Flexor Tendon Tenolysis: PT & Recovery Guide - Hand Therapy Secrets

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Protocol and Recommendations After Flexor Tendon Tenolysis Surgery

Hi everyone, Hoang here! For those of you new to my corner of the internet, I am an Occupational and Certified Hand Therapist.

Have you recently undergone Flexor Tendon Tenolysis surgery and are wondering how often you should do therapy and how soon after the procedure?

Well, buckle up, because today we’re diving into one of my favorite topics. Keep reading for expert tips and insights to optimize your patients’ post-tenolysis recovery.

Textbook vs. Therapist’s Approach

In regards to a patient following a Flexor Tendon Tenolysis, how often do I recommend that they do therapy, and how soon after their surgery?

Okay, so there are two answers here: 

  • a textbook answer 

and then there’s 

  • my answer. 

I’m going to share with you first what the textbook says. When you’re following the early protocol, their idea is that you don’t want to do anything until after day five, because of the healing and high amount of inflammation. You want that to go down a little bit. From a technical standpoint, you don’t want to start them too early, right? 

A Therapist’s Perspective on Therapy After Tenolysis

Then after that, you go into therapy, and the textbook doesn’t tell you exactly how many days a week, but they just say the patient needs to go into therapy to get the movement. Now, my perspective on tenolysis is if you already got stuck the first time, why wouldn’t you give yourself the best possible chance of getting a great recovery after a second surgery? 

Because you don’t want a third one, right? 

Then, the first two weeks: 

  • You are in pain 
  • You are healing 
  • You have edema

As your wound heals, you’re gonna get tighter in the second two weeks. My recommendation for tenolysis is to come into therapy daily for the first four weeks. 

Whether you come in on day number one or two, there are things that you can do to help manage the edema, help with wound healing, and also to promote movement without being very aggressive in that particular area (PIP, MP joint, wrist, etc.). There are things that you can do to help yourself and to start a specific range of motion in specific directions. That will help you become looser. Do therapy daily to get the best possible results after tenolysis.

Why Daily Therapy?

One of the reasons I make that strong, aggressive recommendation is because I have worked with people who have come in for tenolysis and we stick with the ‘oh, the doctor wrote three times a week.’ Well, do you know why doctors write three times a week sometimes? 

They do it out of habit because they write three times a week for everything. Some doctors write just two times a week. They write that out of habit or whatever their perception or assumptions are about that person.

If I am working with somebody and I evaluate them, I get a story and a history of what they tell me. Then I will make that recommendation based on what I see. And a majority of the time after tenolysis, it is five days a week for the first month. And if you can’t do it for the first month, let’s assess where you are after two weeks.

The Crucial Window: Weeks 2-4

Here is what happened: I worked with several people. They came in every day for the first two weeks and they felt really good. They had a great range of motion and they were like, “Because I am doing so well, I am going to stop coming as often.”

But guess what happens? Because you have this perceived notion that you are doing so well, you stop doing the thing that you need to do as effectively and frequently as you need to. And then this healing part, you’re loosey-goosey, right? 

The tendons, everything is moving because you are healing. By the time you have full wound closure, a scar, which is the nature of the injury, starts to tighten up. Starts to tighten up and the fibers start to harden as it heals. And guess what now? You’re like, “I don’t need to come as often,” but that is the most crucial part.

Weeks 2-4 are the most critical for optimal recovery. Then as you get better and you see the results, you feel them, you feel less pain, you see the wound healing, you see the edema going down, you see the motion. This allows you to do more self-care exercises.

Therapy is a Partnership

Now, not everyone is the same. When I can say, “Well, you’re doing so well”, I would hate to see you lose that motion. I would hate to see you lose that progress, because I know who you are, I know how you are.”

If I have someone who is not doing their exercises on their own, they are going to need to come in more often. But if they are like, “Hoang, every two hours, I’m doing it,” then you won’t need to.

It’s important to remember that therapy is a collaborative effort. Therapists don’t make cookie-cutter plans. It’s created for your patients. Based on how they present it to you, what stage they are presenting, and what their capacity is. Regardless of whether they can afford it or not, it is still your responsibility to share your perspective of why they should be doing what they should be doing, based on what you see in that evaluation, based on what you see at that reevaluation every week.

Therapists shouldn’t make assumptions about what people are willing to pay and what not, what people are willing to do with their time, and what they’re not willing to do. Present the two things and tell them what the consequences are. Because the consequence of you not coming in and not getting the results that you need is that you are going to get stuck again. 

And you’re going to be in pain again. And do you want that third surgery? After all, some injuries don’t offer a third chance. You are stuck with what you’ve got. 

So, how are you presenting? How are you speaking to your people? And how are you sharing your perspective of what works and what doesn’t work, and why?

Share your perspective and experiences in the comments below!

If you want to find out more, watch the full YouTube video:

Protocol and Recommendations after Flexor Tendon Tenolysis Surgery

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Hoang Tran

“I help Occupational Therapists develop their skills and grow their confidence in Hand Therapy. No matter where you are on your journey, build a happy and fulfilling career of your dreams. I’ll help you.”