his PIP, but his DIP is completely fused. DIP fusing is bad enough, but if your PIP fuses, you're going to have a big problem with the job probably----

Check your email on this board, and email me direct or call as I know time is of essence-

[HappyMeanie]

My pins came out today... The good news, it didn't hurt.  The bad news...rock solid pinkie.

[jupiterpolice]

i was almost the same way, alot of it is scar tissue that needs to be worked out,, extensive hand therapy, heat, long painfull stretches then ice!  repeat quite a few times a day,your bone is not fused yet, that takes time! usually a few weeks depending on the break and immobility!! i had limited movement in my pip joint and a hair of movement at the dip!  i needed a second surgery 5 months after the initial break and placement of pins(3 pins)(i really disgree with the use of the pins! i feel the old school way of 2 ice cream sticks on the finger works better, no scar tissue damage) but im just a dumb civil servant!! ,the second surgery, called a tenolysis gave me 100 percent usage out of my pip joint , but due to how my break was( it was actually a crush) i was told the dip joint was unrepairable! so my dip is about 80 percent fused and will soon fuse completly straight! it does suck being my dominant hand index finger, im actually typing right now with my middle finger, the tip of my index is stll sensitive! only about 6 weeks from surgery,, hand still weaker than it should be, doctor says it will get stronger with time!  
if i learned anything with a broken finger , i learned to first call cologno rider!, lol, then get to a hand surgeon, and start therapy immediatly,, the longer you dont move your finger and get whats called tendon gliding, your screwed! i would much rather break my fema bone!-it might hurt more, but at least when the bone is healed, you know youll be fine!! anyhow,, good luck and keep the board going with your updates! they actually help people with similar questions!!

[Colnago_Rider]

Just re-read your earlier thread post. Wow, immobilized for 9 weeks. And you had MCP fracture, same as me. Can you tell us if the pinky was immobilized in full extension or if it was in flexion? Also - you say finger is frozen - at both dip and pip? Hows the mcp?

Every case is different, but here's what I might expect. A few months of painful hand therapy. You will know by week 3 or so if its working. I don't want to discourage you in any way - you need to give it all - and then some. Many times at PT I would literally have tears running down my face because it was so painful. I gave it 110% - and more. I did all my home excercises, too, as PT alone is not enough.

Due to prolonged splinting, I'd say you have a hard road ahead. If it proves fruitless, you'll need to wait at least 4-5 months before next surgery. In between that time, you'll need to work on passive ROM on DIP and PIP. What I might anticipate the surgery to be would be a capsillectomy of DIP and maybe PIP, and tenolysis. When you say the finger is 'frozen' it sounds more likely you have joint capsule issues, which no amount of PT will fix, unfortunately.

Your case is very similar to mine, except I actually had 'only' 5 weeks of splinting.

[Colnago_Rider]

Also - please be sure to see a certified hand therapist, not a physical therapist. I've mentioned that before somewhere on the thread, but its worth repeating. HUGE difference.

[HappyMeanie]

I am seeing a CHT she is supposedly the best in the area.  She made my custom splint 2 weeks after the pins were put in.  MCP was splinted flexed and PIP and DIP were splinted extended, but the pin placement caused a slight bend in the PIP.  She's using this new splint to push it into further extension.(looks like 4 more weeks at least in this splint to protect the bone from shattering.)  

The MCP has some flexion, extremely painful.  Tears do run down my face with my at home exercises. I can feel the tendons contracting and things wanting to move, but it's a pain tolerance thing. I know the road ahead will be painful,  but I am hoping for the best.   I start the hard core PT tomorrow, and I

[amit1426]

Hi,

I had a bike accident on friday the 13th Aug. :( I injured my right hand thumb, ring and pinky finger. In all the 3 fingers I injured my PIP. There was no wound in thumb, but a minor fracture in PIP.
There were severe wound in ring and pinky, torn tendons and scratched bones in PIP joint. But no fractures.
TREATMENT: I already have 2 surgeries done till now, but both surgeries were done in 3 consecutive days 16th & 18th of Aug.
1st: Inserting a Titanium pin in thumb PIP. Collagen dressing of the innumerable abrasions in the hand and fingers. Cleaning of ring & pinky PIP.
2nd: Skin grafting on PIP of ring & pinky.

Then my hand was put in a cast for 4 weeks, with regular dressing in every 5 days. The doctor changed the bandage on ring and pinky and again put the cast every 5 days.
Now my cast is removed. But my injuries in ring & pinky are not yet fully healed. So those two fingers are bandaged. Rest of the hand injuries are healed.
My thumb with the titanium pin in PIP: Unable to move, rock solid.
Doc says i have to make my fingers fully movable and soft, then they would go for the 3rd surgery of putting the K-Wire in my ring & pinky with the torn extensor tendons.
My woes: wound is not healing. Thumb not moving.
Is it OK if I go for PT with new skin on my wounds?? (coz i heard they use to dip fingers in hot water/wax etc.)
Again what should I do to make my hand soft and mobile quickly so that I can get over with the final surgery?

[amit1426]

Hi,

I had a bike accident on friday the 13th Aug. :( I injured my right hand thumb, ring and pinky finger. In all the 3 fingers I injured my PIP. There was no wound in thumb, but a minor fracture in PIP.
There were severe wound in ring and pinky, torn tendons and scratched bones in PIP joint. But no fractures.
TREATMENT: I already have 2 surgeries done till now, but both surgeries were done in 3 consecutive days 16th & 18th of Aug.
1st: Inserting a Titanium pin in thumb PIP. Collagen dressing of the innumerable abrasions in the hand and fingers. Cleaning of ring & pinky PIP.
2nd: Skin grafting on PIP of ring & pinky.

Then my hand was put in a cast for 4 weeks, with regular dressing in every 5 days. The doctor changed the bandage on ring and pinky and again put the cast every 5 days.
Now my cast is removed. But my injuries in ring & pinky are not yet fully healed. So those two fingers are bandaged. Rest of the hand injuries are healed.
My thumb with the titanium pin in PIP: Unable to move, rock solid.
Doc says i have to make my fingers fully movable and soft, then they would go for the 3rd surgery of putting the K-Wire in my ring & pinky with the torn extensor tendons.
My woes: wound is not healing. Thumb not moving.
Is it OK if I go for PT with new skin on my wounds?? (coz i heard they use to dip fingers in hot water/wax etc.)
Again what should I do to make my hand soft and mobile quickly so that I can get over with the final surgery?

[UVAgirl2009]

Hi,

I injured my left ring finger on September 8th playing flag football. I went to my primary care physician on September 11th thinking it was just a really bad jam and she ended up putting it in one of those metal-looking splints and ordering an an xray for the next week. I went to get the xray on September 16th (i know - I waited too long to get that done). At the xray center, they said my doctor would call me with the results. Since my doctor was closed on September 17th - 19th, I received a call on September 20th from her saying that I have a displaced fracture and need to see an orthopedist. I went to see the orthopedist the next day and he said I have a rotational deformity (my fingertip curves to the the left when I make a fist) and that I should see a hand specialist/surgeon, so they got me an appointment with one for the next day (exactly 2 weeks since I fractured it).

**Just to give a visual of what my finger looks like: it is still swollen, bruised at the top, and the last inch of my finger (the finger tip) is crooked maybe 10-15 degrees. Fingernail is fine, its just that bone right below the finger nail that is causing the fingertip to be crooked. I can easily bend at the knuckle because it wasn't injured and as for my fingertip, I can make a loose fist with fingertip touching my palm. I keep my finger in the same splint that my physician made and I don't have too much pain.**

So, the hand specialist gave me two options: to buddy strap it and let it heal on its own crooked and I would just have to live with that, or she could do surgery to put pins in it that would straighten it out. Maybe its just the way that surgeons are, but she was very quick about - she didn't really explain the the consequences of either option and expected me to make a decision off just her stating the two options. I don't even know the technical term of my fracture to research it. And, now I am struggling with what to do, mainly because I don't want to risk more damage with surgery (the incision would not be through my knuckle though, just above it to the fingernail). Any thoughts???

[ryyysha]

Hey guys,

i think you are doing a great job here even one year after your inital posts. THANK YOU! ^_^ I hope you guys are doing okay now.

Was a great help to read through this. It's really hard to find information on the internet on this subject cuz the available information is very limited or very technical most of the time.

HERE'S MY STORY (in the hope that you guys could give me some feedback and also this could contribute to the peace of mind of other's like us. hehe) LONG READ...sorry =(

I'm going through a similar procedure, but I guess I should be counting my blessings now. =s

Im 20 years old and I broke my left pinkie in a complete spiral fracture in the proximal phalange. (the bone at the base of the finger. 3rd bone if you count from top to down)

I had a bad fall on the morning of the 31st august. I initially thought it was just a bad sprain or something cuz it went numb and i could slightly move it. It just stayed at an angle averting the rest of my hand. i know, silly denial!

So I put some of those over the counter analgesic anti-inflammatory creams and tied my pinkie with my ring finger and went to sleep. The next morning ofcourse i woke up with unbearable pain. The area the base of my pinke/ring finger had gone completely blue.

By the time I made it to a doctor, it had been 9 hours after the fall. The x-ray showed my proximal phalange broken right in two just a few mm above my knuckle joint. I was referred to a specialist in another hospital. Luckily, he was a well reknowned micro hand surgeon in malaysia. (Dr. Ng Eng Seng)

The doctor told me I had 3 options.
1- pull the bone into position and put a cast for 6 weeks. (which according to him was not recommended cuz it will stiffen my finger for the rest of my days and also, the chances of having to do another surgery cuz the bones didnt heal properly are huge)
2- anasthesize, and pull the bone into position and insert metal wires without cutting open the hand. (which wasnt also recommended for the stiffness as i'd have to put a cast for 4-6 weeks minimum)
3- anasthesize, cut open, screw in metal plate. (which WAS recommended as this was the surest way of success and i only have to wear splint for 4 weeks and can move the rest of the hand immediately.

Now, i had quite a dilemma with choosing cuz im just a student in malaysia all by myself and my parents were oceans away worrying their heads out. But then the doctor finally told me the 3rd option was the only option for me cuz when he viewed my finger, it was clear that the bone couldn't be corrected without surgery.

I had my surgery on 3rd september cuz the metal plate has to be ordered and that takes a day. Until then, i was admitted in the hospital, given regular shots of painkillers, and just monitored for 2 days. They did not do ANYTHING to my hand (except put it in a sling) in the meantime and i found that this is to avoid any further fracture or complications. My hand was swelling up and i was very worried, but that seemed like the normal procedure.

The operation was approx. 45 minutes after which i woke up to see my hand rigidly bandaged. The xray showed that i had a T-shaped metal plate on the bone and 6 screws holding it in place. the surgery wound was almost 1 and half inches long and had 6 stiches.

They removed the bandage the next day and put on a less severe dressing. The physiotherapist fashioned a splint to match my hand(which immobilises the whole hand, but was adjustable) and discharged me. I had a course of antibiotics and painkillers for a week.

From the day i was discharged, i was told to do gentle knuckle exercises (just bend and straighten) and gently try to grip only as far as i could without applying pressure, twice daily.
I could bend all my other fingers normally but bending my ring finger caused pain to the pinkie as well.

A week later i had a follow up and and exactly 14 days after the surgery, the stiches were removed. I could touch water once more and the splint was adjusted to be able to mobilise my thumb, pointer and middle finger.

Also, I had to start serious physiotherapy. I have to bend at each joint 4 times a day. After i massage my joints for atleast 15 minutes, I can bend them my quite nicely. The only problem is my finger cannot be straightened now.it sticks out at the angle of my splint, even after i release my hand. When i try to straighten from the knuckle joint, the finger stays up at a curve. The 2nd joint is not under my control.

