Tendons are cord-like extensions, which connect muscles to bone. As the muscles tighten, the attached tendons will pull on certain bones and elicit motion. Tendon anatomy in the hand is delicate and intricate and so is the surgery required to restore it after injury. In brief, the palm and inner side of the forearm mainly contain tendons which bend (flex) fingers and wrist (flexor tendons). On the back of the hand and forearm lie tendons which straighten (extend) fingers and wrist (extensor tendons). Most of these long muscles originate at the elbow and forearm regions, turning into tendons just past the middle of the forearm, and attach to the bones of the fingers and palm. In the finger, the tendons pass through very narrow tunnels that keep them close to the bones and facilitate their action and gliding.
Tendon injuries are common. Our hands are constantly involved in daily activities and relatively superficial location of tendons in the hand, especially in the fingers, renders them susceptible to trauma. A cut tendon cannot heal without surgery. The severed ends separate from each other due to inherent tension present in all tendons. An injury that appears simple on the outside can be much more complex on the inside. Nearby nerves and vessels injuries often accompany tendon lacerations so may need to be put together as well.
It is important to repair these injuries early (within few days from an accident) in order to facilitate good long term results. Specialist expertise in dealing with these sophisticated structures, as well as dedicated hand therapy help such goal.
Tendon surgery is carried out on a day care basis. Extensor tendons are easier to reach, so repairing them is relatively straightforward. Many can be done under local anaesthetic, but more extensive ones will require general or regional anaesthesia. The simplest and smallest extensor tendon cuts can sometimes even be fixed in the Accident and Emergency department.
Repairing flexor tendons is more challenging because the flexor tendon system is more complex and responds worse to consequences of injury and scarring. Flexor tendon repair usually needs to be carried out under either general or regional anaesthesia, ideally by an experienced hand surgeon.
Tendons ends need to be stitched together in a very particular way: repair must be robust enough to withstand future strong forces, but also neat and elegant not to compromise gliding of the tendon within the narrow tunnel. At the end of operation hand is bandaged and splinted from the tip of the fingers up to the elbow.
Rehabilitation includes wearing a custom made splint for minimum of 6 weeks. During that time fingers however have to be mobilised to stop repaired tendons sticking to nearby tissues i.e. prevent adhesions around tendon which can compromise tendon gliding and ideal outcome. Specialist hand therapist guidance is indispensible in conducting this process.
It takes 6-8 weeks for repaired tendon ends to bond together and another 6-8 weeks for that repair to regain full biomechanical strength. During those 3 months hand therapy is essential yet demanding, but without compliance and dedications with therapy there is no successful recovery from tendon surgery.
Return to work will depend on your job and exact injury details, but tendon injury and its surgery (especially flexor tendon repairs) can affect your work for a considerable length of time. Light activities can often be resumed after 6-8 weeks and heavy activities and sport after 10-12 weeks.
After an extensor tendon repair you should predictably have well working finger or thumb. 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 because they’re often put under more strain than extensor tendons. Also, the flexor system is based on intact, smooth, gliding mechanism yet scarring is inevitable after injury and surgery and it interferes with such fine physiology. This is why after a flexor tendon repair, it is common for some fingers to not regain full movement. However, surgery executed early and competently provides the best chances for good recovery.
Potential risks and complications
Unfortunately, complications can occur following any surgery. Please note below the commonest complications associated with tendon surgery:
- Infection and wound breakdown
- Repair failure/ rupture (5-15% cases) requiring additional surgery
- Adhesions/scarring around tendon repair requiring further surgery
- Stiffness (reduced range of motion)
- Complex Regional Pain Syndrome (CRPS) – rarely people are sensitive to hand surgery and their (seen in 5% of surgery) hand may become very swollen, painful and stiff after any operation.
- Scar sensitivity
It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery.
- Plan your time off school / work / sports.
- Allow at least few weeks after surgery before considering a holiday.
This leaflet provides only basic and generic information, but full details and explanations are provided at the consultation as no two patients are the same and each person’s circumstances are highly individual.
If you have any concerns following your surgery please contact:
Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
|Hospital stay||Day care|
|Anaesthetic||General or Regional|
|Surgery time||30-90 minutes|
|Skin healing||2 weeks|
|Tendon healing||12 weeks|
|Shower / Bath||from week 2|
|Time off work||8-12 weeks those involved in manual activities | 2-3 week for office based work|
|Sports and exercise||from 3 months|
|Driving||4-6 week; please check details with your insurance company|
|Full recovery||12-16 weeks|