Tendon Injury Treatment
Tendon cuts in the hand and fingers, especially flexor tendons, need early surgical repair and careful rehabilitation. The aim is to restore finger movement.
The tendons of the hand transmit the power of the forearm muscles to the fingers, allowing them to bend and straighten. Tendons on the palm side bend the fingers (flexor tendons), and those on the back of the hand straighten them (extensor tendons). Cuts from knives, glass and metal, workplace accidents and sports injuries can divide tendons.
Symptoms
- Inability to bend or straighten a finger after a wound
- One finger resting differently from the others when the hand is relaxed
- Numbness in the finger (an associated nerve injury)
- Sometimes a small wound hides a serious tendon cut
Diagnosis
The diagnosis is usually made on examination, testing each finger and each joint separately. Nerve and blood vessel injuries are also assessed. Ultrasound or MRI can be used when needed.
Treatment
Flexor tendon injuries
Flexor tendon cuts do not heal on their own and need surgical repair. Repair should be done within the first days after injury; as time passes, the tendon ends retract and repair becomes harder. The ends are joined with special suture techniques, and any nerve and vessel injuries are repaired at the same time.
Extensor tendon injuries
Some extensor injuries on the back of the hand are treated with a splint, but most are stitched. Extensor tendon ruptures at the fingertip (mallet finger) usually heal in a splint.
Late injuries
When injuries have been left untreated for a long time, direct repair may not be possible. Reconstruction with a tendon graft or tendon transfer is then used.
Hand therapy after surgery
After tendon repair, rehabilitation is as important to the outcome as the surgery. A special splint and a controlled early movement programme help the repair heal without breaking and without sticking to surrounding tissue. The programme is usually carried out with a hand therapist over several weeks. Strengthening and heavy use start after a few months.
What to do at the time of injury
When the hand or a finger is cut, press a clean cloth on the wound to stop the bleeding, keep the hand above heart level and seek care as soon as possible. Even if the wound looks small, loss of finger movement, numbness or a finger resting differently suggests a tendon or nerve injury. Simply stitching the skin in these injuries can leave the tendon unrepaired.
Differences by zone
Repairs where the flexor tendons run inside a narrow sheath and pulley system in the finger are technically more demanding, and the risk of adhesions after surgery is higher. Injuries in the palm and forearm often involve several tendons together with nerves and vessels. The treatment and rehabilitation plan is tailored to the zone of injury.
Adhesions and second operations
As a repaired tendon heals it can stick to surrounding tissue and limit finger movement. Controlled early movement programmes are used to reduce this risk. If marked stiffness remains despite adequate hand therapy, a second operation to free the tendon (tenolysis) may be needed, usually planned after the tendon has fully healed.
Returning to daily life and work
Desk work may be possible within a few weeks, even while wearing the splint. For jobs that need a strong hand and for sport, return usually takes a few months, so that the repaired tendon becomes strong enough.
Frequently asked questions
How soon after a tendon cut should I have surgery?
As soon as possible. Especially for flexor tendons, repair in the first days gives better results.
Will my finger be exactly as before?
Many patients regain good function. The site of injury, any nerve damage and following the rehabilitation programme all affect the result. Some patients keep a slight loss of movement.
Can the repaired tendon break again?
Removing the splint early or straining the finger can rupture the repair. Following the hand therapist's advice reduces this risk.
Are nerves affected in tendon cuts?
In palm and finger injuries in particular, the nerves running alongside the tendons can also be cut. If the finger is numb, the nerve is repaired in the same operation.
How long will I need hand therapy?
Usually a few months, with more frequent sessions in the first weeks and fewer later.
How long is the splint worn after tendon repair?
A protective splint is usually worn for several weeks, with controlled exercises under a hand therapist during this time.
How will I know the tendon has healed?
Healing is followed at check-ups by assessing finger movement, strength and hand function. Less pain alone does not mean full healing.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.