Signs and Symptoms
- Unable to extend the joint(s) distal to the injury. It is important to note that because of the anatomy of the hand this may not always be the case. You could still cut a tendon and move the joint beyond it.
- Pain, especially with motion
- Skin cut (laceration). The tendons are very close to the skin and are easily injured with what may be a simple cut to the skin. It is important to have these evaluated soon after injury. If ignored they can lead to deformities of the finger and then loss of function.
Diagnosis
- History and Physical exam can usually provide all the information necessary
- MRI is occasionally required especially in older injuries
Background
The extensor tendons are located on the top/back of the forearm, running from the outside of the elbow (lateral epicondyle) to the top of the wrist and fingers. “Extensor tendon” is a general term we use to describe any one of the multiple tendons that serve to extend (or straighten) the wrist and finger joints.
Extensor tendons are often injured through cuts or trauma, sports-related injuries, crush injuries, animal bites, car accidents, shattered glass, etc. The rehab process will vary depending on where the injury happened on the body, and which structures were damaged — however, this is simply a general description of roughly what to expect during surgery recovery and healing, for injuries in the area between the fingernails and the wrist.
Treatment
Conservative (Non-Surgical)
- Only for those injuries with very minimal tendon involvement. The tendon would need to be evaluated either by the Surgeon (direct visualization) or MRI in order to make this determination.
- Splinting
- Hand Therapy
Surgery
- In order to explore the injury and determine the tendon involvement
- The tendons can be directly repaired if the injury is within three weeks
- Grafting of tendons or using non injured adjacent tendons (tendon transfer) may be required if there is significant loss or injury of the tendon or the injury is older than three weeks.
Hand Therapy
Week 1:
- One week after surgery, the bulky dressing will be removed. Compressive gloves, fingersocks, or dressings may be applied for swelling management. Your therapist will create a custom-fitted splint for you to wear, which will keep your fingers/hand protected. The splint design will vary based on your injury, but often stretches from the mid-forearm down to the finger tips. It is extremely important to wear this at all times; keep it on during the day and night, during showers (cover it to keep it dry), and during all activities.
- Sutures are typically removed between 10 and 14 days post-op. At this point, your therapist will begin manual massage techniques to reduce the swelling and soften scar tissue formation.
Week 3-5:
- After 3 weeks, or as soon as it is deemed safe, your therapist will instruct you in gentle exercises involving your wrist and fingers. You should perform these multiple times every day. Continue wearing your splint at ALL TIMES, except when completing the exercises. Your therapist will show you how to carefully take your splint off and put it back on to prevent damage to your healing hand.
- Your therapist may begin to incorporate other techniques into your sessions to help the tendons move freely, prevent excessive scarring, and help improve inflammation and swelling. This could include therapeutic ultrasound, manual massage, neuromuscular electrical stimulation, compression, and other methods. Post-op discomfort will typically have improved quite a bit by this point in time.
Week 5-6:
- If all has gone well up to this point, you will be able to gradually stop wearing the initial splint. Depending on how your range of motion has progressed, a smaller splint may be created for you to position your fingers and maximize range of motion. Continue exercises that are provided to you, but even if your splint is discontinued, do not attempt a tight grip, and do NOT squeeze your hand against resistance (this includes avoid any stress balls, tennis balls, hand exercisers, foam blocks, etc). Your repaired tendon is still very much healing, and still at high risk of ruptures/tears if you squeeze your hand/fingers.
Week 7-10:
- Depending on the type and location of injury, gentle strengthening may be initiated around this time. Carefully follow your therapist’s instructions — strengthening is easy to “over-do,” and you can end up doing more harm than good if grip strength exercises are done recklessly or excessively. Keep in mind that strength is typically pretty easy to regain once you start the exercises, so try to be patient. There is no need to rush into it too early in the rehab process.
- Your therapist and doctor will advise you on when you can return to specific activities such as work, sports, and home activities. The timeline for returning to these activities is difficult to generalize, and will be specific to the person, the injury, and the situation. Do not hesitate to ask questions, and always err on the side of caution. Tendon repairs are fragile, complex injuries.
