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Flexor Tendon Injuries
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The muscles that bend (flex) the fingers are called flexor muscles. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone.
The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers . In the finger, the tendons pass through tunnels that keep them close to the bones, which helps them work better.
The tendons can be damaged by any cut across the palmar surface of the wrist or hand, especially at the finger creases where the tendons lie just under the skin. Occasionally, the tendon is detached from the bone by a violent pulling injury to the finger.
The Nairobi Spine orthopedic center hand surgery team is fellowship trained and specializes in the treatment of flexor tendon injuries, from simple to complex. Our goal is to restore mobility and function of the fingers as soon as possible with minimal impact on the patient’s quality of life.
Signs and symptoms of Flexor tendon injuries
Flexor tendon injuries symptoms may vary from person to person. Below are some of the common signs and symptoms
A wound across the palm or fingers
Inability to bend the finger either partly or totally
Finger lying out straighter than the adjacent digits.
Pain when trying to bend the fingers
There may also be numbness of the finger due to injury to the nerves, which lie close to the tendons.
Causes of Flexor tendon injuries
The most common cause of a flexor tendon injury is a deep cut to the palm or the finger(s). When cut, the tendon acts like a rubber band, and the end pulls away from one another. When this happens it becomes impossible to bend your finger(s).
If a tendon is partially cut, the finger may still bend a little. This usually painful and difficult.
The finger nerves are close to the tendons, and a deep cut may injure them as well. This will cause numbness on one or both sides of the affected finger.
Sometimes, the flexor tendon may tear or pull away from the bone. In sports, a player may grab another’s jersey, the finger may get caught in the fabric causing the flexor tendon to tear. This injury is called a “jersey finger”. People with advanced rheumatoid arthritis may experience a spontaneous flexor tendon rupture.
Risk factors and Diagnosis of Flexor tendon injuries
Whether it takes place in an emergency room or office visit, a thorough physical examination and discussion of the patient’s medical history and symptoms will help diagnose flexor tendon injuries.
There are several factors that can increase the risk for flexor tendon injuries:
- Cuts to the arm, hand or fingers
- Sports activities, such as football, wrestling, rugby and rock climbing
- Chronic illness such as rheumatoid arthritis where muscles are weakened and more likely to tear
Treatment of Flexor tendon injuries
Tendon repair.Cut tendons do not heal by themselves; the tension in the tendon causes its cut ends to separate. Without surgical repair, there is no prospect of regaining the movement that has been lost.
The repair may be performed under general anaesthetic or regional anaesthetic. The wound is enlarged so that the cut ends of the tendon can be found and held together with stitches.
At the end of the operation the hand and forearm are immobilised in a plaster splint that is placed over the bandages with the wrist and fingers in a slightly bent position, in order to protect the repair.
Certified hand therapists can custom fit a splint which, depending on the severity of the injury, may be used without surgery, or following surgery to allow the tendon to repair to fully heal.
At your first hand therapy appointment, your therapist will remove your post-op dressing and make a custom splint.
This splint will be worn full-time for six weeks.
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Other treatment options for Flexor tendon injuries
Hand therapy. The hand therapist will usually replace the plaster splint with a light plastic splint and start a protected exercise programme within a few days of the operation. The therapy programme after tendon repair is crucial and at least as important as the operation itself, so it is vital to follow the instructions of the therapist closely. The objective is to keep the tendon moving gently in the tunnel, to prevent it sticking to the walls of the tunnel, but to avoid breaking the repair.
Tendons will not heal unless the two ends are closely touching. The only effective treatment for a flexor tendon injury is to surgically repair the tendon(s) by sewing the cut ends together.