Should i be worried yet, or is this just normal and it will get better over time? I'm really hoping it does cuz I play the guitar and I recently even got a gig so, my pinkie is real important for me to fret. =(

Who would have thought a pinkie would make things so complicated, we really do take too much for granted huh?

I'll try to update on my progress. Thanks for sharing. =)

[Colnago_Rider]

Yikes. Busy week for pinky and finger fractures I see.

Lets start with AMIT.

Yes, your hand will go in hot wax - not sure if thats possible given the wounds are still fresh - but it is possible to do PT with open wounds and stitches, etc. Been there, done that. No fun. However, anything possible to get motion going earlier is in my view, more critical than wounds. Wounds are gonna heal, flexor tendons, well, not so much without surgery down the road. I'm not quite sure what the k-wire accomplishes at this stage though. Its normally used to stabilize a fracture, and your a month or so out right now. My concern is length of time from fracture to and physical therapy.I'm not surprised your thumb is solid. PIP injuries are always problematic, and the pinky and ring finger actually share some tendon structures, which make it even more troubling. As I stated in a few posts I would at least see if you can get DIP movement so that at least tendons are moving, and also consider passive movement on dip if you are unable to do active movement.

UVAGIRL:
You say its deformed... do you mean when looking at it with you hand down the pinky goes 15 degrees left or right, or up and down?  You say you can bend now at DIP. Honestly, if it were me- I would probably leave it. The surgery guarantees nothing. You will need PT after it. You assume you get same range of motion you currently have - (and of course, it could actually get worse), so it sounds more cosmetic than functional.

RYSHHA:
Its hard to say which of the three options was best to choose without seeing the xrays. Sounds like it must have been really bad fracture. Usually kwire is preferred method to immobilize a bad fracture, and allow early range of motion.

You didnt say how the hand was splinted after the surgery - was it splinted with your PIP joint at an angle - and is that the angle now that you can't get past (extension)... (I think you said that it was).

What happens when you manually try and bend it straight - will it go or is it locked?

As per above - your ring finger and pinky share some structures and can't operate fully independent of each other. INterestingly enough, my ring ringer is now damaged because of how long my pinky was splinted - and my ring finger wasn't even injured when I wrecked on my bike.

I would love to see your original and post surgery xrays.

Yes, pinkies are important. Mine injury is permanent due to the tendon rupture after my second surgery - so it stick outs sorta straight although its starting to bend down at pip and DIP. Yes, its annoying and gets in the way. I can't type well, I can't grip well (and as a cyclist who races seriously, its very much problematic).

But the less is -- yes, this all could have been avoided if I had a doctor that knew even the smallest amount of current information on proximal phalanx fractures, and also if I had been more educated about the serious complications possible with a pinky fracture. So while I do want to blame myself on occassion, in my defense, I'm thinking 'hey its just a pinky - what could go wrong' and plus I put my trust in a doctor who's supposed to know. Not my job to know about this - thats why you go to a doctor, theoretically.

So, we saved a few pinkies already - and the best defense for a dumb doctor is an educated patient. Lot of good info here - ask a lot of questions, and learn from some other horror stories. If I had seen this thread the day after I fractured my pinky - not six weeks later - I would bet anything I'd still have a working finger.

---Dan

[UVAgirl2009]

Thanks for replying!

When looking at my hand with the palm down, the fingertip on my ring finger curves to the right when the finger is straight. Then, when I make a fist with my fingernails pointing toward me, the fingertip curves 15 degrees to the left (toward the middle finger - rotational deformity). My main concern is that I could possibly regret the surgery if I suffer from stiffness, etc. afterwards like people have mentioned on here...especially since I have pretty good functionality now (2.5 weeks after the injury).

[amit1426]

Thanks for replying.

I will start by putting my thumb 1st in hot wax/water, since it has no wounds. And yes as you said active movement in the ring and pinky is not happening. I am concentrating more on passive movement now on the DIP. PIP movement is very painful.
Doc said after the surgery my fingers will move as normal. Lets hope so. As of now i am more worried about getting back my strength in the fingers.  

[Colnago_Rider]

Amit  - keep in mind - the stength in your fingers is not actually from your fingers at all. The flexor tendons pull from the bed of muscles under you forearm. It's not really muscle strength, it's tendon gliding that you want to focus on, both with as much passive and active excercises. It is fine to have DIP movement - and yes - that is still VERY important - but PIP is really the issue we have to be concerned with. You want your PIP as loose as possible before the next surgery to give it its best change of success.

Can you run down again what the surgeon says the full goals are and purpose of the next surgery is? Is tenolysis being performed? Capsillectomy? Your stiffness at PIP could be a result of a joint contracture from the splinting. So I'm just curious what he's going back in there to do---

[Colnago_Rider]

I think you've probably already drawn the right conclusion. I would want to know the primary risks of the surgery, and outside of cosmetics, what else are you hoping to accomplish?

[Colnago_Rider]

Regarding the type of research you should undertake and query your doctor when considered surgery - I thought it would useful to attach my list of questions for my surgeon after my tendon ruptured after my second pinky surgery. This is the level of detail you need to educate yourself on when consider surgery or not. My questions were specific to Hunter-Rod graft surgery (which I did NOT do).

Questions:
It is unlikley that we can reattach the tendon at rupture point, or if so, we have high risk of rupture again. Wont tendon also need to be shortened, therefor resulting in pinky being inherently bent to begin with?

From what little I know about hunter rod grafts, most seem to have been performed on tendon slices or ruptures from specific injuries, not from extensive tenolysis and capsillectomy surgeries. Does this make me less ideal of a candidate for this type of surgery? Are in my internal structures intact, especially a2 and a4 pulleys? I fully understand the theory of the tendon sheath scarring nice and smoothly on the rod, which will give the new tendon an optimal sheath to glide on, however I am concerned that there has been too much trauma to surrounding tissues that there will not be adequate blood supply to the peripheral structures to support this procedure.

What is post-surgical regimen? OT for passive flexion excercises, similar to what I had been doing prior to surgery?

Will the rod come through and stick out my fingertip in between surgeries? What are my post-surgical stage I physical limitations (no riding bike I assume?)

Where will graft come from, and are there many risks from taking graft from other location (is there a chance of losing motor function somewhere else?)

Is there risk to losing any function of remaining fingers?

If I do nothing, I will never have movement at DIP and PIP. Will my MCP lose any function?

If I do nothing, what happens to broken internal tendon flexor tendon? We just leave that as is? Is there possibility of pinky becoming deformed and 'curled up' again? Is there a high likelihood of arthritic complications down the road?

What is likelihood of the new grafted tendon also rupturing in post Stage II, and how far up into the palm/wrist will the new graft be reattached? How many months of rehab can I expect to need after the second stage graft?

Why does surgery need to be ASAP - is it because if we don't, the tendon sheath that no longer contains a tendon will close up, thereby not giving us a channel to ever lay a rod in the future? Is there any complications to worry about cutting finger open again now since its only been a week?

Although I do not know much about this surgical option, I did read up on Paneva-Holevich technique as being a possible option. What's your opinion on that?

You mentioned you do two a year of these procedures. Is this considered a lot given that it is a highly specialized surgery?  What has been your outcome or results of this procedure for your other patients, and have you dealt already with someone with a similar case history as myself?

Lastly, what do you imagine my best outcome to be? And worst outcome possibility.

[mytinger]

I have had a titanium plate inserted in my left middle finger after breaking it by hitting it with a hammer. After about 4 weeks in the plate has apparently somehow broken and the doctor is going remove the existing plate and insert another. Does anyone know of anything like this happening?

[jen21071]

I have been reading this thread and wanted to know if someone can give me some exercises for my pinky.  I had an avulsion fracture to the pip joint of left pinky in July 2009.  EXTREME swelling for weeks.  Ortho Dr. buddy taped to 4th finger for 3 weeks but was still so swollen it was impossible to move, went back to regular dr. who said to keep it taped another 3 weeks.  Neither thought I needed OT.  It was stiff as a board.  I tried working it on my own to the point of pain (not as hard as I should have been obviously) and had a friend who is a PT, do some passive bending with me.  Finally got approval for Hand OT around Oct.  Went there for about 6-8 weeks.  Got full range of motion around Feb (6-7 months).  However, still a year and a half later, that joint is swollen and sore if I press on it or hit it on something.  I really think it's the tendon because I can feel it pulling on the outside of the joint when I bend it when it's stiff in the morning or other times throughout the day if it has gotten stiff again.  It is still quite swollen but I don't care at all about how it looks.  I'm just wondering if that joint will always be sore or if there are some exercises I can do to lengthen that ligament (or tendon whichever it is) if it has shortened or if it's just because that joint is bigger.  It is most tender on the outside of the joint, not on top or underneath or next to the 4th finger.  Will that eventually lessen?  It's livable so I wouldn't even consider surgery but if I can do something to make it less sensitive, I will.  Any help appreciated.

[richard_london_UK]

I fell off my bike last October and broke my ring and little fingers, near where they join at the knuckle. Had my hands sliced open, titanium metal plates put in. Fingers remained swollen but I could use a mouse within days. Returned to work. I could make a basic fist, but they were useless at extension. It was as if the muscles needed to straighten them had disappeared. Did the physio exercises, occasionally but not regularly. They temporarily improved over time but after about 3 months they seized up almost overnight. No amount of stretching could bring them back.

So I had the operation to remove the plates and free the tendons a week ago. As expected, they are all swollen again. I started moving them the moment I came out of the op to try and lossen them up. But the results aren't great. I can make a closed fist (fingers are slightly bent though) but again extension is impossible. I have been off work doing hand exercises for almost a week now, the results are short lived. Sure enough, within 10 mins they are stiff again. And no improvement whatsoever with extension, which is my real concern. The tips of my fingers are limp. I can't even put my hand in my pocket my fingers are so bent!

I am already doing the blocking exercises, where you hold the fingers 90 degrees to the palm and then try to straighten out. When I first started doing them I heard a slight creaking, now no sound but I can feel the tendons moving ever so slightly. I think this is only working though for flexion, not extension?

Does anyone have any suggestions for improving extension?

Many thanks!

Richard

[setofvs]

Hi all.

After lurking for a bit and reading all the posts in this thread, realized it was full of very useful information that I hadn't encountered searching through the internet.

I had a serious accident on 12/5/10 where my middle finger was amputated between the 1st and 2nd joints (above the PIP) and my index finger was fractured (not sure what type of fracture, but it goes horizontally across my finger).

Doctors were unable to save the middle finger, but they sewed up my index finger the night of the 5th (it was pretty much split open). I had surgery the following day and had 2 pins inserted into my index finger. I had those pins in my index finger for 4 weeks (just had them removed on 1/10/11).

I haven't been able to move that index finger for 4 weeks since the pins were still in there, as any movement in that finger caused extreme pain...but now my index finger seems to be stuck in that same position (slightly curved, as if holding a cup). I started OT the Thursday after the pins were removed, but I couldn't do half the tendon gliding exercises as I could not make a fist. I did try to do some blocking exercises (holding a joint in place with the other hand and flexing and extending a particular joint).

But now after my 2nd OT visit yesterday, I'm slightly worried that my finger will never flex or extend fully. MCP is fine, PIP has less than 90% for sure and DIP seems okay. My finger is still extremely swollen at the PIP joint and at the area of the break due to superficial scar tissue and possibly scar tissue near the tendons.

Can anyone please advise their experiences and what the best road to take? I'm currently going to a hand therapist once a week and I'm debating on finding another therapist as well. Thank you all, looking forward to your replies.

-Larry

[poppy_m]

Hi,
I broke my right ring finger two weeks ago playing basketball. Not really up with the medical terms but it was a spiral fracture in the proximal phalanx. Had surgery a week ago today and the doc put three screws in there. Said it went really well. I went back to see him the following day to get the dressings removed and he got me to start hand therapy with a therapist in his consulting rooms then and there! I nearly past out from the pain but now can see it was the right thing to do as I have nearly no pain and am getting more and more movement everyday. I can almost make a fist unassisted however cannot straighten. Its still swollen and bruised though.
My advice would be to find a reputable hand surgeon/ plastic surgeon and trust them. And do the excercises! I do them 8 times a day. Its time consuming but hopefully worth it if my finger heals properly.  

