Extensor Tendon Repair

Extensor tendon repair is the surgical reattachment of the extensor tendons in the hand. Tendons are cords that connect the muscles to bones. When the muscle contract, the bone is, in turn, pulled by the attached tendon, and the body part shows movement.

Extensor tendons are the attachments between the muscles in the forearm and the bones in the hand. They are present right beneath the skin on the back of your fingers and hand and help in straightening thumbs and fingers.

The location of the extensor tendons makes them highly susceptible to injuries. They can be damaged even by small cuts. If a finger gets jammed, a tendon may tear from their attachment to the bone. Damage to the extensor tendon may make you unable to open your hand completely. 

Extensor tendon repair may be performed immediately or in a week after the injury.

This surgery is performed to treat a cut or damage to the extensor tendon. Some common extensor tendon injuries that require surgical treatment include:

• Mallet fingers (drooping of fingertip due to a cut in extensor tendon or its separation from the bone)
• Boutonniere deformity (the bending of a finger from the middle joint due to a tear or cut in the extensor tendon)
• Cuts and lacerations

The tendon may be cut due to a sports or crushing injury, cuts in the back of the hand, bites from animals or humans, and in severe cases of rheumatoid arthritis.

Some of the common symptoms for which extensor tendon repair is done include:

• Drooping of the last joint of the finger
• Inability to extend the wrist or straighten fingers
• Swelling and pain in fingers
• Variation in the feel and appearance of the affected finger

Extensor tendon repair may be contraindicated due to the following considerations:

• Presence of any fractures or need for a nerve or artery repair in the area. 
• Not being able to understand or adhere to the home care regime.
• Any symptoms of an infection in the body.

The following preparations are required before the surgery:

• Your healthcare provider will take your complete medical history and ask details about the injury, symptoms, right- or left-handedness, and whether the wound was cleaned.
• He/she will perform a physical examination of your hands, ask you to extend your fingers to detect the extent of the injury and will check if a nerve injury has affected the sensation in your hand.
• The doctor will also ask you to get an X-ray test done to identify the presence of a fracture in your hand. It may also help in detecting the presence of any foreign objects, such as glass.
• If you take any medicines including supplements, herbs, or over-the-counter drugs, make sure to inform your doctor about them. 
• Discontinue smoking before the surgery for a speedy recovery following the procedure. 
• Inform your doctor if you take more than one or two glasses of alcohol a day. 
• You may need to stop taking blood-thinning medicines like aspirin and warfarin.
• Arrange for a family member or friend to give you a ride home after the surgery.
• You will be asked to sign an approval form to grant permission for the surgery.
• Fasting will not be required before the surgery as you will be given local anaesthesia.

After you arrive at the hospital, the hospital staff will provide you with a hospital gown. They will start an intravenous (IV) line in your arm to supply essential fluids and medicines during the surgery. The surgery may be performed in the emergency department if the laceration is partial and the cut is clean and well-visualised. Otherwise, it is performed in the operating room.

The procedure for the surgery is as follows:

• A tetanus injection for prophylaxis and antibiotics will be administered to you before the surgery. 
• The surgeon will clean the wound and inject local anaesthesia at the operated site. You will lie on your back with your arm extended on a table. A tourniquet will be applied to lower the bleeding during the surgery.
• The surgeon will make an incision (cut) on your hand. 
• He/she will locate the two ends of the damaged tendon and stitch them together. 
• Thereafter, the surgeon will stitch close the cut and place a rigid splint on your hand to protect the repaired tendon. 

The procedure takes about half an hour.

As the effect of anaesthesia fades, you will start to feel pain in your hand. There will be swelling and bruising as well. A nurse will give you painkillers as soon as you feel some throbbing and tingling sensation in your hand.

You will be discharged on the same day or may need a short hospital stay, depending on your condition.

Depending on the location of the surgery, it may take you anywhere between one to three months to recover. Once you reach home, you will need to take care of yourself in the following manner:

• Splint: You will be asked to wear a splint to support your fingers and help in the healing process. Permanently keep your splint on for the first month. After one month, your physiotherapist may ask you to remove the splint while performing exercises. After six weeks, wear your splint as a protective measure in crowded spaces or while sleeping. After eight weeks, you will be allowed to take off the splint. 
• Activities: You can resume light activities such as eating and writing with the operated hand after six weeks. At eight weeks, you may increase the functioning of the hand, and at the end of ten weeks, you may be able to resume manual work. 
• Exercise: A physical therapist will teach you exercises that need to be practised in the recovery period. 
• Sports: You may be able to play contact sports after three months. 
• Driving: Your doctor may allow you to drive 10 weeks after the surgery.
• Diet: Start having clear liquids and gradually move to your regular diet.
• Pain medicine: Your doctor will prescribe painkillers that you may need for up to two days following the procedure. 
• Elevation: Use pillows to support your hand and keep it elevated. This will also help prevent swelling. Keep the hand raised for the first few days for as long as possible and then over the next few days keep it elevated as required. 
• Shower: You will not be allowed to take a bath or go swimming if the bandage on your hand is not removed. Do not let stitches to get wet. The surgeon may ask you to use a water-proof dressing to allow you to take a shower. 
• Ice pack: You may use an ice pack for about 20 minutes every hour or two for the first two days at the operated site and then as required to reduce the pain and swelling.

When to see the doctor?

Visit the doctor right away if any of the following symptoms are observed:

• Fever
• Foul odour from the operated area
• Continuous drainage or bleeding from the wound
• Persistent tingling and numbness
• Breathing difficulty
• Pain that does not reduce even with medicines
• Chest pain
• Swelling
• Redness 
• Any change in the ability to move the fingers or thumb

The surgery carries the following risks:

• Formation of blood clots in the body, especially legs
• Excessive bleeding
• Reaction to any medicines
• Partial loss of function in the affected joint
• Infection
• Rupturing of the tendon
• Tendon adhesion (the tendon sticks to the nearby tissue, causing a reduction in movement)
• Intolerance to cold
• Prolonged swelling
• Stiffness in the finger
• Complex regional pain syndrome (chronic pain after trauma)

A follow-up appointment will be scheduled for a week to 10 days after the surgery, wherein the surgeon will remove your stitches.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.