Does anyone have experience or advice about finger rehabilitation

[Steve Finlay]

I had an accident 10 days ago, which nearly severed the index and middle fingers of my left hand between the end knuckle and the second knuckle. The joints were unharmed. The fingers were reattached yesterday, including pins in the two bones that were cut. I will be in a splint for four weeks, then there may be secondary surgery to free the tendons, then a lot of physio.

The surgeon says that I will not recover all my dexterity.

Has anyone worked through rehabilitation after serious finger damage, and if so, do you any advice and recommendations? I expect a lot of repetitious exercise and slow progress, while being careful not to overdo it or try too hard.

[gfury]

I'm so sorry to hear about this. I hope and pray that you make a full recovery.

I do not have any personal experience with hand rehabilitation, but I do have a couple of friends who have had hand surgery. Results have been mixed.

I hope you have a good surgeon. Maybe consult with several surgeons if possible.

[Dennis Satterlee]

I'm sorry to hear about your experience. I had dupuytrens contracture surgery a few years ago which included cutting open my palm, thumb and 3 of my 4 remaining fingers on my left hand. Have your surgeon recommend a rehabilitation professional and go NOW. The sooner you start the better your recovery chances are. DON'T try it without professional help.

[Steve Mead]

So sorry to hear that! I cannot help with finger issues but have experienced cutting tendons in my wrist that control movement of the wrist and pinky. I can tell you that after 8 weeks immobilized after the tendon grafts it felt like it would never be useful again. This was back in 1977 before the days of physical therapy. Dr recommended filling the sink with warm water submerging my wrist ans squeezing one of those pinkish balls we had as kids. Under water was the only place my fingers and hand would be able to move for a while. Progress was slow but deliberate. After maybe 8 wks more things were moving pretty well and regaining strength but continued to improve long after the Dr expected it to maybe 2 years post op. Good news is you would never know there was a problem. Time, patience, hard work and prayer!

[bigskygirl]

Wow, sounds painful and scary!

My advice is to find the BEST hand rehab in your area or within reasonable driving distance and call them now - it's hard to get in some places. Like the mando - you don't want lessons from the guitar teacher at the music store if you want to study mando. My husband had the surgery between the thumb and hand - CMC/LRTI I think they call it. At the time the only surgeon we had confidence in was 5 hours away...we went and he has fully recovered. The surgeon was highly skilled but so was the rehab and today he has grip strength and pinch back to just about normal...he is 70 so...

Anyway, best of luck with your recovery. Don't push it - so many people think they can get back sooner than they really can and all it does is set you back. If the surgeon/rehab says months don't think weeks...

Also, consider learning mando left-handed...?...you'll get playing faster and you never know you might be good at it. I'm a lefty that plays mando and golf righty and we all know Phill Mickelson is righty who plays lefty, Rafal Nadal, Tua switched hands for their sport...lots of people learn the opposite hand for all kinds of reasons and you now have a doozy.

Best of luck and don't get discouraged.

[pops1]

I had my hand smashed in a printing press in the mid 60's, they said I would never have a normal functioning hand. A lot of work and a few years and I came back to normal usage. I think they prepare you for the worst, and some folks don't have the incentive to work hard enough. My dad had his finger cut off when he was young, 1940's. A drunk doctor from the golf course sewed it back on and he still, at 93, is using that finger. He does have one joint that doesn't bend right, but then it was completely taken off and it was a long time ago, with primitive operating conditions. Keep the faith, keep working on it, don't give up.

[Marcus CA]

I'll second bigskygirl's advice about PT. Hopefully, Steve, you live somewhere that great physical therapists aren't hours away from you. You're not going to want someone who sees your hand and says, "Hmmm, let's see what we can do for you." You want someone who sees your hand and says, "OK, here's what we're going to do."

The two rules of physical therapy when you have a great physical therapist are:
1) Do every single exercise that he/she recommends. If you're supposed to do two sets of eight reps twice a day, you do two sets of eight reps twice a day. No more and no less.
2) You take any meds necessary --- within legal and medical limits --- in order to do every single exercise that he/she recommends.

