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Extensor Tendon Injuries

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Introduction

An extensor tendon injury occurs when the tendon is torn, cut or otherwise detached.  The extensor tendons are attached to the back of your fingers and thumbs.  They allow your fingers and thumbs to straighten and perform fine coordinated movements.  Extensor tendon injuries can result from trauma, burns, or arthritis.

Extensor tendon injuries cause loss of movement, pain, and swelling.  Some extensor tendon injuries are treated with splinting and hand therapy.  Surgery may be necessary in cases of tendon separation, fracture, or malalignment.

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Anatomy

Your hand is composed of many bones that provide structure for your wrist and fingers.  Your fingers and thumbs are made up of bones called phalanges.  The bones are connected with strong ligament tissues.  Tendons are strong fibers that attach your muscles to your bones and allow movement.  Your hand also contains nerves, blood vessels, and fat.
 
Your flexor tendons begin in your forearm and continue to the palm side of your fingers and thumb.  Each finger has two flexor tendons and your thumb has one.  They are located just underneath the skin.  A sheath thickened in areas by fibrous pulleys guide the flexor tendons and keep them close to your phalanges during motion.  The flexor tendons allow your fingers and thumbs to bend, grasp items, and perform fine coordinated movements.  The nerves in your fingers(digital nerves) travel parallel and along both sides of the flexor tendons.
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Causes

Arthritis, burns, and injuries, such as cuts or jammed fingers, can cause extensor tendon injury.  Boutonniere deformities and mallet finger injuries are specific types of extensor tendon injuries.  An extensor tendon may be partially or completely cut.  It can remain intact but pull a piece of bone away from where it attaches on the phalanx.  This is called an avulsion fracture.
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Symptoms

An extensor tendon injury can cause your finger or hand to feel painful and swollen.  It may be difficult or impossible for you to extend your finger. 
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Diagnosis

Your doctor can diagnose an extensor tendon injury by reviewing your medical history and examining your hand.  X-rays help identify an avulsion fracture or joint malalignment.  
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Surgery

There are many ways to surgically repair flexor tendons.  Certain types of injuries need specific types of surgery.  Your hand surgeon will stitch the ends of the tendon together and repair damaged nerves, blood vessels, or bones.  Your hand will be immobilized with a splint to allow the flexor tendon to heal after surgery.
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Treatment

Flexor tendon injuries do not heal well without surgical repair.  When a flexor tendon separates, the two ends pull away from each other, making it impossible for the tendon to heal without surgery.
 
Surgical treatments and splinting are followed by hand therapy.  Your doctor will place your initial splint in surgery which is generally replaced by a light weight splint made by a therapist soon after surgery.  Your therapist will show you initial exercises to promote tendon gliding and help avoid stiffness.  The other joints in your fingers may become stiff and benefit from hand therapy as well.  Your therapist will teach you more active tendon gliding exercises when your doctor indicates that it is safe to do so.  Your rehabilitation program will advance to include exercises for strength, flexibility, coordination, gripping, and   pinching.  The goal of therapy is to optimize return of function.
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Recovery

Hand therapy rehabilitation and continued splinting follow flexor tendon repair surgery.  Hand therapy will help you regain strength, flexibility, motion, and functional use of your hand.  Recovery from flexor tendon surgery is very individualized, and rarely is full normal motion regained.  Therapy protocols vary, and will depend on the nature of your injury and repair.  Splint protection is generally required for six weeks.  Healing continues for three months after repair.  Your doctor will let you know what to expect.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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