Tendon Injuries in the Hand
When any of the tendons in your hand are lacerated (cut) or pulled off their insertions, their function is lost. For that tendon to work again in the future, treatment most commonly takes the form of surgery followed by hand therapy.
Hand Tendon Injury Treatment Options
If the tendon is lacerated or avulsed (pulled off the tendon’s insertion point), an operation to identify the ends of the damaged tendon and repair the ends together, or the avulsed tendon back to its insertion, is usually required. When repairing tendons, we typically stitch them using strong, carefully placed sutures, but even after repair, damaged tendons are not as strong as the undamaged tendon. Strength will come back to the tendon as the tendon heals. A slightly different injury is called a mallet finger, in which the extensor tendon is avulsed from the end of the back of your finger. This injury is usually best treated with a splint without surgery for six weeks, and thereafter at night and during heavy activities for a further four weeks. Using a splint only for most mallet injuries gives the best result, although the site of injury will be slightly tender and inflamed for some months. There is always a small loss of straightening in the finger long term due to the injury, although this is reduced by the treatment in the splint.
A six week rehabilitation period with a splint is required following most tendon surgery, this is necessary to protect the tendon while it heals. No heavy activity is allowed until three months post surgery because the tendon repair may fall apart before it is robust enough to withstand force or heavy weights.
In about 5% of tendon repairs, the repair will fail necessitating further surgery. In a further 5% of repairs, the tendon sticks down, and an operation called a tenolysis is required to free the tendon after a certain amount of months following the original surgery. Please note that there is a risk of infection and nerve or blood vessel injury associated with the procedure, and it is uncommon to return completely to normal following treatment. Outcomes are usually good and considerably better than without intervention.