[ijal]

hey guys been readin the posts since '09. very informative. here is my story:

on 1/27/11 i had a bike xcdent. from the xrays i could c dat there were 2 fractures in the distal phalanx. 1 was right beneath the fingernail n somewhere near my DIP. there was a bone fragment near the DIP n i was told that it was due to a nerve being damaged. my 2nd metacarpal was fractured n twisted.

on 2/01/11 had my surgery.doctor put a hook near the DIP n wires for the metacarpal. hand was heavily bandaged in a pointing position. 1 wk after that bandaged was removed n advised to start therapy since my finger was totaly straight. i could only bend the PIP to abt 20 deg. was given a splint wit the velcros to help pull my finger down.

1 week later MCP able to bend abt 40 deg, PIP 90 deg when MCP is nt bent n DIP abt 3 deg. i had to realy struggle to get the other fingers to touch the palm except for my thumb.

the problem is evrytime i try to bend MCP, PIP would b stiff. DIP will hurt like hell. i was told by therapist that all hand muscles are linked and so by bending the MCP n DIP to make a fist, it will help DIP a little. is this true?

are the pain i feel when bending DIP coming from the muscles or from the fractures?evrytime i try to move DIP it feels like my nail is gonna peel off. is it advisable to keep pushing because im worried that pushing would make the fracture deformed when healed.

m i making good progress? any tips would be appreciated.thank you

[Colnago_Rider]

And other -
sorry for not replying sooner to those who posted in Jan - I didnt get notifications.

Ijal -
Sounds like you have right protocol. The muscle that pulls the tendon for your finger is based in your forearm. It pulls a tendon that goes from there to your fingertip and thus gives you ability to curl you-

The pain you have is probably due to joint contracture issues as well as tendon scarring which you are trying to break free. Muscles don't hurt usually, generally its tendons and joints which do.

You started therapy one week after surgery. HOORAY. Finally a surgeon that didn't screw his patient.

It does sound like you are improving though. Keep flexing and stretching, doing table tops, tendon glides, etc. Your OT should have prescribed all the necessary items. Just always keep it moving.

Anyone else that posts and doesn't get a quick response, try sending me a PM through this board- I think I get notified to my email when that happens, but I may not get notified if another post is added to here--

[ijal]

thnx for reply.i think u may get notified if u 'watch' this thread n do some setting.  have been stretching n excercising. n i hv more questions.

evrynite before i slp i would b able to curl my hand to an angle i can bear wit. bt evrytime i wake up its like back to zero. i nd support to stretch. does it mean im not makin progress?do i hv to keep it stretched even when i slp so that it wont straighten out? would riding a bike b a good therapy since i nd to grab the throttle?

[debmon]

To Larry and others...
This is such a great forum!  I broke my pinky on 12/28/10, had surgery on 12/30.  (I'm not so up on the medical terms either, but it was a "complicated" spiral fracture, and I now have 2 screws in there)

So I'm now ~9 weeks post surgery, and have been seeing a hand therapist for 5 weeks now.  Went from cast to splint to finally nothing, and have been very diligent with the exercises at home.  It's a pain to remember to do them, but I'm forcing myself - not going to the point of pain really, but definitely to the point of discomfort, at least 6 times a day.  Just as of today's appointment, I can "officially" straighten the pinky all the way, and I've just got another 5 or 7 degrees to go on one of th joints.  YAY!

My lingering issue is the adhesion under the scar - still working on scar massage, shearing sorts of massage, but it's pretty "socked in".  Progress is there, but pretty slow.  As someone else said, it feels like the finger was injected with concrete.  Anyway, to those just starting out on this journey, keep up with the therapy; start as soon as your surgeon allows it, and be diligent with the exercises at home.  It takes time, but it will pay off if done consistently.

[ijal]

jz wana share diz...

aft 3 wks of therapy i was almost able to fully bend my finger. diz is the painful part of my journey after the surgery. i was told dat the scar tissue is "stuck" to the tendon. diz prevents me from accomplishing my mission. i now have to do scar massages. n massagi g the scar wen it is still red is a very painful xperience. i tink i read qbt it somewhere here. my therapist said this is the only thing dat needs to b cleard b4

[ijal]

b4 my finger can return to normal. its kind of demoralising to find out dat comes up 1 aft another. bt i thought dat i already went so far to gv up now. if any1 would b kind enuf to point to me any other less painful ways to break up this "unionr" i would really appreciate it. i would rather do more stretching excercises than massage...

[Colnago_Rider]

There is no easy remedy to breaking up scar tissue. If you are referring to scar tissue from the surgery, a scar pad taped to the incision points wrapped in coban tape will help, and manually using your other finger to massage the scars - and also using ultrasound from your OT.

But scar tissue on the flexor tendon is entirely different issue, and will not be solved by massage. Best way to attempt to break up up is to do you tendon glides, and blocks, as well as manually moving your dip and pip joints.

THrough this whole thread, I believe one person freed his adhesions. The rest of us had second (and third) surgeries to perform tenolysis. I had two tenolysis surgeries after my finger was locked due to prolonged splinting (5 weeks).

Regarding OT, yes its painful. I used to take codeine a half hour before mine. Just the nature of the therapy. You have a small window before adhesions form on the flexor tendon. If the doctor green lights you for OT, he should know if you can handle it.

HOWEVER - one warning. If you have had tenolysis surgery on your flexor tendon (this would usually be a second surgery, not done when you first fracture usually unless you waited several weeks) - you should excercise caution. Hours after my second tenolysis surgery, while flexing my finger as prescribed (and boy, it was a joy to move my finger for the first time in 16 months) my flexor tendon ruptured. Game over, pal. Either two more surgeries and being in a cast, and 9 months of rehab and OT, or do nothing. I opted to do nothing, and will never regain use of my pinky again.

As someone who has lost the full function of both my DIP and PIP joints on my pinky, all I can say is it *****. It gets in the way of so much.

So to those who are reading this, congrats on seeking advice. Hopefully you are not here 5 weeks post fracture wondering why you pinky doesn't move anymore. Cause if you are - you may already have a serious problem.

Bottom line, worth repeating. Early range of motion saves your finger. Prolonging splinting will ruin it.

[ScottishDave92]

Hi all, just been reading your posts and recoveries.

I 90% chopped off my left pinky in the middle phalanx end of january 2011.
nerves were "bruised" and dip tendon was 30% damaged but repaired during surgery, along with an artery, I can't feel anything below the dip joint under the line of my nail, ontop I have slight feeling.
I had 2 K-wires in through pip/dip joints for 6 weeks, they got removed last week.
I can move my dip around 25% and my pip around 5% unasisted and 25% assisted but can't tell if it's just contracting with my dip when I hold it still in the middle.
my pip joint feels like the tendan just isn't doing anything, finger overall is v.stiff and swollen, i've been manually moving it since pins came out, having slightly more movement since day 1. I'm worried I won't get any more movement, it feels hard round the middle phalanx and larger than it should be which i'm assuming is bone or scar tissue. After reading some posts here I'm wondering if my dip joint tendon is now adhered to the bone and this is why I can't move it well and why it feels 'loose' and if i'll have to either get surgery to fix OR work hard and try and free it off?
at rest it is slightly bent, I'm told I lost a piece of bone from the pip extensor mechanism? and it may always want to curve round, in which case i'll need another opp to correct this, but I sleep with a spolint to straighten it every night as instructed.

Should I expect anymore movement in months/years to come?

David.

[setofvs]

Hey all,

It's now been about 2 months since i've gotten my pins removed from my index finger. To recap, this was a break between the MCP and PIP and the finger was reduced and pinned for 4 weeks. After 4 weeks, I started rehab, first once a week and then eventually once every 2 weeks.

At first, i was unable to fully straighten or bend my index finger more than 10 degrees. After much painful manual stretching and massage, I was able to move it about 20 degrees after a week. 8 weeks later, I have almost full ROM of my index finger. The middle finger which was amputated just below the DIP has full range as well.

My advice as many have said is to keep working on the finger. I've heard that the fluids that need to drain from the smaller digits take close to half a year to completely flush. OT can only help you so far, 90% of the work needs to be done by you. Although my finger is still incredibly stiff in the mornings and when I don't move/stretch them, I've made vast improvements since the pins were out. Don't give up!

-Larry

[crayonsyringe]

I just had surgery to fix my PIP joint fracture. I remember it being called an avulsion fracture and small bone fragments of my bone on the joint have been broken off. Apparently my finger got dislocated AND fractured and I have been told from everyone I consulted with (hand surgeon, physio, doctor) that the fracture was very serious. I had the sports accident (never knew a soft ball can do so much damage) on the 28th of February and had surgery on the 9th of March, Post-op I started exercising my DIP after around a week (prolonged due to infection of the skin from surgery), it's pretty good so far but I have just removed my k-wire today and started exercising my PIP joint, it is very painful and seems to only be able to move a tiny tiny fraction. I have 3 screws and a pin on my fracture so it hinders movement but my physio has urged me to try my best with my finger exercises. I have to exercise my DIP + PIP joint 10 times every hour for each exercise and I also have to clench my hand together 10 times too, pretty painful but tryign to do my best!!

I hope all goes well for everyone!

[wonkypinky]

Hi All,
Many thanks for everone who has posted in this forum it has made some really interesting reading.  I, like colnago rider have broken my proximal phlanx in my pinky quite badly, with a fracture through both the whole bone and joint.  
After the accident it was badly displaced but was luckily able to be manipulated back in line in two stages over the 4 days after the incident without surgery.  It is now two weeks on and I have a splint holding it in a kind of loose fist shape with the PIP and MCJ (I think thats what they are called!) both held at about 70 degrees, and strapped to a buddy finger.  The positioning of the break is still not ideal and there is still a gap at the joint but I have been advised that surgery would cause more problems then it solves, although is still an option if the bones move apart any more in the next week or two.
Having read so much about keeping the finger moving to prevent problems down the line I'm a bit concerned, as the consultant is suggesting at least another 4 weeks in the splint with no movement for either finger, making that 6 weeks in all with no movement.  Has anyone had any issues of permanent lack of movement and stiffness when they haven't had surgery?  Would surgery be reccommended by anyone given the fracture of the joint and their past experiences? Would it be advisable to try and keep the end bit (technical term) moving and try and get the joint moving or would this risk moving the fracture?  The consultant doesn't think so but then again isn't a hand specialist and this forum has terrified me so any second opinion from those who have done this would be much appreciated!

[Colnago_Rider]

Remember, I'm not a doctor, but I have researched the heck out of this injury, as well as I've experienced it first hand. That being said, here's my advice.

OK, here's the deal. Tomorrow, insist on seeing a hand therapist. DO NOT DELAY. You are two weeks post-fracture with NO RANGE OF MOTION. CLOCK IS TICKING. You are already in serious danger of losing permanent use of the pinky.

Your treating ortho thought he did you a favor by doing a closed reduction on your pinky instead of surgery. He more than likely DID NOT. Why? Because now, due to the nature of the fracture - you can't safely move your pinky at all - and because of this - he wants you to remain splinted for 4-5 weeks. This guys must have gone to the same school as my dopey doctor. What he should have done, instead is surgery and used K-Wire to hold the bones together so that within 3 DAYS you could start range of motion exercise.

Those are probably his first mistakes. Next is - now he splints you - and also splints the entire pinky. DO yourself a favor and make sure your DIP joint is NOT SPLINTED, and move it constantly once you free it. Hold your finger between PIP and DIP and flex your DIP. This keep tendon sheath gliding across the fracture point.

