TENDON INJURY

Tendons are the bands of fibrous connective tissue that connect muscles to bone. Tendons aid in movement of the fingers, hand and all other joints.

There are two types of tendons present in the hand- extensor tendons and flexor tendons. Extensor tendons are on top of the hand and help with straightening the fingers. Whereas, flexor tendons lie on the palm side of the hand and help in bending the fingers. The flexor tendons are smooth, flexible, thick tissue strands which bend the fingers.

Deep cuts on the palm side of the wrist, hand, or fingers can cut and injure the tendon and make it unable to bend one or more joints in a finger. When a tendon is cut, it acts like a rubber band, where the cut ends are pulled away from each other.

Flexor tendon tears may be partial or complete. If tendons are completely cut through, the finger joints cannot bend on their own at all.

Causes

Any cut or laceration to the arm, hand, or fingers can cause a flexor tendon injury. Other possible causes include:

  • Damage to the tendon from -a sports injury, often associated with football, rugby, and wrestling
  • Stretching of the tendon where the tendon is pulled off the bone
  • Jersey finger: When a player finger catches on another player’s jersey or clothing
  • Rheumatoid arthritis
  • Adventurous activities such as rock climbing

Symptoms

Inform Dr Bala if you have any of the following symptoms:

  • Recent cut to hand or fingers  (could be very minor as shown below)
  • Pain
  • Swelling
  • Loss of ability to bend the finger
  • Numbness (loss of sensation)

Diagnosis

Make sure to see a doctor when you sustain a finger injury that is affecting the flexion and extension of your fingers.

First Aid: Apply ice immediately to the injured finger. Wrap a sterile cloth or bandage around the injury and keep your finger elevated above the level of your heart to reduce bleeding if present. A tetanus injection may need to be administered if not current.

Dr Bala will review your symptoms and medical history. A physical examination will be performed, which includes a complete examination of both hands. During the examination, you will be asked to bend and straighten your fingers. Your fingers will also be checked for sensation, blood flow, and strength. An X-ray may be ordered to check for any damage to the surrounding bone.

Treatment

A ruptured tendon cannot heal without surgery because the cut ends usually pull away after an injury.

There are many options to repair a cut tendon; the type of repair depends on the type of cut. The aim of the procedure is to restore normal function of the joints and surrounding tissues following a tendon laceration.

The tendon repair is a surgical procedure and can be performed under wide awake local or general anaesthesia. An incision is made on the skin over the injured tendon. The damaged ends of the tendon are brought together with sutures to achieve a secure repair. If the tendon injury is severe, a graft may be required. A graft is a piece of tendon that is derived from other parts of the body such as a foot or toe. Dr Bala uses the Modified Kessler repair technique to repair torn tendons in the hand. If the tendon has pulled off from its insertion onto a bone it can be attached back onto bone with strong suture material through an implant called suture anchor or a button. Dr Bala uses special magnification loupes to visualize and protect individual blood vessels and nerves in this region to minimize complications. After the repairing of the tendon, the incisions are closed with sutures and a dressing pad is placed over the surgical site. Your hand will be placed in a protective splint to restrict movements until the tendon ends heal.

 

Depending on the injury, you will be advised to start hand therapy a few days following surgery. This is to improve the movement of the finger. Follow the specific instructions for a successful recovery.

Flexor tendon injuries can be complex. Possible complications of surgery include pain, bleeding, infection, stiffness, rupture of the repair, and damage to the surrounding nerves or blood vessels. A second surgery may be needed to release any excess scar tissue that interferes with finger movement.