Careful with butter knives, children

I’ve wanted to write for a while about a serious injury I sustained to my finger in October. Finally getting around to it.

Prologue

I’m now week 9 in recovering from severing my FDP tendon in zone II of my little finger with a butter knife. I was separating some chicken with it (trying to use it as a wedge), when my hand slipped down the shaft and the “blade” cut into my little finger in the worst spot. I noticed something was wrong a few days later when I couldn’t move the end of my little finger. It may not sound like a big deal losing the little finger like that, but trust me, it’s worse than you can imagine. Severing this tendon in the little finger also affected the function of the ring finger (the tendons controlling the two come from the same muscle, and the tendons themselves are usually connected in the wrist).

Fixing the problem

In the words of my hand surgeon, these kinds of injuries are actually fairly severe, even if they appear minor. I had to have surgery done on the finger to reattach the two parts of the tendon (they don’t come back together on their own; think of it like rubber bands snapping), which was actually a lot more major than I was expecting. They told me I was under “twilight anesthesia” but I was asleep for most of the surgery. I just remember waking up with them wrapping my arm with a bulky dressing and not feeling anything in the entire arm (they gave me a nerve block as well).

After the surgery, I required (and am still as of this writing still attending) physical therapy twice a week for 12 weeks. This is to prevent the creation of adhesions (tendon repairs in zone II tend to cause the tendon to adhere to surrounding tissues which limits movement), restrengthen the now weakened tendon, and relearn how to use my hand. It’s not been a very fun process.

As part of the process, my hand was placed in a dorsal blocking splint after surgery, and I was forced to cope with only my left hand for 6 weeks. It was one of the least pleasant things I’ve had to endure. I had to relearn how to do everything with my left; I am actually left-handed, although I was encouraged to use my right most of my life. Relearning was easy but it was still something I disliked.

Assistive technology

During this time I tried out a variety of assistive software and hardware to help me use a computer.

Talon

Talon Voice was the best thing to happen to me during this injury. It’s a fairly good text to speech engine, impressive given it’s just one guy doing it. It has a steep learning curve, but it definitely helped a lot. It was the primary means I used a computer for two months.

I did find programming with it was more trouble than it was worth however. I had enough on my plate to be relearning how to input code. That said, this guy had far more success. Your mileage may vary.

Tobii 5

Someone (I forget who, brain doesn’t work so good since a TBI I sustained years ago) bought this device for me. The Tobii 5 is an eye tracking device primarily targeted at gaming. Tobii also makes accessibility-targeted products, but they cost far too much and are clearly priced at a level to be purchased by governments for disabled people, not by ordinary humans. I found it didn’t work acceptably well under Linux with Talon Voice (which has integration for it), because I couldn’t make the pop sound required to click. It also runs with too low of a refresh rate due to limitations in Talon Voice itself, so the movement is shaky at best. It had some usefulness but was not as useful as I had hoped. I did play some ATS with it on Windows, but overall I find it a bit gimmicky and it doesn’t play well with dual-monitor setups like mine.

Left-handed mouse

I got out one of those old-school mice with the transparent bottom half and the red LED inside. They were in every one of my schools as a kid. It’s a far cry from my MX Ergo Plus (a Best Buy exclusive version of the MX Ergo with a special stand to increase the angle further), but it had the advantage of being ambidextrous.

You know that setting you’ve probably seen in your OS for “left-handed mouse”? Yeah, that’s actually useful. Unfortunately, I had to find a cursor pack in KDE to reverse the mouse, which was far from comprehensive and didn’t work in GTK+ applications. I found the default cursor was really weird and out of place with a left-handed mouse, for reasons I can’t quite put my finger on. I think it’s the angle.

Intermezzo: a rant about right-handed hegemony

By the way, 10% of the world is left-handed, and I’m among them (although I use both equally well due to practise so I usually say ambidextrous). Design your software and hardware with lefties in mind. It grinds my gears that the world literally gives lefties the (right-handed) finger and makes very few products or accommodations for them. For instance, there is no left-handed version of the MX Ergo, which infuriates me to no end. KDE should definitely include a left-handed cursor pack as well, and GTK+ should work with it. This is inexcusable and stinks of greed/apathy at the expense of millions of people.

Single-handed layouts

I found single-handed layouts with chording to be more trouble than they were worth. Admittedly, I had only a short-term disability; it’s probably worth it for the long-term disabled to learn one. That said, I found I became relatively proficient at one-handed typing on a standard QWERTY layout, although still much slower than two-handed.

The aftermath

As for the amount of function I have back… well, I can type obviously. The tip of my little finger still won’t move very much, but I’m doing exercises which are slowly helping. Grasping is still very hard. I am much clumsier than I once was. I still am not allowed to lift heavy objects until a few more weeks in. But the swelling, pain, etc. are all going down as time progresses.

Unfortunately, I do now have a new problem: it appears I’ve developed ulnar tunnel syndrome. I don’t know what’s causing it, but this combined with my carpal tunnel is rather unpleasant. My physical therapist has me doing nerve glide exercises to try to fix this.

I still need release surgery for carpal tunnel as recommended by my doctor, as other treatments have failed. I’m told it’s 3 days of recovery, which is an improvement over the 6 weeks or more it used to be. I’m going to discuss this with the hand surgeon next time I see her.

Don’t give up

I wrote this partially to document my experience and partially to give hope to others who are suffering this kind of injury.

If you are one of the people suffering from this type of injury and you come across this: I know things might seem really hopeless. It’s a very difficult thing emotionally to sustain this kind of injury. Having a working hand one day and a non-working hand the next is awful. The physical therapy is grueling, the splint sucks, and there were times I wanted to take the damn thing off and be done with it.

But I promise you, it will get better. It just takes time. I still have a finger, I have more function than I did without the surgery, and I know it will only improve. Keep at it, it’s worth it.

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