Types of surgery - Hand tendon repair

Surgery is a treatment option to repair damage to tendons in the hand. The aim of surgery is to restore movement in your fingers or thumb.

Tendons are cords of tissue that connect muscles to bones.

Damage to tendons in your hands

Tendon damage can cause pain, swelling and problems moving your hand.

Common causes of damage include:

• cuts across the back or palm of your hand
• sports injuries - from sports that involve grabbing or strong gripping
• bites - animal and human bites, or punching another person in the teeth can cause damage
• crushing injuries - jamming a finger in a door or crushing a hand in a car accident
• rheumatoid arthritis - can cause tendons to become inflamed and rupture in severe cases

The 2 groups of tendons in the hand are extensor tendons and flexor tendons.

Extensor tendon damage

Extensor tendons run from your forearm across the back of your hand. You use them to straighten your fingers and thumb.

If you damage your extensor tendons, you may not be able to straighten 1 or more fingers.

Sometimes you can treat damage to the extensor tendons with a rigid support called a splint.

Flexor tendon damage

Flexor tendons run from the forearm through your wrist and across your palm. You use them to bend your fingers.

If you damage your flexor tendons, you may not be able to bend 1 or more fingers. Your finger may feel numb due to injury to the nerves. These are located near the tendon.

Tendon repair surgery

Tendon repair is ideally done as soon as possible after the injury. It is emergency surgery and should be repaired within days.

If the repair is delayed, a healthcare professional should clean the wound, remove any damaged tissue and close it temporarily.

Treating the injury early can help prevent scarring, infection, and stiffness or loss of movement.

Before the surgery, you may need:

• x-rays of your hand and forearm - to check for pieces of glass or any other damage, such as a fracture
• antibiotics and a tetanus injection - to prevent infections

The tests and treatment you need depends on your injury.

Extensor tendon repair

For an extensor tendon repair, you may have a:

• local anaesthetic - an injection that numbs part of your arm
• regional anaesthetic - an injection that numbs your whole arm
• general anaesthetic - where you are not awake for the surgery

Your surgeon will:

1. Clean the area and remove anything from your wound.
2. Make a cut in your hand or make your wound larger to identify the cut end of the tendons.
3. Stitch together the 2 ends of the tendon.
4. Close the wound with stitches.

Sometimes it might not be possible to repair the tendon and a tendon graft or a tendon transfer may be necessary.

You may need to wear a rigid splint on your hand. This stops you from fully moving your hand until your tendons heal.

In most cases, your finger or thumb will work again after an extensor tendon repair. But you may not get back full movement. The outcome is often better when the injury is a clean cut to the tendon.

Flexor tendon repair

Flexor tendons are usually repaired using a local or regional anaesthetic. In some cases, you may need a general anaesthetic.

Your surgeon will typically:

1. Wrap a tourniquet (a cord or tight bandage) around your upper arm.
2. Make a cut in your hand or make your wound larger to get to the tendons.
3. Stitch together the 2 ends of the tendon.
4. Close the wound with stitches.

Tendon reconstruction

Sometimes it is not possible to repair the ends of the torn tendon. This may be because the ends of the tendon are too frayed.

In these cases, you might need tendon reconstruction. This usually means using a tendon graft to join the two ends of the tendon.