It only took a few seconds, several wet leaves, and an unlucky step to cause 50% of my fingers to be injured, one so bad that it got stuck at an awkward angle and required surgery to fix. Unfortunately, I wasn't doing anything fun or adventurous, just the normal life task of moving the garbage can!
The Anatomy of my Finger Injury
Each time I described the mechanism of injury to the medical staff in the emergency room, their initial response was a look of confusion. I admit, the way I injured myself was odd and each time it took a while to explain why I landed directly on my knuckles, or proximal interphalangeal joints (aka PIPs), instead of a more traditional fall on the palm of the hand. Turns out rolling a trash can across the alley can be treacherous!
Unfortunately, when I fell, the PIP of my right index finger took enough force to break through the skin, tear through the central slip and lateral band of the extensor tendon, and even part of the joint capsule. This disruption to the extensor complex resulted in my finger getting stuck in a flexed position with the complete inability to actively extend my finger. There was also a lot of blood and alleyway asphalt stuck in my open wounds. My quick, post-fall assessment of my injury led me to the conclusion that I would need some sort of surgical repair in order for my finger to work normally again.
The Emergency Room Experience
After a quick stop into my Primary Care's urgent care office, it was clear my initial assumption that I would need hand surgery was correct. Luckily, only 15 minutes from my house, UCHealth's University of Colorado Ansheutz's ER has hand surgery residents on call. This is the first time I needed to go to a Level 1 trauma hospital in Denver (and hopefully it will be my last!) and I was impressed with their organization, kindness, efficiency, and level of care. I would highly recommend UC Anschutz for any emergency care in the Denver area.
Occupational Therapy and Recovery Expectations
Even physical therapists need recovery help sometimes! Especially when my finger wound didn't heal as well as expected due to the rough nature of the laceration and surrounding tissue damage, the amount of swelling, along with my inability to sit still and do nothing. At my 2 week follow-up the surgeon and occupational therapist had stern words warning me about the possibility that a boutonniere deformity was forming which could require another surgery. I heeded their warnings, got a different finger splint made, and did a better job being kind to my injured finger.
Luckily, my finger did not develop into a boutonniere deformity and at 6 weeks I was discharged out of the splint! Due to persistent swelling and trouble with the incision closing, a lot of scar tissue formed and continues to significantly limit motion of my finger. I anticipate another several months of finger exercises (such as stretching, theraputty and rubber band exercises, swelling management, scar mobilization, etc.) before my finger can start acting like a real finger again!
Managing Health Insurance
Navigating and understanding health insurance in the United States is complicated, even under the best circumstances. A couple of years ago, my husband fell off a ladder and broke his wrist which required a trip to the ER and surgery. At the time, we were both self-employed and had a basic health insurance plan from the Colorado Healthcare Marketplace. Not only was the out of pocket cost very high ($8,000+), but finding a surgeon, anesthesiologist, and a surgery center that was in-network for our Bright Health plan proved to be more difficult than I could imagine. But even with "bad" insurance it was still better than the alternative: paying for the ER and surgery without insurance, which I estimated at $35,000+ for a fairly simple wrist and hand surgery.
Lucky for me, my husband now works for a great company and has access to a much better health insurance plan. Plus, his company contributes to our health savings account (HSA) every month. My finger ER and surgery bills currently stand at ~ $3,000, all of which has been covered by the HSA funds. Without insurance, the estimated costs for my finger repair stand at ~ $15,000. Health insurance is a total racket and there are no indications that the ease of using it or premiums and out of pocket costs are going to improve anytime soon, but I am still grateful to have it in cases like this.
Injuries can happen at any moment and significantly disrupt normal life. And cost a lot of time and money.
Health insurance coverage and costs can vary greatly but no matter what, it's still confusing and expensive.
Sometimes you have no choice but to ask for help. My husband learned more than he ever thought he would need to about the anatomy of a finger (he actually got to watch the surgery!) along with wound care and how to put my hair in a ponytail.
If you ever need to go to the ER in Denver, I highly recommend CU Anschutz!
My household chore list no longer involves moving the trash can.
Sometimes outdoor activities and life lead to injuries. If you're injured, or looking to work on injury prevention skills, schedule an appointment! In-person visits in Denver, CO (Santa Fe Arts District) or virtual visits available globally.
Dr Jessica Klain PT, DPT, COMT, CSCS, OCS, CNPT
Board Certified Orthopedic Clinical Specialist (OCS)
Certified Strength and Conditioning Specialist (CSCS)
Certified Orthopedic Manual Therapist (COMT)
Certified Nutritional Physical Therapist (CNPT)
Certified Vestibular Specialist
Certified Concussion Specialist
Trigger Point Dry Needling Certified, Level 1&2
Certified Yoga Teacher
University of Florida, Doctorate in Physical Therapy (2009)
The Ohio State University, Bachelor of Science in Biology (2006)