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Flexor Tendon Injuries

Tendons are bands of tissue that connect muscles to bone. In the hand, the tendons control the movement of the hand and fingers. They allow the fingers to bend, straighten out, grab, and grip. The flexor tendons are long rubberband-like structures that run along the palm of the hand and along the fingers on the palm side. The muscles of these tendons run through the forearm. The tendons travel along tunnels which hold the tendons in place and keep the tendons lubricated so they can slide through the tunnel smoothly. The flexor tendons control the bending of the fingers.

Injuries to the flexor tendons

Injuries can occur if there is a cut to the hand or fingers, or if some type of force causes the tendon to be pulled off the bone. These injuries are commonly seen in football, rugby, wrestling, and jiu-jitsu. Jersey finger is an injury that is caused by fingers getting caught in someone’s jersey and the fingers are forcefully pulled upon. Most often, this occurs with the middle finger. Activities that require significant hand strength like rock climbing can also put strain on the flexor tendons causing tears or ruptures.

Symptoms

A flexor tendon injury may include a cut or open wound on the palm side of the hand, wrist, or forearm. Inability, or limited bending, of the finger, may be present. There may be pain with bending the fingers. The tendons may be tender when pressure is applied to the palm side of the hand or finger. Numbness and poor blood flow to the fingers may also be present if there is also injury to the adjacent nerves and arteries of the fingers.

Diagnosis

In the presence of a cut or an open wound, immediate measures should take place to prevent complications such as excessive bleeding or infection. The wound should be irrigated with saline to keep prevent infection. Dressings or bandages may be applied to slow bleeding. A tetanus shot may be included. If the cut is deeper than the skin, this should be evaluated by a medical professional. If the tendons are completely cut, they should be repaired surgically within 7-10 days for the best recovery results.

A medical provider will perform a physical examination if a flexor tendon injury is suspected. They will check the blood flow by applying pressure and releasing it to see how quickly blood returns to the area or finger. They will test if you can feel an object touching the skin in the hand and fingers. They will see if you are able to bend the finger on your own. The examiner may hold down other fingers, or certain joints so they can check which specific parts of your finger you are able to bend. They will test the strength of your fingers.

An x-ray may be ordered to evaluate for fractures and dislocations.

Treatment

If there is an open wound, this will be cleaned to prevent infection. If there is a partial tear of the tendon, a splint may be applied to restrict motion for a temporary period to allow the tendon to heal.

If the tendon is completely torn, surgery is usually indicated to repair the tendon. A splint may be applied after surgery to decrease the amount of movement of the affected tendon to allow for healing. Therapy and exercises are usually needed to restore motion in the affected hand or fingers. These injuries take approximately 3-4 months to heal completely. One of the biggest complications after these injuries is stiffness. This is the reason therapy and exercises are a vital part of the recovery process.

Flexor tendon injuries can be very challenging to treat, as many patients develop stiffness and poor function of a digit after flexor tendon injury and repair. It is very important to be seen quickly if you think you may have a flexor tendon injury. It is also essential to work with therapy and follow all instructions after you undergo a flexor tendon repair to get the best results possible. Recent advances in surgical technique have improved outcomes, and many patients are able to restore function and return to active lifestyles.