Extensor Tendon Injuries

Extensor Tendon Injuries
February 24, 2017

“The positioning of the extensor tendons being superficially placed makes them prone to easy injuries. I have observed in my 25 years of profession that they are more difficult to treat in comparison to flexor tendon injuries that are in themselves complicated enough. Extreme skill in repairing extensor tendons is required because they are much flatter and thinner as compared to flexor tendons and also very closely located to the bones.” Pensively puts forth Dr. Gupta.

Pondering for a few moments he tries to explain what extensor tendon injuries are in simple terms, “The muscles that extend from the forearm and connect to the bones of the fingers and thumb running through the hand and wrist on the backside are termed as extensor tendons and they govern the straightening ability of the fingers. Not going much into intrinsic details I would just say that if you have a cut on the backside of your hand, wrist or finger by any blunt object or sustain an injury by jamming or crushing of the fingers which results in extreme pain while you try to straighten your fingers, seek medical advice for your extensor tendons may have been injured.”

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“After having performed surgeries on more than 6000 patients who had approached me with severe complexities, I believe that when a patient sustains an extensor tendon injury he should be very careful about consulting a hand surgeon and a therapist because hand therapy and the technique with which extension tendon injury is repaired are the key to complete and a little trifle recovery.”Dr. Gupta says gravely.

“We usually run a few physical and imaging tests including radiography on the patients to ascertain a conclusive presence of these injuries and then depending on the mechanism of injury we decide on the technique. Partial tear or cut in the tendons may be treated with splinting and therapy but usually the torn ends of a tendon need to be stitched back together surgically. Mallet finger or Boutonniere Deformity are an example of extensor tendon injuries.” Asserts Dr. Gupta calmly.

“And I would just say that patients should have their extensor tendons repaired else they might lose mobility in the fingers and thumb and be mentally prepared that the road to recovery and resuming activities is slow and difficult.”

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FAQ- Extensor Tendon Injuries

Injuries caused to the extensor tendons by mild cuts or jamming of a finger which may result in the tendons being ripped out from their bone and cause difficulty in straightening of finger joints are known as Extensor Tendon Injuries.
Tendons are tissues that act as connectors between muscles and bones. The movement ability in the fingers is governed by muscles that are located in the forearm. The strong cord like structures that connect the forearm and hand muscles to the fingers and thumb bones to enable straightening of the fingers are referred to as Extensor Tendons. They are located on the back side of the wrist, hand and fingers and run just under the skin.
When any cut at the back of the hand, wrist or fingers wounds or rips the tendons out from their bones extensor tendons get injured. As the tendons run very closely underneath the surface of the skin they easily get damaged by a mild or severe cut or crush to the skin. Depending on the joint of the fingers that sustain injury, extensor tendon injuries result in Mallet Finger (injury to the end joint of the finger) or Boutonniere Deformity (injury to the middle joint of the finger).
The signs that mark the presence of extensor tendon injuries are: - Prevalent cut on the back of the hand, wrist or fingers more so at the joints of the fingers
- Intense pain on straightening a finger / thumb
- Inability in fully straightening a finger/thumb
- Downward droop in a finger/thumb
Reasons for the infliction of Extensor Tendon injuries may vary from - Extreme load on the fingers
- Absence of subcutaneous tissue between the tendons and the skin
- Direct lacerations,
- Severe burns or bites
- Blunt trauma or deep abrasions
- Crush injuries
After a systematic and in depth examination of both the hands each extensor tendon is run through a passive and active range of motion against resistance and the patients have to undergo certain physical tests along with imaging tests such as radiography and x-ray to clinically validate the presence of extensor tendon injuries.
Extensor tendon injuries are treated with a combination of surgical repair and hand therapy exercises. Splinting, to hold the tendons in place and some therapy exercises are taken as mode of treatment for partially cut tendons but for complete cuts the hand surgeon undertakes outpatient techniques that may comprise of either stitching back the tendons together with special sutures and placing a pin through the bones to hold the repaired tendons firmly together or free the tendon from is scared tissue.
A surgical repair performed on a cut extensor tendon is likely to bring back functionality to the finger but fails to restore complete mobility. The results of the surgery may vary depending on the severity of the injury and how soon was the repair performed after the injury. In cases of severe crush or broken bones and joints the recovery options may face certain complications else the outcome of surgical repair is highly successful.
Physical Therapy is an essential prerequisite for healing the extensor tendon injury. To avoid complications like break in the repaired tendon or tendon sticking to its surroundings even after being released from its scar tissue it is essential that the patient follows a well formulated therapy exercising regime shortly after surgery for a period of two months or so.
On general basis resuming activities after tendon repair is dependent on mechanism and severity of injury. Activities cannot be resumed until 8 to 12 weeks after the surgery. Extensor Tendon injuries take time to heal completely. The splint is essentially to be worn for a long period of time even after mild activities are permitted by the hand surgeon. The resuming of activities is introduced back into the routine very gradually and slowly so that the injury does not reappear.
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