Hand tendon, repair

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.