Even if your surgeon is correct about your ultimate dexterity, you may recover enough to play mandolin well again, although not necessarily at your previous speed. You should let your PT know that you are a musician.

I don't know if switching to playing lefty will work for you. Given that your left index finger was injured, you might have difficulty holding or controlling a pick with your left hand.

A mandobuddy of mine lost the tip of his left index finger in an accident about ten years ago. He started learning how to play dobro, since he had no problem holding or controlling the slide with his left hand. Eventually, though, he went back to mandolin and keyboards, because he enjoyed them more --- even with his limitation.

Best of luck on your journey. It will be a slow process, but with good PT, you should see gradual improvement over the next few months.

[CarlM]

I lost the ends of my ring and little fingers from the end joint out in 1995 in a woodworking accident. I was playing guitar but not mandolin at the time. For about five years I did not play at all due to pain and lack of mobility. I possibly could have started again earlier but did not know quite how to go about it and had resigned myself to not playing. I finally started messing with it after about five years and figured out some unique chord fingerings and started to recover. It took about ten years of playing to really regain mobility subject to the missing joint and length. I still work on it to some degree. I took up mandolin about six or seven years ago. I cannot do most of the full four finger chop chords and use thumb wrapping and other work arounds for some things but am able to do a lot of what I want on guitar and mandolin.

If I had it to do over, aside from not doing dumb things in the shop, I would probably switch to left handed. I believe the recovery of playing would have been quicker and easier.

[Steve Finlay]

Thanks very much, everyone. I'll do as you say -- find the best hand physiotherapist around, and follow all the instructions. My CEO knows a very good hand surgeon, and he is going to ask that surgeon who the surgeon would recommend as a PT. I'm going to need all my discipline and patience.

[Louise NM]

Lots of good advice above. FWIW, hand therapists are almost always OTs (occupational therapists) instead of PTs. Don't overlook a great one because of the initials behind their names.

[Mando Mafia]

Thanks very much, everyone. I'll do as you say -- find the best hand physiotherapist around, and follow all the instructions. My CEO knows a very good hand surgeon, and he is going to ask that surgeon who the surgeon would recommend as a PT. I'm going to need all my discipline and patience.

Sorry to hear about your accident, Steve. I’d reiterate everything folks have said so far, especially following your physical therapist’s instructions to the letter.

I’ve had a few hand accidents over the years and the last, and worst one resulted in my losing the pad at the tip of my left middle finger, and severing the tendon(I’m right handed, so that is a fretting finger). With two surgeries, I got a new pad on the end of the finger and a reattached tendon, but unfortunately during the healing process, there was internal scarring which prevents full movement of the tip of that finger. So, I’d advise talking to your surgeon and physical therapist about scarring and how to minimize it.

You may not get to the point where you can play mandolin again, but don’t give up hope. If you’ve got music in your bones, you’ll find a way to keep it a part of your life…when I injured my left hand, I switched for a while to accordion as I could still operate the bellows with that hand and play melodies with the right hand, and eventually i moved back to octave mandolin, which was easier to navigate than mandolin.

I always had Django Reinhardt as an inspiration..his horrific fire-caused hand injury didn’t seem to slow him down, and Joni Mitchell, whose childhood polio affected her ability to play guitar using regular chords, didn’t let her disability prevent her from coming up with alternate tunings to let her get her music out. Jerry Garcia and Tony Iommi(Black Sabbath) both overcame hand injuries to play pretty awesome music. So keep the faith!

Here’s wishing you as complete a recovery as humanly possible.

Pete

[JiminRussia]

Well, yes and no. I had a procedure done several years ago at a time when I was not playing any instrument at all. It was to correct Dupuytren’s contracture in the little and ring fingers of my left hand. Firstly my condition was not nearly as traumatic as yours and the recovery was completely different from what you will need to do, but the principles should be the same. Just follow your doctors instructions (hey, that’s what he gets the big bucks for). If it hurts, do it anyway, it will only hurt for a little while and it will make you better. Be patient (no pun intended) it takes time and you will improve. Good luck and we are pulling for you.

