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Our three-year-old had surgery a week ago for a tendon laceration of the thumb. Even though he's in a cast to keep him immobile, he's like a regular Houdini. He's gotten out of three casts so far. One more time and they will just leave the cast off. Will this keep him from healing properly?

There is still quite a bit of debate about the best way to treat and rehab tendon injuries of this type. Some experts recommend casting to immobilize the joint. Others suggest splinting works better.

The success of immobilization post-operatively may depend on the child's temperament and level of cooperation. Some nurses and doctors say there's no point in an early rehab program. There's little cooperation and kids heal quickly anyway.

The main problem is scarring along the length of the tendon. Tiny adhesions can keep the tendon from gliding and sliding as it should. This can affect motion. Sometimes the sudden loss of motion affects the joint, resulting in greater loss of motion from a joint contracture.

Teenagers can be treated like adults. Early immobilization followed by a period of mobilization is usually followed for the best results. Work closely with your surgeon and hand therapist. This may ensure the best results in a patient this young. Give nature time. Healing is remarkably fast in this young age group.

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