Tendons are tough cords of tissue that connect muscles to bones. When the muscle contracts (tighten), the attached tendons will pull on the bones, resulting in movement across the joints.
If any of the hand tendons are damaged, the movement of the fingers and thumb will be affected. Surgery may be needed to repair them and help restore movement in the affected fingers or thumb.
Common causes of tendon injuries
- cuts – cuts across the back or palm of your hand can result in injury to your tendons which lie just beneath the skin
- sports injuries – tendons can rupture when stubbing a finger, such as trying to catch a ball; tendons can occasionally be pulled off the bone when grabbing an opponent’s jersey; and the pulleys holding flexor tendons can rupture during activities that involve lots of strenuous gripping, such as rock climbing
- bites – animal and human bites can damage tendon. A person may damage hand tendon after punching another person in the teeth
- crushing injuries – jamming a finger in a door or crushing the hand in a car accident can divide or rupture a tendon
- rheumatoid arthritis – rheumatoid arthritis causes tendon inflammation, which in severe cases can cause rupture of tendons
Treatment of Tendon Injury
Some tendon injury can be treated with a finger splint such as mallet finger injury and boutonniere injury. The splint positions the finger joint at a position that approximates the two tendon ends.
However, majority of the tendon gets retracted considerably after cut or rupture and they require surgery to bring the two ends together.
Tendon repair surgery
Incisions are made to locate the ends of the divided tendon and to stitch them together. The wounds are then closed and dressed and the hand and fingers are protected in plaster splints.
In some cases, it isn’t possible to reattach the two ends of the ruptured tendon. This may be because the ends of the tendon are too frayed or shortened due to tendon loss. In these circumstances, surgery may be carried out to detach a tendon from one of your healthy fingers (each finger has two flexor tendons connected to it) and reattach it to the damaged finger or thumb. This is known as a tendon transfer.
Some common complications of tendon repair include infection, the tendon rupturing and the repaired tendon sticking to nearby tissue.
After surgery, patient will require a period of recovery (rehabilitation) because the repaired tendons will be weak until the ends heal together. Depending on the location of the injury, it can take up to three months for the repaired tendon to regain its previous strength. Rehabilitation involves protecting the repaired tendons from repair failure using a hand splint which need to be worn for several weeks after surgery till the tendon heals. Hand exercises need to be performed regularly during recovery to stop the repaired tendons sticking to nearby tissue, which can lead to finger stiffness.
Return to work
Time to return to work will depend on the occupation. Light activities can often be resumed after 6-8 weeks and heavy activities and sport after 10-12 weeks.