Orthopedic guys don't have a clue about finger fractures, as evidenced by both yours, mine and countless others here who have been given the same exact bad advice. They are not hand surgeons. Three subsequent hand surgeons told me same thing they would have done: Surgery immediately, hold bone together with k-wire, and start physical therapy 3 days later. My dopey ortho kept me immobilized for 5 weeks. 2 surgeries, 40 occupational therapy visits to try and undue his damage. Last surgery resulted in flexor tendon rupture. Game over.

No one usually thinks much about a pinky fracture. Try going through your life without the use of yours, or never be able to make a fist and bend again.

Please, please go see a hand surgeon before its too late. Email me your x-rays if you have them. Your fracture is just like mine. Not sure if joint you reference is MCP or PIP but mine was MCP. Regardless, that tendon right now is slowly being fused to your bone as it tries to repair itself. If it aint moving, the body thinks it's part of what needs to be fused. And then its surgery to try remove all this scarring.

[Colnago_Rider]

I MEANT TO SAY "Tomorrow, insist on seeing a hand SURGEON' . You will need a hand therapist later-

[Jun2]

Broke my right pinky's proximal phalanx playing basketball. I had surgery 1 week later and the doctor had it in a cast for six weeks till he removed the pins inserted during sugery. My pip joint is stiff and cant make a fist. I was wondering if anyone could recommend exercises I could do

[richard_london_UK]

update on progress

it's been 3 months since the removal of my plates, and i've been going to physio twice a week. i've got almost full flexion movement back, as i can make a fist. still feels a bit stiff from time to time though.

only problem is that extension (straightening out fingers) hasn't improved greatly, as the tendons are stuck to the scar tissue.

any ideas/advice/encouragement? how long before i can get complete extension? trying to straighten my fingers is about as useless as trying to move my ear - doesn't feel possible!

[Colnago_Rider]

Thanks for the update.

As for ideas to help with straightening, you might ask if they have a DynaSplint to wear at night which basically is a splint to force the finger straight. Every day you turn some screws on it and it extends it more.

And do as much passive extension with other hand. Keep at it. Because of the original damage to my pinky from the splinting, my ring finger also became damaged and could not extend. It's taken about 2 years to ger straight.

TO THE OTHERS WHO POST HERE.
Please provide updates to your cases. If we're going to be able to help others we need to know your how you have made out. Too many people posting what they're issue, we post advice, and then never hear back. Just let the others hear know what's happened afterward.

[setofvs]

Hi all,

Another update on my progress. It's been...wow 14 weeks since I've had my pins out, and almost 19 weeks since my accident (amputation of middle finger at the middle phalanx and complete fracture of the index finger at the proximal phalanx).

Index finger has significantly reduced in swelling, though it is still stiff at times. Range of motion has almost 100% returned, though making a fist still feels strange (this maybe due to the shortening of the middle finger).

I've been experiencing this 'creaking' in the DIP joint of my index finger, I'm not 100% sure what this is and I intend to ask my Dr. on our last follow-up next Monday. Will keep you guys posted.

Good luck to all still recovering, its a long journey for such a small digit but you really start to appreciate how things progress.

Cheers,
-Larry

[vballcraz]

On April 4th i broke my left pinky finger(avulsion fracture at top joint), playing volleyball. Went to hand care center ER in Louisville, KY(thank goodness we have this speciality), and was told i really should have surgery to pin it, but since i was going on vacation the next day, they agreed to splint it and i would follow up the next week to see if it was healing properly.
I went back to see hand care specialist(kleinert Kutz), on April 11th.  He recommended pins, so we scheduled it for the 13th.  it's been just over a week since surgery. they just have my finger in a splint, top 2 joints are immobile.  (funny thing is the bone between the 2nd and 1st joint hurt more than where fracture is)
I go back next week to check pin sites to make sure everything is healing right, then 4 more weeks after that in the splint.
I broke the same finger same place, same type of break, same way 15 years ago playing volleyball and they just splinted it and it healed fine after quite a few months(but know that i used my finger quite a bit because i refused to keep my splint on at 18 years old-maybe a good thing from all these comments i am reading)
First time i broke it was just military dr....this time i have hand surgeon suggesting surgery(surprise), and i guess it was a good thing, as they said when i did have surgery that they had to twist the bone back in to place before pinning.
Guess just worried now that i won't have range of motion they were saying, and maybe i would have been better off just leaving it in splint.  They said that i had 30% chance of proper healing with just splint, and surgery would be much better and quicker healing.
He did say i would need some therapy afterwards, but kinda wish i found this board before undergoing surgery...
guess i should be happy my entire hand is not in cast right now at least, and to just make sure i at least excercise what i can for the next weeks to come.
Thanks for all the good info...not sure of all the medical terms or what pip and dip is, but hopefully i have some success when this thing is taken off
btw..this thing is annoying and itchy...now that the pain is gone for the most part....grrr

[vballcraz]

Just an update:  had 2 week check up, took off splint, could move the 2nd joint a little unassisted, really good assisted, which was a good feeling...but obviously with pins still in can't move top joint...very hopeful...back in splint for 4 more weeks and then get pins removed!  yeah!  can't wait!

[ncbuckeye]

I have two avulsion fractures from a softball to my pinky.  They are at the first and second knuckle.  This happened 8 days ago went to the er then to a hand specialist.  The first visit which was the next day they couldn't tell what if anything would need to be done because of the swelling, so they told me to come back in a week.  I almost have full motion of it but it isn't straight right now and I'm not wearing a splint.  The doc said we can let it heal by itself and if problems exist they would have to fuse the bones together, or they can put screws and plates in it.  He said there is a good chance I will never have full movement in it.  I opted for the surgery this Friday which will be about 12 days since it happened, he was ado ate that we get it done this week.  Now after reading all of this I'm wondering if I should go through with it.  This facility is a hand specialist with hand pt in the same location.  Any opinions what I should do?  Wires were never an option.

[ncbuckeye]

I have two avulsion fractures from a softball to my pinky.  They are at the first and second knuckle.  This happened 8 days ago went to the er then to a hand specialist.  The first visit which was the next day they couldn't tell what if anything would need to be done because of the swelling, so they told me to come back in a week.  I almost have full motion of it but it isn't straight right now and I'm not wearing a splint.  The doc said we can let it heal by itself and if problems exist they would have to fuse the bones together, or they can put screws and plates in it.  He said there is a good chance I will never have full movement in it.  I opted for the surgery this Friday which will be about 12 days since it happened, he was ado ate that we get it done this week.  Now after reading all of this I'm wondering if I should go through with it.  This facility is a hand specialist with hand pt in the same location.  Any opinions what I should do?  Wires were never an option.

[Newdawnguitar]

I wanted to post my experiences to give you guys so hope.

I broke the DIP joint of my right hand ring finger. At first, I thought it was just a jam. Turned purple and swelled up like a little grape. After a week, the swelling started to go down and it felt stiff. I forced myself to keep bending it until day 10 when I had full range of motion again (but still stiff).

I also went to the hand doc on day 10 for an xray. Turns out it the joint was pretty broken (more than 30% of surface was fractured). He was pretty upset I waited so long, as the longer you delay treatment, the worse the results are. He scheduled me for surgery the next morning.

I had two pins placed in that finger, immobilizing that joint for 6.5 weeks exactly. When he took out the pins, I couldn't bend it at all for the whole day.

The next day I forced myself to bend it much as possible, to the point where I thought I actually may be injuring myself. After that I stopped forcing it, and just tried making fists all day for a few weeks.

I am now at 5 weeks after getting the pins removed and I have great range of motion. Can nearly make a full fist (ring finger is maybe 1.5 cm shy of being in line with other fingers when making a closed fist), and everyday stiffness is totally gone. I never went to PT.

I am very pleased with how my results have turned out, and wanted to share my story to give you guys some hope and maybe figure out why I was successful in getting my finger mobility back. Some other facts about me:

- 25 year old male
- pretty active (broke finger playing flag football)
- Vegetarian
- lift weights 2x week and treadmill 2x week (maybe that got blood pumping to my fingers and helped repair them? For first for weeks after surgery, I did absolutely no work out though).

Good luck!

[sillydog87]

I broke my left wrist and right pinky while learning to ride a motorcycle (Revenge of the Cones!)  I had a plate in the left wrist.  Right pinky area has a fracture and dislocation.  Surgery fixed both.  But they put two pins in the right hand.  From day one, it was painful.  Even with casts on, I felt like the pins were being pulled constantly.  My work doesn't offer sick pay so I had to go to work.  Once the casts were off, I was able to get some relief but within a week, I spent the night in extreme pain.  The pin area was bleeding and most likely infected.  The next day, I was at the doc, took 4 tries to get the pins out.  The doc had to put the pliers in the wound and attempt to pull.  I was glad they were out but I was screaming through it.
Now my right hand has a pinky that doesn't work right.  I am attempting to move it but I am running out of money for docs and therapy.  

[richard_london_UK]

hi there
quick update on my situation:

1 oct 10 - broke ring and little finger on right hand in cycling accident, had metal plates put in
14 jan 11 - had plates removed in order to try and get more movement in fingers

i can make a fist now quite well, but am unable to extend my fingers out. they are permanently bent. saw the hand specialist again and he is suggesting another operation to have gel inserts placed between the tendons and bone, in order to prevent the tendons from sticking down.

third operation? i don't know if i can go through this all again!

anyone have any ideas/suggestions? my hand basically looks normal except for when i straighten my fingers out. bit of a nuisance as i cannot put my hand in my front pocket.

cheers

[paulwilko10]

Hi all

July 7th 2011, broke my Proximal Phalanx on my pinky in a bike incident

Anyway, I have a appointment with the surgeon in a week as "mr break goes into the joint and i am young" apparently (im 40 !!)
Its the joint that joins finger to hand if u know what i mean

I am in a splint with pinky and ring finger in a proper splint not just a temp type one !!

I am very concerned from what i have read on here and i would not be surprissed if surgery is needed

Any advice u can give me and thought on my injury

Many thx

Paul

[richard_london_UK]

i also broke the joint between my finger and hand in a cycling accident
i needed titanium plates (you can the see the xray on my icon, above)
the finger was fractured on the joint between hand and finger, which is the worst type of fracture.

i needed surgery to put plates in, then more surgery to have them removed later - as the plates were blocking my finger movement.

if you have an op, you'll probably be out of work for a week and not able to type for a couple of weeks. doing the exercises is important, the first time i had the op i didn't do them and the tendons stuck.

if you use a mouse at work i suggest the microsoft natural wireless laser mouse 6000 as you can just about hold it with a splint on.

good luck

[richard_london_UK]

a couple of photos uploaded in my profile - bit gorey but this is what to expect...

[paulwilko10]

Not sure whether to thank you or not lol

Looking at your pics i cant see where the break is

How long after initial x-ray did you see the surgeon ?

I have a weeks wait

[Greenie8352]

I've read this thread with interest as I too am having stiffness, swelling  and limited range of motion after breaking my pinky. After reading this thread I’m glad I didn’t have surgery. But I’m still having problems.

On March 28, 2011, while on a trip, I broke my right pinky near the knuckle during a hard fall on concrete. The knuckles of my right hand took the brunt of the fall. I went to urgent care immediately, where they X-rayed the hand, splinted pinky and ring finger together and put the hand in a brace. They advised me to see an orthopedic surgeon but said the only one available was so overbooked they doubted I could get in to see him. And they were right - my calls to his office were never responded to.

I elevated and iced the hand as much as possible. It was horribly swollen and black and blue. After the first few hours, there was no pain unless I moved or touched the hand, which made me see stars.

After 2-3 days, I removed  the splint as I felt it was not good to immobilize the hand that much and the pinky seemed stable.

I was traveling far from home at the time. It took until my return April 28 to be able to see an orthopedic surgeon. X-rays showed the break was healing well. The pinky is crooked but should be functional enough, no surgery is recommended. But my hand remained extremely swollen and stiff. I could use the thumb and forefinger, but the others were useless.

