Tendon Lacerations

Hand
  • Carpal Tunnel Syndrome
  • Cubital Tunnel Syndrome
  • Trigger Finger/Trigger Thumb
  • Basilar Thumb Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
  • Dupytren’s Contracture
  • Tendon Lacerations
  • Tetraplegic Reconstruction

    Wrist
  • DeQuervain’s Tendinitis
  • Wrist Ganglion
  • Distal Radius Fractures
  • Scaphoid Fractures
  • Triangular Fibrocartilage Tear
  • Wrist Arthritis

    Elbow
  • Tennis Elbow
  • Distal Biceps Tendon Tear
  • Elbow Fractures
  • Elbow Ligament Injuries
  • Elbow Arthritis

    Shoulder
  • Rotator Cuff Tendinosis
  • Rotator Cuff Tear
  • Shoulder Instability/Dislocations
  • SLAP Lesions

    • Tendon lacerations in the hand are a serious problem, especially on the palmar side, where the flexor tendons are.  The anatomy of the tendon complex is complicated.  The flexor tendons have to go through sheaths (tunnels) in order to function properly.  There is a limited amount of space in these tunnels, and just a little bit of scar can cause the tendon to stick down so that the finger doesn’t move.

    Tendon lacerations are optimally repaired within 2 weeks, although due to people coming to the doctor late they’re often repaired after that.  However, this contributes to more scar formation.  In addition, when the tendon is cut and retracts, there’s nothing in the sheath (tunnel) to keep it open, and the tunnel narrows narrows.  If the flexor tendon isn’t repaired within a few weeks the narrowed tunnel pinches the repaired tendon, making it highly likely that the tendon will get stuck in the tunnel after surgery.
    In my opinion, flexor tendons should only be repaired by hand-fellowship trained surgeons.  The surgery is not very painful.  However, the hand therapy after surgery is very intensive.  This is a ‘big deal’ and can take over your work/school schedule for weeks after surgery.  However, it’s very necessary and the surgery will not work without the therapy. You’ll have permanent motion loss.

    The therapy is 3-4 days/week for at least 4 weeks.  A ‘dynamic flexion’ splint with rubber bands that pull the finger down is worn for 4 weeks to allow the finger to move without stressing the tendon repair.  There’s no functional use of the finger for 4 weeks following surgery.  No light lifting for 3 months and no heavy lifting for 4 months.

    Extensor tendon injuries (on the back of the hand) have classically been underestimated.  However, it has become evident that extensor tendon injuries have at least as many problems as flexor tendon injuries.  These should also optimally be fixed within a couple of weeks.  Depending on where the tendon laceration is, a finger joint may need to be pinned for 3-6 weeks to allow the tendon to heal.  Other times, early motion is started with a ‘dynamic extension’ splint with rubber bands that pull the finger into extension without stressing the tendon repair.  The amount of therapy required after surgery is often similar to that required for flexor tendon repairs.

    However, while these are very serious injuries, if the patient puts the time and effort into the therapy and observes the restrictions they’re given, good results are common.