Advanced Hand Rehab

Tendon Repair

What are tendons?

Tendons are tough cords of tissue that connect muscles to bones. When a group of muscles contract (tighten), the attached tendons will pull on certain bones, allowing you to make a wide range of movements.

There are two groups of tendons in the hand:

  • Extensor tendons – which run from the forearm, across the back of your hand to your fingers and thumb, allowing you to straighten your fingers and thumb
  • Flexor tendons – which run from your forearm, through your wrist and across the palm of your hand, allowing you to bend your fingers

Surgery can often be carried out to repair damage to both these groups of tendons.

When hand tendon repair is needed?

Hand tendon repair is carried out when one or more tendons in your hand rupture or are cut, leading to loss of normal hand movements.

If your extensor tendons are damaged, you'll be unable to straighten one or more fingers. If your flexor tendons are damaged, you'll be unable to bend one or more fingers. Tendon damage can also cause pain and inflammation (swelling) in your hand.

In some cases, damage to the extensor tendons can be treated without the need for surgery, using a rigid support called a splint that’s worn around the hand.

Common causes of tendon injuries include:

  • Cuts – cuts across the back or palm of your hand can result in injury to your tendons 
  • Sports injuries – extensor tendons can rupture when stubbing a finger, such as trying to catch a ball; flexor tendons can occasionally be pulled off the bone when grabbing an opponent's jersey; and the pulleys holding flexor tendons can rupture during activities that involve lots of strenuous gripping, such as rock climbing
  • Bites – animal and human bites can cause tendon damage
  • Crushing injuries – jamming a finger in a door or crushing the hand in a car accident can divide or rupture a tendon 
  • Rheumatoid arthritis – rheumatoid arthritis can cause tendons to become inflamed, which in severe cases can lead to tendons rupturing

Tendon Repair Surgery

In Flexor or Extensor Tendon Injuries, the tear (rupture) or cut (laceration) of the tendon ends are pulled apart, and they cannot heal without the ends touching. 

Tendon repair may involve the surgeon making an incision in your wrist, hand or finger so they can locate the ends of the divided tendon and stitch them together.

Extensor tendons are easier to reach, so repairing them is relatively straightforward. Depending on the type of injury, it may be possible to repair extensor tendons in an accident and emergency (A&E) department using a local anesthetic to numb the affected area.

Repairing flexor tendons is more challenging because the flexor tendon system is more complex. Flexor tendon repair usually needs to be carried out under either general anesthetic or regional anesthetic (where the whole arm is numbed) in an operating room by an experienced plastic or orthopedic surgeon who specializes in hand surgery. 

After surgical repair, it is critical that you follow your surgeon’s postoperative orders. You will be referred to certified hand therapy to follow a Tendon Repair Protocol. 

 

Certified Hand Therapy Treatment Plan:  After careful evaluation by the physical or occupational therapist, the first step in treating this condition is to fabricate a splint for you to wear for 6-8 weeks. Treatments may include edema control, scar massage, and specific passive exercises per the protocol ordered by the hand surgeon.

After your initial prescription for therapy is completed, your physician and therapist will decide if you need to continue therapy or if you will be discharged to a home exercise program.

This information is provided as a learning resource for the benefit of our patients. It is NOT INTENDED to replace personal consultation with your medical professionals.

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