MD focussed on reducing the swelling. He had me elevate the hand and soak it in hot water with Epsom salts twice a day. He prescribed a non-steriodal anti-inflammatory (Meloxicam) and had me wear a compression glove. The epsom salts reduce the swelling temporarily, but the meds and gloves did nothing. The meds wrecked my digestion and I stopped them after 2 weeks.

He started me on OT June 6. I've been going twice a week and doing the glides and other exercises and passive ROM several times a day; and doing hot epsom salt soaks alternating with cold 2-3 times a day.

I'm seeing almost no progress in ROM. My right hand is still quite swollen. My thumb is fine (always was); my index finger is about 80% functional, but the middle, ring and pinky fingers feel like they're in concrete if I try to move them past their current range, which is half-way to a fist. They cannot straighten fully (maybe 90%)

I can almost bring each finger to the curled fist position passively, after soaking, massage, patiently working each finger. But they can't get there on their own. The tendons inside the palm are tight and knotted, and feel like steel bands. It hurts like hell to try to make a fist.

I saw an orthopedic hand specialist this week for a second opinion. The MD said the swelling would go down by itself in time - a long time. He wasn't concerned about that. Nor does he think there is soft tissue damage. He thinks the stiffness is from inactivity and will improve through aggressive OT. He does not think I’ll recover to the point of making a fist again. (His OT does. She said she’s seen many hands like mine make full recoveries.)

The OT gave me a few other things to do. They told me to ditch the compression glove, which they said was just reducing movement, the most important thing for me right now.

Over time, I've seen progress in some things I can do with the hand. It's not excruciating any more if I bump it; the fingers are able to curl a bit around the steering wheel; I am able to cut some soft vegetables; within its limited range of motion it’s getting stronger.

But in terms of the measurable ROM and stiffness, there’s almost no progress. I feel as if I'm trapped in the 'Groundhog Day' movie. Each morning when I wake up, the hand is completely stiff, with only the slightest ROM in the last 3 fingers. I spend the day soaking and exercising and torturing it in the recommended ways and am rewarded with being able to touch the thumb to the tips of the other fingers. But the next morning, the hand is stiff as a board again, no change, as if the previous day hadn't happened. I climb that same hill each day, again and again and again.

It’s all very upsetting.

Has anyone here had a similar injury and made a full recovery? How?

[richard_london_UK]

Hi there

It's hard to say whether my injury is similar but I have had similar experiences with fingers being stiff each morning. It does get better once the scar tissue stops building up and the swelling goes down. I had physio for about 4 months after the op, after then there was no benefit as the fingers had stopped being stiff each morning.

The only bad thing is now, after 6 months, I am coming to terms with the possibility that my fingers will never be the same again. I just uploaded some more photos of my hand onto my profile - as you can see after 6 months they won't straighten out fully but at least I can make a fist. I have started wearing the splint again to get it to straighten but it has no effect.

The surgeon has said I can have another operation (3rd one now!) to put gel inserts in to stop the fingers sticking, but I am not sure whether it is worth it. The main thing is being able to grip things.

[richard_london_UK]

sorry just read your last post and noticed you didn't have surgery - i am not sure what is causing the stiffness. in my case it was the scar tissue and inflammation...

[Gary7591]

I broke my right (dominant) pinky on July 8 at the bottom joint. It has a V shaped fracture up to the knuckle and the left side of the V appears to be sticking out a bit, but not thru the skin. Doc says it is rotated too as it sticks out to the side. Im getting really worried about my upcoming surgery on Friday, July 15. He said he could put possibly put pins in it and immobilize it without opening it up, but if that wasn't possible, he would have to open it up and put pins or screws in and a plate.  I'm not clear on what would determine the decision? Right now it is sticking out to the right side at about a 25 degree angle.  What can I do to help matters before surgery, and is one option better than the other?  What is the longest time I should have the finger immobile?  And should I be moving it around now?  I draw, paint, play the harmonica and write & I'm worried this surgery could mess up my future in these activities.  Any advice is greatly appreciated! Oh, doc is a hand specialist and he has already said I will have OT with a hand therapist.  Didn't care for his "bedside" manner but he did seem to know a lot about the issue.
Thanks! Gary

[Greenie8352]

Thanks for your reply.

I'd be thrilled to be able to make a fist and have a fully functioning hand once again.

I do my best to avoid meds and surgery, and allopathic medicine in general. With various natural approaches, the cure for the disease strengthens the whole system and improves overall health. Western medicine cures the disease but almost always harms the patient. Still, it's necessary sometimes, and broken bones is for sure one of those times.

My mom had two shoulder surgeries for bursitis by the best of the best surgeons in NYC at the time and I remember the misery she went through as one of the surgeries was botched. And I have my own horror story  -- completely unnecessary exploratory surgery and appendectomy for what was a stomach virus. During the following week in the hospital I met 8 other women who had been operated on by the same doctor, all exploratory abdominal surgeries, for no good reason. This was by the head of surgery, well-respected guy.

I know it's sometimes necessary and there are many good, skilled doctors, but there's usually a price to pay..

I guess what I'm trying to say, Richard, is that your hand looks pretty darned good to me. If you're not in any pain and you can do what you want with it, I would think hard before more cutting. Just my 2¢, and I realize I'm very biased due to my past experiences.

[paulwilko10]

Went to the surgeon today, 1 week after accident and he told me that surgery is not needed thank goodness !!

He said it was doubtful it would improve the situation plus the fragment was very small and there is a chance it would splinter even more with surgery

So luckily its just a splint for me for a few weeks

Gd luck to all not so lucky

I took my splint off for the x ray today and it hurt to stretch the fingers out so i can only imagin what pain i will have during physio :(

Cheers

Paul

[Colnago_Rider]

Please do not keep your finger splinted for more than a few weeks. 7-10 days max, then make sure you are moving it like crazy. Do not splint you DIP joint at all during this splinting spocess, makes sure you are moving DIP LIKE CRAZY while splinted. If your DIP is also splinted, find a new doctor.

Trust me - on this, or read up online on the medical journals post-fracture stiffness of the finger due to prolonged splinting.

[Colnago_Rider]

Gary-

Why didnt they try to fix the finger right after the fracture? Why is surgery 7 days post fracture? Did they try to do an open reduction to rotate the finger back in place? Thats what they did to me - but it was hours after the fracture - not a week later. Is finger immobilized now? Is it fully immobilized now?

Here's what I would be concerned with. If you have the surgery, when is the earliest range of motion available to you? Subsequent to my moronic doctor ruining my finger I learned that range of motion should be instituted within 3-5 days of surgery. And using K-Wire would be preferable because its less obtrusive. Right now as far as what you should be doing - I need to know which joint you fractured. You said 'bottom joint' - you mean closest to the nail - or closest to knuckle/palm.

[pinky2000]

Hi Colnago_Rider
My wife also suffered a similar injury (right pinky fracture) to her right pinky at the bottom of the knuckle joint on July 5th evening and I rushed her to ER the same night within a couple of hours and they took x-ray and tried to pull the pinky finger to adjust the bone after numbing her pinky finger. They splinted it after wards all the way upto DIP on that pinky along with buddy (ring) finger. But good thing is ring finger is not splinted upto DIP , so a little room to wiggle that.

After that we went to see Hand Surgeon on July 8th Friday, and she took an x-ray again and told my wife that bone was not yet in it's place and was a little away from it's original position and she called it as a tranverse fracture at MCP, I believe and said that only way to get it fixed is to do a outpatient surgery , poke with drill machine to put put pins in a X shape diagonally across the bone , so that it will not move later and then she will cast it  for until July 29th,.

So tomorrow is her O/P surgery.

Any suggestions, please let me know. I am glad to see this thread online, other wise it would be total grey area to me on this subject.

[Colnago_Rider]

Her fracture is same location a mine. You are ten days out from actual fracture, with finger fully immobilized for nearly ten days. Why these docs do not have a greater sense of urgency is beyond me. Why they also splinted DIP is also beyond me. I swear these guys either all went to the same med school or haven't read the same journals I have. But what do I know after all - I went to a doctor too, and if I had used popsicle sticks or buddy taped my finger instead, I would have a working pinky today. Or if I had read this thread before I realized something was seriously wrong.

Ok sorry, rant over. Two years later, a few surgeries, and 40+ occupational therapy visits, and I'm still slightly aggravated with my doctors incompetence. And as a graphic designer and cyclist, it ***** that I'll never bend my pinky again.

Anyway, if you she is casted please ask about leaving DIP exposed so you can bend at that joint and at least get movement at that joint so tendon glide can occur over the fracture point at MCP. I think it would be better to not be casted and have some opportunities to passively bend. I would ask why no K-Wire for the surgery. One of the most renowned hand surgeons on the east coast told me if I had seen him first, he would have done surgery within a day, used K-wire to stabilize the fracture, and would have had me moving the finger again with 3-5 DAYS. Not weeks - DAYS. My moronic doctor splinted my entire pinky immobilized for 6 WEEKS.

I would love to see the fracture/x ray.

Be careful of ring finger issues. Its two years later and mine is still messed up even though no injury to it from my fall - instead the prolonged splinting ruined it.

Listen, just ask a bunch of questions, study all the info presented here on this thread, and just know what's to be expected. The more you know the better. People don't understand that pinkies are so important - its like 40 percent of grip strength.

Two years later and I'm still thinking about doing the two more surgeries they said MIGHT fix it with a new tendon graft. So it's two surgeries, plus 30+ OT visit and countless rehab - it must really be a pain to lose use of your pinky.

[paulwilko10]

Everyday, after my shower I have been told to take splint off, hold the injured area in place and flex my pinky and ring finger 10 or so times to keep it flexible

Until yesterday, I wasnt doing that so it is stiff, but hopefully not left it too late

I cant believe only having my splint on for 10 days will be beough for the bone to heal, i reckon more like 3 weeks + I should see a good improvement

At the end of the day, I/you have to go by the doctors advice and hope he is a goodun

Cheers

Paul

[Colnago_Rider]

If you are under the illusion that doctors are infallible, I've got non-working pinky as proof to the contrary.

It is good you are moving it after showering. Having splint on 10 days is not enough for bone to fuse, but it's plenty to allow passive range of motion on unaffected joints.

Like you said, hold injured area securely and flex. I would spend more like 15 minutes flexing rather than flexing ten times.

[paulwilko10]

Thx matey

TBH I do little and often, so will see how it goes

[Gary7591]

I don't know why they didn't do anything right after the fracture, the hand doc asked that too, but he did nothing 4 days later?  Probably an incompetent ER doc? The joint is the one closest to the wrist.  The plan is to do closed reduction tomorrow, or open reduction if it doesn't seem feasible.  Im wondering why nothing else has been suggested so far, prior to surgery?  Thanks for your help, as I'm clueless as to what they are doing and why! I've learned more on this site than from any doc!

[Colnago_Rider]

Closed reduction is preferable. They will take xrays after manipulating (and it moves back into place, thats good), but like you said you're a week or so out from fracture, so its possble the bones have started to fuse. I'm sure it will be easy to rebreak if it has started to fuse. Then maybe they can move into place.

Question to ask is what will allow you earliest range of motion- surgery or closed reduction. Be mindful of how splint is configured after surgery or reduction. Mine was splinted bent. After 6 weeks in splint - guess what  - surprise - my pinky stayed bent.

Your fracture location was identical to mine.

Ask to have you DIP left exposed so you can exercise that.

Good luck pal.

[pinky2000]

Hi Colnago_Rider,
Thanks for your reply earlier last night, we just got back from the hospital.

Just a quick modification on what I had mentioned in my first post, instead of the MCP, my wife actually got her Right Hand Pinky fracture at Proximal Phalanx), so I assume it;s PIP.

