Physical Rehabilitation Medicine/Finger injury


Hi Brian,

Around 10 weeks ago I injured by hand in a rugby game. My hand was fully extended with my fingers pointing up, my arm outstretched with my wrist flexed. Basically I was doing a hand-off, at that point a guy slammed his hand directly down onto the top of my middle finger. With all the adrenaline I didn't think much of it, but after the game I taped it straight.

After 6 weeks I still could not move the middle finger (middle and distal phalanx) but after 10 weeks I have since gained 80 percent of the movement of my middle phalanx. Although I can manually move my distal phalanx I still seem to have no ability to flex my distal phalanx without using my other hand for help, although it seems to have some strength in extension.

My finger cannot yet completely form a fist shape but can get 85 percent of the way after some stretching. I have a small swell in the palm of my hand between the distal and proximal palmer, directly inline with the affected middle finger. There is also pain in that region when I try to form a fist.

I think I have damaged a ligament in my finger which restricts mobility, but I am really concerned that I cant flex my distal phalanx.

My Doctor now says that my distal phalanx won't ever flex under my control again, what should I do? Is an operation possible?

Well this could be a number of problems...more than likely you have an adhesion of the flexor tendon particularly of the flexor digitorum profundus somewhere in flexor zone I-II in the palm of your hand.  Burning or stinging when you try to flex the finger is characteristic of scar tissue and if you can manually bend the finger but can't actively bend it then it's almost positively a flexor tendon adhesion.  

A tenolysis is indicated for this condition.  It's a complicated procedure and needs to be performed by a board certified hand surgeon.  Look for one at

Let me know if you have any more thoughts or questions but look all of the above up on the web and you'll see what I'm talking about.

Good luck!

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Brian Neville, OTR/L, CWCE


I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!


10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

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Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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