Hand tendon repair 

  • Overview

Introduction 

Having an operation

If your GP has suggested you may need surgery, this guide is for you

If any of the tendons in your hand are damaged, surgery may be possible to repair them and help restore movement in the affected fingers or thumb.

What are tendons?

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

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 will be unable to straighten one or more of your fingers. If your flexor tendons are damaged, you will be unable to bend one or more of your 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. A flexor tendon can occasionally be pulled off the bone when grabbing an opponent's jersey, such as in rugby. In activities that involve excessive and strenuous gripping (such as rock climbing), the pulleys holding the flexor tendons can rupture.
  • Bites – Animal bites can cause tendon damage. Human teeth can also cause tendon damage, usually when a person punches another person in the teeth, cutting their hand in the process.
  • Crushing injuries – Jamming your finger in a door or having your hand crushed in a car accident can divide or rupture a tendon. 
  • Rheumatoid arthritis – Rheumatoid arthritis can cause your tendons to become inflamed. In the most severe cases, this can lead to tendons rupturing.

Tendon repair surgery

Tendon repair may involve making an incision in your wrist, hand or finger so the surgeon 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 anaesthetic 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 anaesthetic or regional anaesthetic (where the whole arm is numbed) in an operating theatre by an experienced plastic or orthopaedic surgeon who specialises in hand surgery.

Read more about how hand tendon repair is performed.

Recovering from surgery

Both types of tendon surgery require a lengthy period of recovery (rehabilitation) because the repaired tendons will be weak until the ends heal together. Depending on the location of the injury, it can take up to three months for the repaired tendon to regain its previous strength.

Rehabilitation involves protecting your tendons from overuse using a hand splint. You will usually need to wear a hand splint for several weeks after surgery.

You will also need to perform hand exercises regularly during your recovery to prevent the repaired tendons from sticking to nearby tissue, which can prevent you from being able to fully move your hand.

When you can return to work will depend on your job. Light activities can often be resumed after 6-8 weeks and heavy activities and sport after 10-12 weeks.

Read more about recovering from hand tendon repair.

Results

After an extensor tendon repair you should have a working finger or thumb, but may not regain full movement. The outcome is often better when the injury is a clean cut to the tendon rather than one that involves crushing or damage to the bones and joints.

A flexor tendon injury is generally more serious as they are often put under more strain than extensor tendons. After a flexor tendon repair, it is quite common for some fingers not to regain full movement, although the tendon repair will still give a better result than no surgery.

In some cases, complications develop after surgery, such as infection or the repaired tendon snapping or sticking to nearby tissue. If these occur, further treatment may be required.

Read more about the complications of hand tendon repair.




Page last reviewed: 08/10/2013

Next review due: 08/10/2015

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

rebeka193 said on 17 September 2014

my right hand's little fingers tendon was cut on wrist , it was repaired and 2 weeks later my plaster was open and i was hurt without plaster and exercised now i feel swallowing hot water kind of inside my hand then i was plastered again . But i feel no improvement. Is there any way to know my tendon is damaged again due to hard exercise and hurt only after 2 weeks platering???? please let me know how to get well from swallowing feeling and hot feeling inside ?????

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Kooshan said on 16 June 2014

Hi . nearly 4 years a go because of my old arthritis between my pinky finger joints and due to playing guitar and the need of pinky finger there , I went to do some physiothrapy on it.they did some gelling on my left hand pinky finger and internally warm it by some kind of tool that was placed on the finger,while the process was being done sometimes I felt real pain on my joint maybe due to warming it. after 10 session of doing it.I started to feel weird pain on that joint and also the area on the top of the joint swelled a little . now after 4 years still have the pain more than time before the physiothrapy process and still the swollen area hasn't changed.could you help me to what should I do to for recovery ? thanks.

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Frank237 said on 04 January 2014

I lacerated the extensor tendon at my middle finger on the right hand 100% just above the knuckle on broken glass whilst putting rubbish in my bin. I went to A+E thinking I would only need a stitch but was told what I had done was serious and it was explained to me the what the actual injury was and that it could take up to twelve weeks to get back to work. Two days later I was in Day surgery for a operation to repair the injury, I was told it would be a GA and not to eat however it took that long waiting I was offered a LA which I took. A large splint was put on for ten days after which a light splint for seven days, I then got my stiches out and the light splint on for a further three weeks. Next the splint was removed and I attended physio for nine weeks where I found the recuperation painful however it was worth the agony and I am now back to work with a working finger and hand. My advice would be to take the surgeons advice and don't rush it.

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User611626 said on 31 October 2011

The majority of flexor tendon injuries are repaired by plastic surgeons, rather than orthopaedic surgeons

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