[CarlM]

The two things that helped me most in recovering mobility were playing, particularly fingerpicking guitar and typing (on a computer) using proper finger assignments. These were both over a very long, frustrating haul. I am talking about a ten year period.

The other thing which was weird was that nerves were rerouted, due to the complete loss of part of the digits so touching the outside of the fingers felt like it was on the inside. That has been pretty much retrained so it feels more or less normal, again over a long period.

[rcc56]

I had a machine accident in 1989. It caused a double compound fracture and cut half way through the tendon in my left index finger. Also crushed the middle finger, but not to the point of breaking bones or cutting tendons.
As the doctor was sewing the tendon back together, he calmly stated that "If your finger had been rotated five degrees more when it got caught, I'd be taking it off right now." After the splints came off, the finger was slightly bent. It couldn't point, and it couldn't pull in. My range of motion was maybe 5 or 10 degrees.

Doc said work it carefully. In a year, you will make all the progress you're going to make.
Several months later, I picked up a guitar. It couldn't bend the finger enough to make an E chord, couldn't feel the strings, and it hurt like the dickens. I kept at it, and played what I could. The range of motion improved very slowly, the pain grew less, and I started to feel the strings just a little. Six months later, I could make an E chord, another month later a C chord. I kept at it

The doc was wrong. I made more progress in the second year than I did in the first. In 1991, I went back to school, working on a music degree. My guitar teacher gave me some exercises. They hurt. I did them anyway. The only one I couldn't do was a barring exercise-- I could feel it trying to pull the tendon back apart. The teacher said, "OK, don't do that one."

Later that year, I got a phone call. They needed a bass fiddle player to back up a piano player at a classy local restaurant, 3 nights a week, steady gig. I borrowed a bass and got the job. We worked there for 3 years. The finger got better, the pain went away, and I could feel the strings a lot better. I finished up my degree, kept playing jazz bass, and got additional work playing guitar in an R & B band. Sometimes the finger would lock up when I played rhythm guitar on a gig. I'd reach over with the other hand, push the finger back so it would move, and keep playing.

I paid off my house with that bass fiddle, the electric guitar, and giving lessons on string instruments. I'm still in the music business, mostly teaching and repairing instruments these days.

That finger still feels a little numb even today, but it works. But if I don't play enough, it gets weak and sluggish.
Scales and exercises are a good thing, if I do them.

Listen to your body. The fingers will tell you what they can and can't handle. When you get the moderate, sore or dull burning pain, that can be muscle trying to rebuild, but be careful. Know when to quit for the day. When you get the sharp, stabbing pain, back off right away.

No one can tell for sure how long your recovery will take. I kept making progress for several years after the injury.
And remember-- Django Reinhardt takes away all our excuses.

[Kenny]

When you inquire about PT you should also ask about one that has experience with musicians. They’re, unfortunately, hard to find even in big cities. It won’t be necessary for the basic recovery of function but it’ll be really helpful as you resume playing. Good luck to you!

[EdHanrahan]

... the recovery was completely different ... but the principles should be the same.

YESSS!! When I shattered my right humerus in '07, the doc said it would be a looong time before stretching around a guitar again, as in, "Don't you dare...". He was correct: 18 months to hold a dred, 3 years to relative comfort, 5-6 years to full flexibility (at least on guitar).

But I could comfortably hold a mandolin at 7-8 weeks in. That lead to way more learning and exposure, my finally (after decades of avoidance) absorbing some music theory, and playing in more groups than my wife can keep track of (some because I can switch between mandolin, guitar, bass). What I feared was the end of my musical journey turned out to be just the start.

May your rehabilitation go as well!

[EvanElk]

Hey Steve - I had a similar accident and surgery 10 years ago. Couldn't touch an instrument for about 2 years without serious discomfort. I began the PT and rehab right away after the surgery though - all directed by a top hand surgeon who had operated on stringed instrument players in the past...happy to share some of what worked for me via messaging or a phone call. I can now play pretty much without pain...along with a few fingering workarounds. Hang in there

[Steve Finlay]

Thanks very much again to everyone. It is now 4 days after surgery, and I'm experiencing minor pain only. For the present, my primary responsibility is elevating the hand as much as possible so that the unavoidable swelling is minimized.

