For Dr. Gupta after 25 year long experience, flexor tendon injuries are not very threatening even though they are considered to be serious injuries. He asserts, “Tendons that govern the bending movement of the fingers are called flexor tendons and a deep cut on the surface of the skin anywhere on the forearm, wrist palm side of the hand or at the fingers can potentially damage the tendons as they run very close under the skin.” Going ahead with a little more explanations he states, “Do you know that tendons are under tension and are more or less like rubber bands and when they break their ends get pulled apart? They have to be repaired as they cannot heal on their own. Thus I would coercively enforce seeking an experienced and skilled surgeon for the surgical intervention. There is seriously no alternative treatment for theses injuries besides surgery as the two torn ends of the tendons need to be brought together and stitched with special sutures.”
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After providing relief to more than 18000 patients by surgical techniques and at present designated as the head of hand and shoulder department at Max Healthcare Dr. Gupta’s humble demeanor is evident in his introspections, “Over the years, major cases that I have dealt with have been of flexor tendon injuries incurred during sports like rock climbing, wrestling, rugby or football or patients who are suffering from rheumatoid arthritis. Patients with seeming simple cuts but intense harm on the inside have also approached me. For me besides clinical diagnosis the other prevalent symptoms to look out for are the area of the cut i.e. if it is on the palm side of the finger and the severity of pain, numbness and difficulty in bending the fingers.”
“Flexor tendon injuries are not as simple as they appear to be and patients should be well prepared that they may never recover some of the functions in their fingers. Therapy is an important prerequisite in these injuries aided by the mental strength of the patients themselves. The principle that works here is to get on with doing what you did before the injury but according to your surgeon’s advice even though the stiffness might hinder your activities”, states Dr. Gupta.
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With momentous graveness he sums up his introspections on flexor tendon injuries, “These thick like strings that help you to bend your fingers work on a precise mechanism more or less like a bicycle brake system and on sustaining even a minor cut, the system breaks and the functioning of the fingers get affected. You have to carefully seek medical attention as they are delicate and complex injuries which if not treated efficiently will permanently damage your fingers and you may be compelled to take assistance of your other hand.”
FAQ – Flexor Tendon Injuries
When fingers, hand, wrist or forearm on the side of the palm are inflicted with a deep cut or injury such that they damage the flexor tendons and the bending of a finger or thumb becomes impossible then it is referred to as a Flexor Tendon injury.
Tissues in the form of cords that connect muscles to bones to enable movement are known as tendons. Movement in the fingers and thumb are controlled by muscles that are located in the forearm. These muscles turn into long tendons that stretch right through the wrist on the palm side to connect to the bones of the thumb and fingers. Thus the tendons that help the fingers to bend are known as flexor tendons. The flexor tendons pass through tendon sheath (tunnels) which not only helps them stay close to the bones but also increases their functional level.
When the fingers, forearm, wrist or the palm sustain a cut they most likely affect the flexor tendons. Since flexor tendons run very close to the surface of the skin theybreak into two parts with their ends pulled apart. Thus a tear or cut in the flexor tendon makes the bending of the fingers difficult and almost impossible to be repaired on their own. The cut or tear may also damage the nerve and blood vessels in the fingers making the fingers numb or unable to function.Diagnosing an injury to the flexor tendon is not easy.
The signs that mark the presence of a flexor tendon injury are: – Intense pain on bending a finger
- Numb fingertip
- Difficult to move or bend finger joints
- Soreness in the fingers that lie on the palm side of the hand
- Prevalent cut on the palm side of the hand on the finger usually at the joint where the finger is bent
There are many common causes which might become the reason for the infliction of the injury. Some of them are:
- Cuts in the arm, hands, wrist or fingers
- Injuries sustained during sports which include football, rugby and wrestling
- Stretch or tear in the tendons or tendon sheaths in sports such as rock climbing
- Presence of Rheumatoid Arthritis
The hand surgeon will thoroughly inspect the injured fingers and check whether they are bending or are jammed and also inspect the fingertips. The blood flow to the fingers is also another important key point for diagnosis. After this physical check up, an x-ray is run on the injured hand to clinically validate the presence of flexor tendon injuries.
There are rare cases of flexor tendon injuries that do not require surgery. Torn ends of the tendon can only be repaired by operative techniques. The surgery is usually conducted after 7 to 10 days of the injury but if the blood flow to the fingers is being restricted then the surgeon will perform an immediate operation.
There are various ways in which tendons might tear and thus depending on the type of tear are the techniques of repairing them but all surgical repairs requiring special sutures. The surgical procedure is performed on an outpatient basis protected by a splint thereafter.
Flexor Tendon injuries are severe injuries and even with a small exhibited wound their impact is deeper. The complications that might be insistent post surgery include break in the repaired tendon needing re surgery or the tendon getting stuck to its surroundings without sliding back into the tunnel to become functional requiring the assistance of other hand.
Tendons that have been cut usually do not self-heal. When a cut tendon is not treated it may permanently damage the bending ability of the finger knuckles. Sometimes the tendons are partially torn and the patients leave it untreated presuming that they will not result in any severe outcomes and get healed on their own. This does not happen and even though a partially torn tendon might slowly start to heal, it will completely tear apart after a few weeks requiring surgical intervention.
The location of the injury plays an important role in ascertaining how well the patient recovers after the surgery. Tendon injuries take a longer time to heal than injuries in other parts of the body and the cuts in the fingers are not as fast healing as the cuts on the forearm. Stiffness is persistent in the fingers even after surgery. Even after a highly successful surgery the patients are likely to lose some movement in their fingers permanently but otherwise the functioning of the hand and fingers become better with surgery.
The presence of broken bone or another nerve injury near the flexor tendon injury or the damage being result of crush injury are injuries that usually fail to get back complete motion.
Certain precautions are essential after the surgery for better recovery outcomes. They include:
- The fingers of the repaired hand should not be forcibly moved for at least a month after surgery
- Therapy exercises should be strictly followed even though they might seem a little difficult
- Protection in the form of splint should not be removed for the stipulated time instructed by the surgeon
Activities cannot be resumed until 2 months after the surgery. This time is strictly considered as the healing time for the hand as it cannot be used without protection until this period. It takes another 1 month for the hand to be used with force. Though therapy helps the patient to regain mobility and strength, the hand surgeon is strict about reintroducing work activities gradually in the daily routine of the patient so that the injury does not relapse.
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