Broken Pinky Finger - Post Surgery Stiffness

[imq]

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.