I will look for a therapist who has experience with string players. I know some people in the Vancouver Symphony who might be able to advise me.

I am avoiding pain killers as much as possible, because I want to be aware if I do anything dangerous. I only needed two of the 40 Tramacet that the surgeon prescribed.

The most encouraging information is that adaptation and improvement can continue for many years. Patience will be paramount.

Fortunately, my job in the local mandolin orchestra is mandocello. I will have only my left ring finger and pinky for a long time, but that should be enough to play simplified parts. I'll ignore any fast runs and arpeggios and stick to oom-pah.

[Steve Finlay]

Progress report: The pins came out yesterday (Nov. 16). The joints can move somewhat, but the bone is not healed yet. In the middle finger, it is still mostly cartilage. One could argue that the pins should have been left in longer, but those pins are a conduit for infection, and the surgeon did not want to push our luck any longer. If an infection gets into the bone, that is real trouble.

I'm allowed to do gentle passive motion of the index finger, as long as I hold the still-healing bone firmly so that it doesn't bend. Only the hand therapist can move the joints in the middle finger, until the bone hardens more. I wear the splint at night only now, and the overall pain and stiffness is going down fairly rapidly.

[B381]

I have a pinky finger that no longer works. It stays straight all the time. Injured when I was LEO when I was fighting someone to put cuffs on them (fingers inside the cuffs when they are on somebody and flailing does real harm apparently).

Two surgeries later, a pin, 3 months out of work and the end of my LEO career but I still am able to play mandolin. Actually thankful that it stuck in the straight position, makes reaching that 7th fret that much easier.

The human body will adapt and overcome if you work with it.

[HonketyHank]

Steve, I'm thinking of you and cheering your progress. Thanks for the update.

[Jeff Hildreth]

I had a very serious "accident" a couple months after I had returned to mandolin after a couple years break.

I was now a furniture maker. I shoved my right hand into a shaper.
Gruesome would be understating the event. This involved the right thumb, index finger and middle finger..
re-assembly required.

Surgery was successful for the entire baggie of parts. But I was told I would never have the dexterity or
strength I had and playing guitar (finger picker) would be doubtful, mandolin possible not likely.

Re-hab was a joke.. I was told they were the best, not so. After my third visit I left and developed my own re-hab.
Details on request.

I took it upon myself to be as good (marginally competent) as I was prior to the event. I made re-hab a job.. as I could not work.
My surgeon could not believe the recovery. He had me use a small device which you hold and squeeze and it gives you lbs per square inch pressure.
There is a chart that tells you where you should be given age etc etc. I blew it off the scale for a seasoned carpenter half my age.

Within six months I was functional, within a year I was playing guitar, within 2 years I far exceeded my, and everyone else's expectation.

Sadly because I was told I could not play.. I sold my 5 mandolins 3 guitars and my Bart Reiter banjo (custom made for me) .
Why? because I believed in someone else , not myself.

OK.. Go to re-hab.. if you don't jive, get out and find someone else. Don't consider your weekly or twice a week visit to re-hab as
adequate, wallow in it. Determination is the key. Recovery is as much mental as physical.

Best of luck.

[CarlM]

Congratulations thus far and good luck. Keep the faith and think long term,three, five or even ten years. You will make it back.

[Kenny]

Congrats on your progress, Steve! I think it was author James Baldwin who said, “Those who say it can’t be done are usually interrupted by others doing it.” My advice: be patient but be persistent.

[Steve Finlay]

Thanks so much for the advice and the hope. As you say, Kenny - patient but persistent. B381, I know what you mean about the pinky. Mine curves toward the ring finger enough to make stretching unpleasant. I always wonder whether some orchestral string players, who seem to have straighter pinkies, were born that way or did exercises to get there.