Hand Therapy – Central Slip Surgical Repair

What is a central slip injury?

The central slip makes up part of the extensor tendons of the fingers. The extensor tendons are responsible for straightening your fingers. The central slip works on straightening the middle joint of your finger. A cut or injury to these tendons is a serious injury and will require regular hand therapy to regain movement after surgery.

What can I expect after a central slip repair?

You will have:

• A large bandage which you must not remove.

• Swelling around the area of injury. This is normal and should reduce over time. Elevating your hand above your head can reduce this.

• Pain which can be normal immediately after surgery. Please discuss this with your Hand Therapist.

• An appointment with the Hand Therapy Team within 1 week after your injury.

How long might my recovery take?

After the surgery your tendon is very weak and can break very easily. Your hand will require care and attention for the next 3 months. This will allow the tendon to heal and regain strength, reducing the risk of it breaking.

Patients are referred to the Hand Therapy Team within 1 week of the injury being repaired, to help rehabilitation and improve the fingers long term use.  The Hand Therapist will guide you through each stage of the rehabilitation process, which takes approximately 12 weeks.

What are the potential complications?

• Boutonniere deformity (deformed position of the finger).

• Rupture of surgical repair (unable to straighten finger again).

• Development of extensor lag (unable to fully straighten the finger).

• Scar tissue limiting range of movement.

• Joint stiffness.

How do I care for my wound?

Please do not remove any dressings yourself. Your Hand Therapist will assess, check and change your dressing at each appointment.

The wound on your hand may now be bigger than the original cut as to allow the Surgeon to fully inspect and repair the damage. Care has to be taken in order to minimise the risk of infection and this can be helped by keeping the dressing clean and dry.

You will have special stitches in the tendon as well as stitches in the skin. Stitches in the skin are either dissolvable, which dissolve in 2 to 3 weeks, or removable that will be taken out by your Hand Therapist 10 to 14 days after your operation.

In your fist appointment your bandage will be changed and reduced to a lighter dressing.

Although the wound will be covered, it is very important that you monitor it for signs of infection, such as increased redness, swelling in the surrounding skin area, and oozing and odour through the dressing.

Also general symptoms of infection, such as high temperature, confusion or delirium, rapid heartbeat, skin rash or feeling unwell in general.

If this happens you should contact the department, your GP or Urgent Care Centre as soon as possible.

What exercises can I do?

After your injury you will follow a strict rehabilitation programme for 12 weeks. At your first appointment with the Hand Therapist you will be given specific exercises that should be completed regularly.

Please do not try your own exercises as this could cause damage to the tendon.

How do I care for my splint?

our Hand Therapist will provide you with a plastic splint. This will protect your tendon and help to keep your finger straight during the healing process. It is secured with Velcro and must be worn continuously for a 2 week period.

You should:

• Keep the splint clean and dry – cover in a plastic bag for showering/bathing.

• Keep away from sources of heat.

• Clean the outside with baby wipes or a damp cloth.

You should not:

• Remove the splint.

• Try to make alterations to your splint.

Please be aware wearing a splint continuously can cause irritation of the skin on your hand. You may notice some rubbing or digging in. If this becomes red, dry or blistered please contact your Hand Therapist. Please bring your splint to each hand therapy session.

How do I care for my scar?

Your Hand Therapist will show you and advise you when to start scar massage. This is normally once the wound has healed and is scabbed over.

Scar massage is useful as it helps to breakdown the scar tissue. This allows the scar to move more freely and reduces the risk of the scar becoming sensitive.

To complete scar massage you should:

• Apply firm pressure in circular movements along the length of the scar.

• Use non perfumed cream.

• Complete for 5 minutes at a time at least 4 times a day.

When can I return to normal activities?

Your repaired tendon is weak for approximately 12 weeks after the operation and care has to be taken to protect it.  Your Hand Therapist will guide you through each stage of the healing process.

The table below gives you some examples of timescales and activities.

Do I need to take time off work?

Your Hand Therapist will discuss with you when it is appropriate to return back to your normal work and hobbies. Please speak to your GP, if you need a sick note. The table below gives you a guide of when you may expect to return to work.  This will depend on the type of work or activity you do.

Contact numbers

If you need any further advice regarding:

• Your appointment with the consultant,

• The surgery you may have had,

• Your wound, dressing or cast.

Please contact your local Orthopaedic Outpatient Department.

University Hospital of North Tees

Orthopaedic Outpatient Department

Telephone: 01642 624473

Monday to Friday, 8:30 a.m. to 5:00 p.m.

Saturday, 8:30 a.m. to 1:00 p.m.

University Hospital of Hartlepool

Orthopaedic Outpatient Department

Telephone: 01429 522590

Monday to Friday, 8:30 a.m. to 5:00 p.m.

Hand Therapy:

Please contact the Hand Therapy Team if:

•          You have any concerns or questions regarding your exercises.

•           If your splint is rubbing, uncomfortable or damaged.

Hand Therapy Team

Telephone: 01429 522471

Monday to Friday, 8:30 a.m. to 4:30 p.m.

You will be asked to attend either:

Hand Therapy

First Floor, North Wing

University Hospital of North Tees

Physiotherapy Outpatients Department

Ground Floor

University Hospital of Hartlepool

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]