Tendon repair, hand

Introduction

Tendon repair of the hand is surgery to repair damaged or divided tendons. Most damaged tendons result from cuts to the hands from broken glass or knives.

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 finger and thumbs
  • flexor tendons - which also run from your forearm, through your wrist and across the palm of your hand, allowing you to bend your fingers

Why do I need tendon repair surgery?

Tendon repair of the hand is necessary when one or more tendons in your hand are divided or ruptured (split), 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 cause pain and inflammation (swelling) in your hand. Some common causes of tendon injuries are described below.

  • Cuts - Cutting your hand can result in an injury to your tendons.
  • Sports injuries - Tendons can be overstretched and rupture when you take part in sport. This is more common in contact sports such as football and rugby or activities that involve a lot of gripping, such as rock climbing.
  • Bites - Animal bites can cause tendon damage. However, human bites are a more common cause and most often occur 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 arthritisRheumatoid arthritis can cause your tendons to become inflamed. In the most severe cases, this can lead to tendons rupturing.

Tendon repair surgery

Tendon repair involves making an incision in your hand to locate the ends of the divided tendon, and then stitching the tendon ends together.

Extensor tendons are easy 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 complex because they can be difficult to get to and are often located near important nerves. Flexor tendon repair usually needs to be carried out under general anaesthetic in an operating theatre by an experienced plastic or orthopaedic surgeon who specialises in hand surgery.

Read more information about how hand tendon repair is performed.

Recovering from surgery

Both types of tendon surgery require a lengthy period of rehabilitation because the repaired tendons will be very weak until the ends heal together. Depending on the location of the injury, recovery can take between one and three months.

Rehabilitation involves protecting your tendons from overuse using hand splints. A hand splint is a rigid support worn around the hand, which is designed to hold your hand securely in position to prevent excessive movements that could cause the tendon to rupture while it is healing. You will also need to do hand exercises regularly to prevent the repaired tendons from sticking to nearby tissue.

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 tendon repair of the hand.

Hand splints

You will need to wear a hand splint after surgery to protect the repaired tendons from damage. In cases of extensor tendon repair, you will need to wear the splint all the time for at least four weeks, then at night for a further two weeks.

In cases of flexor tendon repair, you will need to wear the splint all the time for at least four to five weeks, then at night for a further two weeks.

Outlook

After an extensor tendon repair you should have a working finger, 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 responsible for carrying more force than an extensor tendon. After a flexor tendon repair it is quite common that some fingers will not regain full movement, although the tendon repair will still give a better result than no surgery.

In some cases there can be complications after surgery, such as infection or the repaired tendon ‘snapping’ or ‘sticking’ to nearby tissue. Read more information about the complications of tendon repair of the hand.

Last updated: 11 April 2012

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