Tendons are the cord-like structures that attach muscles to bone. Some of the muscles that bend and straighten the fingers and thumb are situated in the forearm and there are also smaller muscles in the hand – the anatomy is complicated! There are two groups of tendons: the flexor tendons on the palm side of the hand that bend the fingers, and the extensor tendons on the back of the hand that straighten the fingers. The tendons are situated between the skin and the bones of the hand and fingers. A laceration may damage the tendons and will lead to reduced movement or loss of movement of the digit.
When a laceration to the hand or finger has been sustained, it is important to check that the tendons (and other structures such as nerves) have not been damaged. The tendons are assessed by examination of the hand; in some cases an ultrasound scan is required.
A tendon that has been partly divided does not cause complete loss of function, but movements are painful.
Most suspected tendon injuries require surgical exploration and repair. Repair of the extensor tendons is in general somewhat more straightforward than repair of the flexor tendons. Surgery for an extensor tendon injury is often performed under local anaesthetic but flexor tendon surgery requires a general anaesthetic.
Tendon repair requires meticulous and delicate surgical technique. Tendons are repaired with strong sutures (stitches); the repair must be strong enough to allow movement and neatly done so that the tendon glides smoothly. Following tendon repair it is necessary to protect the repair with a splint. My hand therapy team will custom make a light weight plastic splint and also supervise a hand therapy programme.