Tendon injuries in the hand and arm either involve the flexor tendons, i.e., those tendons that help bend the fingers, and/or extensor tendons, those to help straighten out the fingers. The healing process and incidents of complications are very different for each tendon injured. Flexor tendon injuries often occur when the patient is cut by a sharp object such as a glass and/or knife. Evaluation of a patient with a laceration is critical to determine whether a tendon injury is present. If the patient has difficulty in flexion of the fingers, i.e." making a fist, one must assume that there is serious damage to the tendon. Surgical intervention is then indicated on an urgent basis. If a tendon repair is not performed within a period of 10 to 15 days subsequent to the injury, then often the primary repair, i.e., sewing one end of the tendon to the other, cannot be done and then a more complicated surgical reconstruction might be indicated with the use of a tendon graft.
The surgical procedure in the primary repair or secondary repair of a flexion tendon is done under regional anesthesia on an outpatient basis. Subsequent to the surgical procedure, the patient requires very specialized therapy under the care of an occupational therapist to regain maximal function within the hand and fingers. Typically, there is immobilization and protection of the surgically repaired tendon for a period of 4 to 6 weeks.
Prior to the elimination of the splinting protection, specialized therapy can be initiated, if appropriate, to regain better motion in order to diminish the chance of adhesions and also promote greater tendon healing. Again, this must be prescribed by the treating surgeon and done under the care of an occupational therapist who has specialized training in this field. Extensor tendon injuries present with an inability to extend the finger and/or wrist. These injuries tend to be more forgiving with regard to the development of adhesions and stiffness within the fingers. Again, these injuries must be addressed on an urgent basis within a timely course of treatment. Usually, the patient is immobilized for approximately 4 weeks in a cast subsequent to the tendon repair and then begins the therapy protocol as well to regain maximal function within the hand and wrist.