What they did today:
--------------------------------
Today my wife had the surgery done (per Doc's chart, it is " Closed Reduction Percutaneous Pinning Right Small-Finger at Proximal Phalanx) and it also mentioned Mini carm and K-wire have been used in the process via Live -xray

Before the surgery, I asked the Hand doc to see if they could leave the DIP of right pinky from the splint that will be put after the surgery, and she told me that they do NOT want any movement at fracture for atleast 2weeks, as there is a risk that pin might break due to use of that finger.

After the surgery, which is done in 40 mins, the doc came back to me and said that it went just fine and gave me 2 pics (handouts like x-rays) and on the discharge sheet, she gave Narco (presc.med)  for pain relief and asked us to come back after 7-10 days. Now the splint is fully covered including  DIP of fractured finger as well as buddy(ring) finger. I really want my wife to give it good rest for 3-5 days, and will have her stretch her last 2 fingers that are splinted as much as she can, to give atleast some sort of movement until we see er back on 23rd of July.

So we plan to schedule an appt with Hand doc on July 23rd, when she is going to remove the splint and examine the finger to see the healing process. Per today discussion, she said then she might put a cast on July 23rd for the next 4 wks, after which the pins will be removed and she would suggest Occ-Therapy visits. I also made sure to ask her about my wife earliest ROM and she said after 6weeks. I did not want to argue further and thanked her and got back home just an hour ago, after 2 hrs in recovery.

Basically from what I have seen in this thread and other's experiences, here is what I pan to do:

1) Have my wife start to moving her splinted fingers as much as she can in the next 3-5 days.

2) Once we go for July 23rd appt for post-op, I will insist that Hand doc put a smaller splint (if possible a removable splint at times during day, to allow some motion) for the next 4 wks INSTEAD of a cast .

3) Continue to ask my wife to repeat the moving exercises with those fingers to ensure no formation of scar tissue or stiffening on tendons/finger.

Please feel free to chip in any advise.

Thanks
Pinky2000

[Colnago_Rider]

The k-wire is good. Its OK I guess if doc wanted DIP immobilized for first few days. But be very careful beyond that. You're already a week out post fracture. But you were asking for movement of your proximal phalanx, you're asking for movement of dip WHILE proximal phalanx is immobilized. Was this surgeon a hand surgeon or regular orthopedic?

But 6 weeks as earliest range of motion? Really? Hey, I'm no doctor, so just read up and make your own informed choice. Can't believe she would cast you after this in a week. Seems bizarre to me. My doctor gave the same line of garbage about early ROM - not wanting anyone to rebreak it in therapy, etc. I finally gave up and went on my own to PT - but it was already too late and the DIP, and PIP joints had all had contractures at that point. The surgery to remove the joint contractures was excruciating. No way I would keep finger immobilized that long.

As far as where her fracture is - you are confused. Proximal Phalanx is just another name for the bone between MCP and PIP. My fracture was also at proximal phalanx, just close to the MCP joint/knuckle. Where is hers?

Upload your fracture images/xrays. The problem with proximal phalanx fractures - is the nerve work and tendon sheaths are so intertwined to the bone, that when the bone starts healing and the tendon doesnt move for weeks, the body thinks its also something that needs to be 'healed' and scar tissue accumulates. Thus the reason to begin early ROM as soon as possible - so tendon glides against fracture point and body does not lock it in.

The tendon sheaths are in a few places on the finger. Almost like a string in a straw, which is cut in a few places. The exposed string can adhere to the bone beause its not moving. Then it no longer can slide back through the straw because there's scar tissue on it.

Not sure if the analogy helps but here's an image. http://www.wheelessonline.com/image2/phl3.jpg  See all those criss crossing structures? Those are the tendon sheaths. INside that is your tendon itself. In my case - all scarring on tendon meant it could not pull through the sheath.

Tenolysis is medical term for removing the scar tissue from the tendon. In my case, they removed too much, and my ruptured (broke) somewhere. There for, I can never bend my finger again.

Hope I'm not scaring you too much -just trying to educate you. I think we've saved a few fingers here. As part of my mental therapy dealing with my own pinky loss, I need to save a few more in order for some good to come out of my doctors incompetence.

[Gary7591]

Thanks, man, for all the advice.  Wish I had found this site before we went to doc! I wrote down your suggestions, hope the doc is cooperative.  So far our exp. has not been real positive with docs on many levels, and impairments.  I'm really sorry about your situation, maybe something will develop in the future to reverse your finger's lack of motion.  Will keep checking in post op.  Good luck to everyone, never knew a pinky could be such a big deal!

[richard_london_UK]

had my 3rd operation on this hand last wednesday.

basically i was getting tired of not being able to stretch out my fingers.
the surgeon scraped out all the scar tissue around my tendon and bone and has inserted a sheet of Mitek 'Divide' mesh, which prevents the adhesion of scar tissue to tendons. i must admit that i have a lot more movement now, but am a bit disheartened that i still cannot straighten my fingers fully. however it is early days. for those that are interested check out this link

http://www.springerlink.com/content/q1408802h7k34281/

i am told that by doing 'blocking' exercises (holding the joints near the knuckle) and stretching that i may be able to loosen the tendons on the sides of the fingers...

[Colnago_Rider]

Rich - just take it easy on flexion after the tenolysis surgery. My doc gave me no warning as to the possibility of a tendon rupture and hours after my surgery, mine gave way while I was flexing. Game over.

There is roughly a 10% chance of tendon rupture after tenolysis - so just take it easy mate---

Blocking exercises are good - yes.

[Dontwanttoreveal]

Hi, I am 15 and I broke my pinky around the middle bone in the joint and I have a surgery tomorrow. The doctor said he will put Pins to attack the bones and I will have a cast on for 4 weeks, then I will have to do exercises after as he said it will be stiff. Is this correct?

[Dontwanttoreveal]

Hi, I am 15 and I broke my pinky around the middle bone in the joint and I have a surgery tomorrow. The doctor said he will put Pins to attack the bones and I will have a cast on for 4 weeks, then I will have to do exercises after as he said it will be stiff. Is this correct?

[Dontwanttoreveal]

attach*

[realman202]

I had a PIP fracture on my middle finger and ended up with 2 pins. It's been two months since they removed the cast and the pins. Although I've got full range of motion now, my middle finger is still sore every morning, as well as the two adjacent fingers. Besides, the inflammation has not completely subsided. During the day my hand is close to normal, however. I can even lift heavy objects.
How long does it take for the morning stiffness to go away, If you had similar experience, would you mind sharing?
Stas.

[paulwilko10]

I am now into my 7th week in a splint

U may remember i have a break in the joint of the proximal phalanx

After 3 weeks there was not much healing, only a very slight clouding which suggests healing had started but nowhere near enough to remove splint.
I was told a further 3 weeks.
Anyway appointment came through but earliest was 4 weeks !!

So now i am into my 7th week overall and boy do i hope its the last week in this splint as it is doing my head in

In fact rightly or wrongly i take it off and do my PIP excerscises that i was told to do !
I am also getting a bit more brave in some slihgt movement overall, maybe i shouldnt be doing it but if the thing aint healed now, surely surgery would be the only option anyway !!

[bbgurl202]

In 2004 I broke by PIP joint during a basketball game.  I had surgery about a week later and had a pin put in.  I then started physical therapy a few days later.  From day one I was not able to bend the PIP joint at all.  I thought this was due to the fact that I just had surgery.  7 years later I am not able to bend the PIP joint at all.  It is basically in a straight line with no movement.  My DIP joint won't staighten.  It is constantly at an angle which causes lots of problems during sports.

I recently decided to have my finger relooked since it has been many years.  I'm kind of hoping to have another surgery and, in my opinion, it can't get any worse than it is.  Am I wasting my time having it relooked at?  Is a second surgery worth it?

[chint2]

hi,
i broke my right hand pinky on 29 august while attempting a rebound shot it was an metacarpel fracture with bone broken from both inside and outside my family doctor splinted it with next two finger  when i consulted another he puted cast my whole hand now today i had my cast removed but x ray shows my bone is at same position at which it was before cast i can also feel that my bone has not obtained its exact location and my finger is showing only 10 % movement .
can anybody help my doctor has not suggested any therapist.

[Colnago_Rider]

how long was it casted? where on pinky was fracture (mcp, pip, dip?). is your ring finger now experiencing issues?

how long was is splinted by family doctor? how can bone be in same position before the cast (usually the point of cast is so it doesnt move). Did they xray the finger AFTER the cast was set?

Not to scare you, but you probably have a very long road ahead. IN my experience, usually nothing good comes out of prolonged casting.

[chint2]

cast  was for 21 days.my rest of the hand is perfect ring finger is fully functional splint was on for 48 hours as i was not comfortable with it i think it was due to swelling no x ray was done after cast was set. fracture was at pip lower with only inner and outside corner were broken doctor also suggested surgery in place of cast but i opted for cast . today i am able to move my finger completely but it is not bending completely.i am able to bend is only half way through  i am felling some improvement but very little after 24 hours of removing cast .fracture is just below pip and broken bone is metacarpel

[chint2]

i am also having swelling at pip region can any body tell me will the swelling decrease ?and how?

[renny25]

I had screws put in my ring finger 3 months ago for a spiral fracture and have done well post operatively and can almost fully bend the finger at the same degree as the others.  However, now I am experiencing swelling and pain at the surgery site.  Has anyone experienced a set back 3 or months later like this? I am wondering if  I need to go back to the doctor to check on it.

[markw12]

I have broken 6 fingers in the last ten years (i race motorcycles) and the only finger that remains stiff is the one i left in a cast.Most recent was pinky finger through pip joint which was placed in a cast 2 weeks ago. i removed the cast myself today ,i hadnt taken any painkillers on purpose ,and started light movement .personaly i move the finger assisted untill i feel pain then stop . This has worked for me on five fingers but i cant stress that they are my fingers i chose to move them and its worked for me.Please its your choice and you have to way up all the options but in my opinion the longer your in a cast the less chance you have of regaining full movement. hope this helps

[brendon154]

I've read this whole board from top to bottom and from what I can gather, I'm totally screwed. I crashed downhill mtn biking and had a crush fracture of the finger at the middle finger knuckle as well as a diagonal break of the metacarpal below the ring finger.I was sent in for surgery to remove bone fragments around the knuckle and have 2 pins inserted running down the length of the metacarpal to secure the break. Surgery was on August 7th 2011, ended up w/ not only a splint but also an external fixator (OMG, what a horrible contraption) to ensure the finger healed at proper length. Four weeks post surgery, pins came out. Six weeks post surgery, ex-fix was unscrewed. there was no mention of OT until pins removed. It's been 1 week free of all metal, and my hand is locked in a cup shape (as if you were going to drink a cup of water out of your hand). I've been working on the pip and dip joints since the pins were pulled 3 weeks ago. I've very little independent movement but I have been able to loosen up the joints through assisted movement from my good hand. I hope to have full range of movement back by next spring. I'll try and keep posted to let everyone know how it goes. I've been extremely aggressive w/ my PT at home and push it to the limit. I try and get to PT as frequently as possible but have a hard time getting appointments due to overbooking. I'll keep posting to let you know how it goes and hopefully provide a time line to use as a baseline for recovery.  

[nobblytanner]

Physio is absolutely crucial (I am 15 months since my PIP joint displacement and fracture).
My key learning was that taking pain relief was vital to getting as far as possible with your exercie (I tried to be macho about it at first, which was stupid because my physio showed me how much better I did with codeine tablets).
My joint remains swollen, and I'm told that it could take 2 yrs to improve, maybe never. PIP and DIP are both important even if you haven't broken one of them, becasue they are all affected due to how the tendons mesh together. Always work on fullest range of movement you can across MCP, PIP and DIP.

