Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is an extensor tendon?
The extensor tendons of the hand are important elements of normal hand function. These tendons work together to straighten, or extend, our fingers allowing our hands to perform a seemingly infinite number of tasks. Each finger is controlled by at least one extensor tendon which begins as a strong muscle in the forearm. The index and small fingers often have an additional extensor tendon.
There is an important relationship between form and function in the hand. A delicate balance exists between the bones, joints, tendons and other soft tissue structures. A small disruption of this fine balance can affect the overall function of the hand. This is made apparent with extensor tendon injuries. Early diagnosis is very important to obtain the best outcome.
How is the injury diagnosed?
An extensor tendon laceration (cut) is often caused by a sharp object such as a piece of broken glass or knife. This diagnosis is usually obvious to the patient and caregiver, as the patient cannot lift (extend) the finger after a deep cut. Extensor tendon injuries in the fingers can also occur from blunt trauma (without a laceration). The diagnosis can be more subtle in these cases. Associated injuries to the skin, bones, joints, nerves, and blood vessels of the hand are also important to evaluate. Although tendons cannot be seen on x-rays, an x-ray may be ordered to look for a fracture in the underlying bones. CT scan, ultrasound, and MRI are not usually required.
What are the treatment options?
In any case, the wound should be cleaned thoroughly to help prevent infection. The treatment of the tendon injury depends on which tendon was injured and at what location. When an extensor tendon is completely lacerated, the muscle belly in the forearm pulls the two ends apart. This gap prevents the tendon ends from joining back together and healing on their own. Surgery is the only way to reconnect lacerated tendon ends. In cases of blunt trauma, some extensor tendon injuries can heal with non-surgical splinting. A specific injury to the terminal extensor tendon of the finger is called a mallet finger, and is discussed separately.
What is involved with surgery?
The surgery is usually performed on an outpatient basis using either regional anesthesia or general anesthesia. During surgery, the tendon ends are identified and repaired using sutures. This is called a “primary repair.” Often the skin incision is extended in order to retrieve the retracted tendon ends. Injured nerves and/or arteries are also addressed at the time of surgery and repaired if needed. If there has been a delay of more than a couple of weeks, it may not be possible to bring the ends of the retracted tendons back together and perform a primary repair. In this case, a tendon graft can be used to bridge the gap, or the tendon can be attached to an adjacent intact tendon.
Is therapy required?
Yes. Occupational therapy guided by a therapist trained in hand care (certified hand therapist) is important in the recovery from a repaired extensor tendon. The therapist will guide the patient through the rehab protocol and promote an increase in range of motion and reduction in swelling, scar tissue, and pain. While the tendons are healing it is possible to rupture (break) the repair if too much force is applied to them. On the other hand, if a patient does not work on adequate range of motion during recovery, the hand and fingers will invariably be stiff. Therefore, patients require guidance by therapists to perform optimal rehabilitation and "walk" this fine balance. I will oversee the rehabilitation process and make adjustments as needed.
What can I expect after surgery?
Rest and elevation of the hand to the level of the heart is very import for the first few days after surgery to reduce swelling. Shoulder and elbow range of motion exercises are important to help prevent stiffness in these joints.
After the surgery, your wrist and fingers will be immobilized in a plaster splint to protect the repair. The splint will be removed in our clinic after a few days and a removable splint will be made for you. At first, the therapist will focus on reducing pain, swelling, and increasing range of motion. Later, as the tendon repair heals, strengthening will be emphasized.
Most patients can return to more normal function 3-4 months post-operatively, but maximum improvement can take 6-12 months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Sometimes people do not regain full range of motion or strength after the injury. My goal is to help each patient obtain the most function possible.
What are the complications from surgery?
Possible complications include bleeding, infection, swelling, stiffness, rupture of the repair, and damage to the surrounding nerves and blood vessels. If scar tissue and stiffness become a problem during rehabilitation, an additional surgery called a “tenolysis” can be helpful to gain more motion. This procedure is designed to remove scar tissue around the tendons. Other complications are also possible but are uncommon.
This material is intended for general reference only and does not replace an evaluation by a physician.
If you have a cut finger or hand, please call the Raleigh Hand Center to be evaluated promptly.
Copyright 2014 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609