What you should know about extensor tendon surgery

Extensor tendons are located on the back side of the hand, and are responsible for extending the fingers. They connect the muscles of the forearm with the bones in the fingers, and they are sturdy cords that glide smoothly across the bones in the wrist and the hand. A complicated sheet of tendon fibers covers the back of the fingers, and short extensor tendons are connected to a longer tendon at the base of each finger. When the forearm muscles contract, it causes a series of pulling motions that open the hand and extend the fingers.

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Because they lie just below the surface of the skin, a cut across the back of the hand, wrist, or fingers can potentially sever the extensor tendons. These tendons are exposed when damage occurs near the joints on the back of the hand, or when the tip of the finger experiences localised trauma.

How can you tell when an extensor tendon has been injured?

The most common types of injuries to extensor tendons result from significant cuts to the back of the hand, and can be damaged from animal bites, severe burns, or direct trauma. When these tendons have been damaged, it is impossible for the patient to straighten their fingers, and the affected fingers will hang limply. The best way to be certain is by seeing a medical professional as soon as the injury occurs.

What is the difference between extensor and flexor tendon treatments?

Extensor tendon injuries are more challenging to treat because the hand must heal in an open position to allow for the tendons to regain their full tension. Unlike flexor tendons, extensor tendons are not located in sheaths, and this prevents them from fully retracting after surgery.

Flexor tendons are thicker and rounder than extensor tendons, and that makes it easier for surgeons to reconnect severed flexor tendons. Because extensor tendons are flat and not as wide, they are vulnerable to sticking as they contract, and may shorten after surgery. When this happens, the patient has a limited range of mobility, and it can affect the functionality of their fingers.

What are the available treatments?

Extensor tendons can only be repaired through tendon hand surgery, and you will need to find a specialised surgeon to help you repair the damage. Tendons must be operated on within a certain amount of time, and if you are having trouble opening your hand, you should seek medical help immediately.

The typical procedure for surgeons is to remove any sensation of pain from the patient with anaesthetic, and stitch the tendon back together. It is important to participate in physical therapy within a few days of surgery so you can begin to recover from this serious injury. Your arm will be immobilised for about six weeks, and it may take three months before you regain function in your hand.

What are the potential consequences of this surgery?

Hand tendon surgery is the best option after an injury to the extensor tendon, but it may not fully restore the mobility in the affected fingers. If the injury was more severe, than you may be working towards restoring your hand’s functionality for a long time. After surgery you want to take it slowly, and give your body enough time to properly heal. If you rush into things too quickly, you can break the tendon and need surgery again. The sensation is described as a soft snap in the finger, and you will notice that your finger does not move like it did just before. Sometimes scar tissue can develop after some time, and another surgery may be required to remove the unwanted tissue to promote better movement.

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