Very best of luck to you

Rick

[nobblytanner]

one other thing to add.
The assisted movement is a really useful guide I found.
When I was having physio last year, I was at 45 deg unassisted and 76 deg assisted. I have gradually worked my way to 72 unassisted now.
It gives you a realistic benchmark for what you may be able to achieve in time.

[Colnago_Rider]

Make sure it is an OT or CHT - not a PT. Big difference.

[brendon154]

I should have been more specific, I am in OT w/ a certified hand therapist. The recommendation to use pain killers is a good one. I'll try that before i go in for appointments w/ my therapist. I have regained allot of the movement in the pip and dip joints of my fingers that were frozen due to the splinting, pins and ex-fix. The knuckles that were pinned, as well as the knuckle that had surgery & ex-fix on it for so long are useless. I've found that if you can't more your knuckles what good are your pip and dip joints. So, I'll keep at it and hopefully be able to grip and hold on to things again someday. thanks for the advice and encouragement.

[Colnago_Rider]

As an addendum to my pinky, etc. It's now nearly a year since my failed surgery in which my flexor tendon ruptured. This has left me unable to move my pinky from DIP and PIP. I've found it to be annoying enough to consider going for hunter-rod graft surgery, but there are only like 2 surgeons in NJ who perform it, one of them being my original surgeon, and frankly, I'm not really up for that. So I'm trying to find another surgeon who even thinks it would work, as hunter rod is generally performed when tendons are sliced, not as much from a patient with an extensive history of problems with the joints, contractures, etc. So I'm not even sure I am good candidate. But it another 2 rounds of surgery for me if I go for it.

Few important lessons learned for those reading:

[singlemom333]

I was trying to help my sister-in-law up after a fall and she grab my finger for support and bent it backwards. The next morning my hand was swallen and blue. Went to ER and they recommended that I should go to ORTHO, that my 5th metacarpal was broken. Went through surgery have a metal plate with 7 screws and alot of pain. I started therapy 3 times a week and at home 4 times aday. After reading this page I feel like I  have no chance of full recovery. I am a single mother of 3 and work full time. My surgery was on the 19th of October and my therapist keeps telling me that I am doing great and I am where I should be at. Even though I cant straight my pinky or ring finger. PLEASE tell me WHAT SHOULD I EXPECT IN MY ROAD OF RECOVERY?

[LouiseDoh]

Hi – looking for some help with physio exercises/tips to get my little finger moving post surgery.

Background is I broke my left pinky finger 11/09/11, had my op and 2 k-wires inserted on 22/09/11. My arm and hand was put into a cast no had no movements. The pins and cast were removed on 14/10/11 and it has been buddy taped to the next finger until this morning when they checked it again, confirmed the bond had healed but now because of the build up of scar tissue I need physio to help get back the movement.

I’m now waiting for my first physio appointment but wondered if anyone had any good exercises I could be doing in the mean time. The movement in my finger is extremely limited. I can move my finger at the joint closest to my nail using my other hand about 50% movement but nothing if I try to move it unassisted, the next joint up where the k-wires were inserted does not move assisted or unassisted. The third joint up has about 60% movement unassisted and feels like it is getting better, the other two don’t unfortunately.

All tips and advice welcome!

Many thanks 

[xtremlee1]

My son had surgery to fix a boxers break in his index and middle finger. After surgery he has 70 percent movement as opposed to 90 percent. dr said we could do another surgery - rebreak and plate both bones but there is a chance bone dies due to lack of blood flow 10 percent chance. Most people on here wished they did not have a second surgery. Im thinking if it was me 70 percent is good enough. Any advice please post

[Colnago_Rider]

The question is as to whether 70% could be improved with aggressive OT. I would not opt for another surgery until I had exhausted all reasonable OT options. If the reason why I can't improve to 90% is because of the bone misalignment, that's another issue.

As someone with 0%, I can tell you 70% would be a dream. You have to be certain of the abilities of the surgeon. You are treading in dangerous territory - btu have to weigh all the options and long term implications.

[Colnago_Rider]

Singlemom - can you update us on your progress? Sorry I missed the notification of your posting.

[luckyhealing]

broke left pinky on 10/17 between first/second joints in multiple fracture sites.  by the time it was seen by a specialist and splinted/casted properly was 10/31.  i pleaded for a half-cast, got it, but kept it on for a full week without changing (by dr. orders).  after that i changed the dressing every nite for a week.  about 11/21-23 i saw this message board and read many helpful comments (did further research on other med sites).  that nite i began trying to move the finger -- it was like injected with cement and totally non-mobile.  however there was no cracking in the break area so i attributed to ligaments/tendons.  i kept at it thru pain/cracking /etc and at the risk of further injury.  within 2 days i no longer even wore the half-cast and i kept up the rom exercise until seeing the dr again on 12/5.  i had regained so much rom that the dr had to call his senior dr in the room to verify the amazing outcome.  x-rays confirmed that i was well into the remodeling phase and healing rapidly.  they said i didn't even need pt or ot.

summary:  i had broken a finger, been reduced to zero rom, then returned to almost "like new" all within the span of 6 weeks.
moral of the story:  prolonged splinting will ruin your finger, early rom will save it.
also i took calcium/vitamins/minerals (not sure how much that had to do with it).
thank you everyone who wrote in -- the information i gathered here and elsewhere likely saved my finger from longer-term damage.

[cnev]

Broke my pinky on Oct 8th, 2011 but didn't know it and had surgery two weeks later. They put 4 pins in. Never was in a cast just a splint and my doctor warned me about losing my range of motion if I didn't really work hard at it in therapy. It's been 6 weeks since surgery and I'm doing the therapy thing and I had about 80% of my motion back when my therapist decided to measure my grip strength the week before last. When I did it with my hand that has the broken finger she was suprised how strong it was. Well the next week I go back to therapy and I was going to see the doctor right after but for some reason she wanted to measure my grip strength again. So she tells me to pull as hard as I can which I do but feel something. I go see the doctore maybe 10 mins later and now one of the screws has come loose and it looks like the whole break is open again.
I'm seriously pissed right now. The doctor is trying to make me believe it couldn't have been that but I am 100 % sure it was...now what another surgery to lose more motion and have to pay for that and another round of therapy.

[brendon154]

well it's been about 3 months of OT  (2x a week) and just had consult today w/ surgeon for tendon release surgery. unfortunately I got shot down by the doc. he want 6 more weeks of progress on passive range of motion b4 he'll  give the green light. I got passive range back to about 70%. I can wrap my hand around a pair of handle bars again well enough to ride almost as aggressively as I did b4 the injury. I'm told that recovery time from the tendon release surgery should only be about 2 weeks because it's just tissue trauma, no bone healing required. I'm pretty psyched about it. hopefully this will all be behind me and I'll be good to go by next season. if one thing I've learned from this it's if your 're gonna crash… don't land on your hand.

[emmyd21]

Last Friday, I fractured my right pinky finger during a basetball game. I went to my regular doctor to get x-rays. x-rays confirmed I have a displaced fracture to my middle phalanax in my pinky along with torn ligaments and a bone fragment that chipped off of my pinky joint. I was sent to an orthopedic surgeon who put me in a cast for 2 weeks. my pinky and ring finfer are in the cast along with the rest of my hand about half way up my arm. my middle, index, and thumb are free from the cast. The position my last 2 fingers are in are bent in the cast. He put me straight into  this cast. No surgery or anything before the cast was put on. He believes the bending of the fingers in the cast will allow the ligaments to pull the bone fragment back where it is supposed to go. Does this seem possible? Does anyone think I will need surgery? Will the cast make my pinky too stiff that I will need surgery?

[Colnago_Rider]

Be careful about physio after tendon release surgery. Read my earlier posts. My tendon ruptured after mine (well, actually my second tenolysis) - so don't push too hard. If your tendon ruptures, you're really screwed, as I was - you then need two more suregeries to try and fix, which I never did. Therefore I have lost full movement of my pinky at dip and pip.

[Colnago_Rider]

please read up as my experience with being splinted with pinky in a bent position. Two weeks splinted may be OK but try to move dip as much as possible while casted. Do not stay casted more than two weeks.

[wiley303]

I like some others wish I found this board sooner!  I fractured my right pinky, ring, and middle fingers on 11/19.  Visited with the Hand surgeon on 11/21 and had surgery on 11/25 then visited with OT/CHT on 12/6 for first time and got a new splint.

Fractures were the following:
Middle - directly above MIP (two pins inserted to stabilize break)
Ring - between PIP and MIP (plate inserted to stabilize bone & two removable pins)
Pinky - between PIP and MIP several small breaks (two pins inserted)

On 12/21 I had the pins removed and then couldn't schedule a OT appt until 1/5. I wish I hadn't waited and I wish I would have insisted on going sooner.  My OT even said she submitted a therapy request to the doc with a plan for me but he turned her down because the breaks weren't fully healed.

Now I've been to two OT appts with the third today.  I will try to remain positive but right now,  7 weeks out, I have no movement in the PIP/DIP joints unassisted and some movement assisted. They are extremely stiff although we've heard some popping and tearing of the adhesions - she's gotten very excited when she's heard that.

My question is what can I do at home to help try and release the adhesions as much as possible?  It's my dominant hand that I've injured so some of what she does with both hands is very difficult with my weaker hand...

[Colnago_Rider]

Just make sure you are doing the prescribed therapy. You are 7 weeks post surgery and in a very tenuous position right now because your surgeon delayed your OT. I wish these morons would better understand that a well healed bone with no movement and tendon scarring is worthless without a good chance of regaining ROM. You didnt say how you were bandaged - or worse - casted during the post surgery. Were you DIP exposed? Could you bend those joints (and its MCP, not MIP joint)

My best advice - take codeine before your OT visit, and work the fingers until you are ready to black out. If you're not crying, you're not working it enough. You're window of having any chance to break your adhesions is closing, if it hasn't closed already. Having all those fingers broken is rough. One is bad enough. Constant movement on your joints is needed, passively and proactively. Soak in hot water at home and do it as much as possible. Your OT should give you a list of exercises, tendon glides, etc.

Time is of essence. I can't believe they delayed you as long as they did to get you OT.  I swear, just once I want to hear of a hand surgeon who truly understands what they are doing....

Two years later, and I'm still carrying a grudge - sorry. When you lose your finger due to an incompetent doctor, its a hard pill to swallow.

Do not lose hope though. Read through this post - theres a few that things worked out OK for.

[elmo99]

I broke my metatarsal below my pinky and there was apparently a second, unremarkable fracture. On 12/16 i had four pins placed and was put in a hard cast for three weeks and then put into  removable splint.  It has been three weeks since the pins have come out. I have been in PT three days a week beginning a week prior to pin removal but really saw little progress till pins came out. My pinky was stiff as a carrot and ring finger was pretty stiff as well and I had a good deal of swelling. Last week my doctor gave ok tht fracture was sufficiently healed for PT to really get aggressive. I had no idea of what aggressive felt like... yes, tears of pain.  I have seen some progress but not great - more progress on bending and less so on straightening and strength is nill.  I was given a tension splint to be worn 6 times a day -- talk about pain. I am pushing as hard as I can but I am still not at a point where i can grip a steering wheel and safely drive.  I see the doctor on 2/16 for a re-evaluation and he mentioned a second surgery... which i really do not want to have.  It is a long and painful road - I too broke an ankle and wrist - but breaking this pinky is far worse.  How do I know if I am doing enough .. I want to give this my all because surgery appears to only create more problems. And yes, no one can imagine how painful post surgery is on a hand.... it is weeks later and I still have shooting pains during the nite presumbly from muscle and tendon tightness nd swelling is still there. Any advice you can offer would be appreciated. Thnk you.

[Colnago_Rider]

Wish I had good news for you Elmo. I doubt the tension splint will do much. Take codeine before your OT visits - and hopefully you are going to certified hand therapist not a physical therapist. Theres a big difference.

