Hand Tendon Injuries

Tendons are the continuation of muscles which transmit the force of muscles to the bone it attaches to around a joint to generate motion.

Pathology

Tendons are the continuation of muscles which transmit the force of muscles to the bone it attaches to around a joint to generate motion. After a laceration that is more than 30 % the diameter of the tendon, there is significant loss of resistance to withstand tension. In addition, if left untreated, the lacerated part can catch with surrounding tissue and create an impediment to free gliding. More importantly, only a formal exploration can reliably confirm the number and severity of the structures injured. Tendons take approximately 6 weeks to reach 80 % of what will be their final strength and approximately 10 weeks to reach 95 % of their final strength. There are several techniques for tendon repairs using different patterns of suturing techniques, and different types and sizes of suture material used in combination to approximate the tendon core and periphery. The resultant strength of the repair and the type of post operative therapy will change according to the above variables.

Treatment

Tendons lacerations about the hand are repaired with sufficiently strong, non-bulky suture techniques that permit early mobilization. A meticulous technique is critical to allow proper tendon gliding to avoid adhesions (stuck tendons) from forming. This is particularly important for the hand at the finger level (zone II) where the flexor tendons run through a tight fibro-osseous tunnel that is at risk for restricted motion if a bulky repair is done, that places the repair at high risk for rupture. This area (zone II) in the digits was dubbed by hand surgeons “No Man’s Land”, due to the technical difficulty of repair imposed by the pulley system and the poor results that were historically obtained. The surgeons at ROC have specialized training to perform these techniques with optimal results obtained for many years. When there is a significantly large defect on the tendon that does not allow for primary repair, a tendon graft or tendon transfer is performed. A repaired or reconstructed tendon will require initial protection in a splint. The use of updated techniques and the creation of strong tendon repairs permit the early initiation of a safe and well structured hand therapy program. A hand therapy program for tendon repair will initially focus on techniques to control pain, decrease swelling/edema, initiate and increase protected tendon gliding, advance to differential gliding and provide tendon/muscle strengthening.