You'll likely need joint contracture surgery coupled with tenolysis for your flexor tendons, and extensors. Your ring finger is also injured due to the splinting. Was your finger splinted at an angle?

Right now you are 6-7 weeks post surgery. Finger's been immobilized for that time which just compounds the problem. Presumably your PIP was also immobilized.

You're up against the clock, or past it. Do as much passive(assisted) ROM as your can. Read every word of advice here on the this thread. Dozens in same position as you. Bend the fingers with your therapist until you pass out. Only chance to break the scarring on the tendons. But even that, very few people free their tendons on their own. I think in this whole thread there's only one.

You can't do surgery for another 3-4 months until all the swelling goes down. Until then they'll have you get as much assisted ROM as possible. Be careful after the surgery that your don't rupture the flexor tendon (like I did).  I'll spend the rest of my life without a pinky that bends and sticks straight out when I grip something. Were it my dominant hand I would really be screwed.

Judging by the amount of doctors who seem to not know how to deal with a pinky fracture, you're clearly not alone. I spoke to one of the most prominent hand surgeons (after my finger was ruined) on the east coast who told me he would have done surgery, used kwire and had me bending the finger within three days of surgery. For me, my idiot doctor splinted for over 6 weeks. Its too late by then.

Sorry pal, wish I had better news. Do the best you can but be educated about what you are up against. Make sure you're surgeon knows what he's doing. Judging so far, I'd say maybe he's not so up to speed.... I dunno.

Obviously I'm no doctor, but in preparation for my lawsuit, I researched the hell out of the topic. And I lived it. Take it for what it's worth.

[brendon154]

YAHOO!! approved for tenolysis surgery on 2/13. can't wait! 2-3 weeks of aggressive everyday therapy afterward and I'll have this in my rear view mirror finally. timeline so far broke down like this: accident last week in July, 1st surgery -  august 16th. all pins and fixator removed 8 weeks later. Went to physical therapy FOREVER.  approved for 2nd surgery yesterday. almost finally over!

[Colnago_Rider]

Good positive thinking. I hope your tenolysis surgery goes well. Just be very careful post surgery; my flexor tendon ruptured 6 hours after my surgery. Doc told me to bend it, and I did, and popped it.

Ask about the extent of the damage to the flexor tendon, and how strong he thinks it is before you go very agressive on the OT after.

If the Flexor tendon ruptures,  its pretty much game over unless you go through another two surgeries, which I did not do.

Good luck and please post back after....

[stuckintherapy]

Broke my left ring finger skiing on 1/6.  ER told me it was a severe fracture of the joint (PIP), and I needed surgery.  Saw the hand surgeon on 1/11. Told it was an extremely rare and serious injury, with a 20% chance it would be stuck at 90 degrees and another 10% chance it would be stuck at full extension.  Had surgery on 1/12.  Got donor bone graft, a pin and K wire. It was a success, and doc said he was able to bend it to 90 degrees in surgery and fully extend it as well.

To my surprise (but apparently not to the surprise of Colango-Rider), my surgeon started me on physical therapy less than 24 hours after surgery.  Today (2/6) I am at passive bending of the pip joint 86 degrees, with full extension.  Can get to 50 degrees with blocking exercises.  Was very worried, because it seems so bad, to not be able to actively bend my finger too much 3.5 weeks after surgery.  But this board certainly has reinforced my opinion that I found an amazing team - great doc, great hand therapists, and, yes, great insurance.  

I'm still worried about the DIP joint - not broken, but hard to bend and will not straighten.  They say taking out the K wire will fix that.  They also said I may need the tendon release surgery, but it is too soon to tell.  

I'm worried I won't get full range of motion (prior to surgery, doc said a good result would be movement between 30-70 degrees. I can already fully actively extend, so better than that, but we'll see on the bending).  Never realized how hard it was to recover from finger breaks!  Good luck to everyone!

[brendon154]

yeah, I asked him about that happening because of what you had wrote on this board. he said rupture shouldn't be a concern in my case because the tendon had not been "frayed or stressed" in the initial injury or surgery. he said that tendon rupture can become a concern if there was weakening of the tendon previously. I appreciate the info. This board has been helpful. I would not have recognized that as a possible concern if it hadn’t been for your post so I thank you for that. I'll get back w/ the follow up after the two weeks of post OT and let everyone know what the final outcome was with this whole event. I wanted to be able to provide a time line for those beginning or in the middle of a similar situation so they have an idea as to what to expect to go through and how long it all takes from injury to full recovery

[SAABSTER]

Hello, I am writing to add my finger injury to the blog.  I am a Police Officer that was injured while struggling with an offender. I went to the ER and they told me that my right hand pinkie was a mallet finger. Then I went to a specialist who put my finger in a splint for 9weeks. Then he did a surgury of pin fixation for 6weeks.  The pins were removed and I went to hand therapy for 5 months.   The finger would still not bend and I could not make a fist.  Because this injury was work related my employer sent me to a second opinion MD who stated that I needed to a tendon fusion surgury done which they would place a pin and a screw in my finger. The screw stays in permanently . I then had 4 months of hand therapy and went back to work light duty.   The MD says I have a Permanent injury  and  limited work restrictions because this is my dominant hand.  The MD is recommend tendon release surgury, but I am not interested in having a third surgury done which may take away further movement from my hand.  I am now in a postiion at work where they came out with new rules for limited duty officers that state you must be able to perform the essential duties of an officer in order to remain  in a limited duty position.  The main ones that effect me are that you must be able to punch and hit a combative resistor.  My MD has already informed me that I have a permanent injury and I am un able to perform those requirements so I will have to apply for disability/pension benefits in the next couple of months.

[Colnago_Rider]

9 weeks in a splint. Sheesh. If you read up on Jupiter Police (also another guy on the job), he had similar issue. Tendon release could perhaps work, but you have had a lot of trauma on the tendons and I believe might have strong possibility of tendon rupture post surgery (like I had). It would depend more on how much tenolysis was done initially on other two surgeries, but maybe not a lot was done.

I believe Jupiter may have also needed to go OOD, as his surgeries were not able to correct the issue, and his finger was trigger finger.

That really ***** though that your first doctor sounds like mistreated the injury. I was agravated enough to learn how the splinting screwed my finger - and mine was splinted 6 weeks. I can't imagine why yours was splinted for 9 weeks.

That's actually the longest I've ever heard.  Maybe these two knuckleheads are buddies. After you surgery you were again splinted for 6 weeks. So 15 weeks with no movement. No wonder the finger isnt bending. I'd say you have joint contracture issue and extensive scarring on flexor and extensor tendons.

Wish I could be more optimistic for you--

[Colnago_Rider]

Keep us posted buddy. Yeh, I wish I knew about tendon rupture possibility before my surgery. ONly after it ruptured did moron #2 doctor advise me it was possible. (Um, information that might have been useful before you send me home and tell me to bend the finger as much as possible).

[brendon154]

so yesterday had the stiches out from my tenolysis surgery. I'm pretty sure I made the right decision to through with it now but thought I had made the wrong choice at first, I'll explain. After the surgery,  I woke up expecting to be able to move my finger the way it had always worked before my injury, not the case. I had no more mobility than I did before I went under the knife. my surgeon then ran by my bed and yelled at me to make sure I bend it as far as it would move, so that's immediately what I started doing. once the anesthesia wore off several hours later, that task became more of a challenge. Opening and closing your hand w/ 35 stiches running from the center of your palm to the tip of your middle finger isn't what I consider "good times". the next day I went in for 1st therapy session fully stitched up. I figured she would start slow since my hand was swollen and very sore from surgery the day before, I was wrong. she proceeded to pop 2 of the stiches open in the 1st session trying to fully extend my hand open. yeah, it was painful and yes, it was gross.  she told me that I had a 2 week window to get the mobility back before it scarred down again or the 2nd surgery would be for nothing. from that point on I decided to pretend my hand was fine and forget about the incision and stiches. I began using my hand as normal w/ the help of a lot of vicodin and went to therapy 5 days a week for two weeks. I went to the gym, rode my bike, did everything I normally do but backed off the intensity slightly. my surgeon told me before the surgery that we could always put in more stiches if needed. I took this to heart.  therapy was a bear, bled a lot and felt as if the incision would split open every time, overall, it was brutal. now it's been two and a half weeks and I have regained most of my original movement from before my injury. there is definitely a lot of stiffness still there in the mornings, and if I work at opening my hand for a while, it will not close well afterwards. I attribute this to tendon stiffness which I'm sure will soften over time. I feel good about having gone through it now that I am seeing progress, but it is not a quick fix. I hope my entries provide a helpful understanding of what may lay down the line as well as hope to some of you. I was told that my fractures were some of the worse they had seen when I came in and now I'm about 90% back to normal. I expect to get back about 95% of my original mobility all said and done. good luck and keep working. you're results all depend on the amount you are willing to do.

[brendon154]

Get the 3rd surgery (tendon release surgery). Sounds like your only hope. Either that or retire and have a bum finger/hand for the rest of your life. It helped my situation and I had 3 pins in my hand for 6 weeks and an external fixator on for 8 weeks. My whole hand was locked up and w/ the help of the tendon release i got it working again.

[tommyef]

Thanks to everyone for posting here.  This has been my new "support group."  I fractured my pinky in a cycling accident about a week and a half ago.  Surgery was one week ago today with a plate and 6 screws (hand got caught in the wheel and pinky broke my carbon fiber fork...which demolished my pinky).

The biggest thing I am taking away from this form is to start movement ASAP.  I was in a cast for a few days and now I have a removable splint which I only wear in instances where I feel I might bump my finger. I try to keep it off as much as possible and I am constantly challenging my pinky to move.  It has been one week and I am optimistic I will heal up...maybe not 100% back to normal but my goal is to get very close.  

I am already typing again with no problem which helps since my work is computer related.

I will try to update my progress in hopes of sharing information with others.  At this point I am still gunning for the best and not ruling out the release therapy.

My fracture was on my left proximal (pinky) and it was more of a shatter.  The break was in 5 places and they removed a lot of dead bone during the operation.  PIP flexibility is great right now...the gashes from stitches and the MCP seem like the challenge at this point.

[LouiseDoh]

Hi, thought I would post an update - timeline to date:

11/09/11 broke my left pinky finger at the proximal phalanges
22/09/11 had my op and 2 k-wires inserted and my arm and hand were then in a cast for 3 weeks
14/10/11 cast and k-wires removed, buddy tapped for another 3 weeks
04/11/11 buddy taping removed and confirmed the break had healed but now because of the build up of scar tissue I need physio to help get back the movement.

I have now has 6 months os OT and have regained 70% passive movement in both PIP and DIP. 25 % active movement in DIP but extremely limited active movement in PIP.

I have seen a hand surgeon who said he thinks the tendons are caught up in scar tissue and i'm going for an ultra-sound scan on 08/05/12 to find out more. I think it is likely they are going to suggest a second surgery to release the tendons.

Has anyone had the second surgery to release tethered tendons, and if so how successful has it been?

Many thanks, Louise

[mcdougaldjimmy504]

I have its was broke pretty bad and I late it heal and its starting to get in the way of me working and doin things so I need to go ahead and get it fixed straight back out its my pinky its its bent also I have no insurance surgery Im tryin to see if there is a hospital in jackson ms or gulfport ms or new orleans

[nwa187]

I had my FDP tendon on pinky cut, due to a breakdown of communication from the hospital, I did not see a hand therapist till 2 weeks after which done me in terms of scar tissue.

Fast forward 4 months later I had tenolysis. It will be successful, you will get good movement but you may not be fully happy because the surgeon will probably do the minimal as possible to get back movement of the tendon like in my case, but the full movement will not be achieved because of previous scar tissue.

If they took out the scar tissue, and perhaps fixed the tendon, e.g. shave off the knot to make it smooth so it passes through the pullies with ease, it can be much better outcome. I will have to wait for a year and propose my idea to other surgeons to see what they can do.