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Flexor Tendon Injuries

What are flexor tendons?

The flexor tendons are strong bands of tissue that bend or flex the fingers by connecting the muscles of the forearm and hand to the bones in the fingers and thumb. There are two flexor tendons for each finger and one flexor tendon for the thumb. Within the fingers, the flexor tendons run in small canals (called “pulleys) that help move the fingers in an efficient manner (prevent “bowstringing”). The flexor tendons can be injured by any cut across the palmar surface of the wrist hand or fingers. The tendons can also be detached from the bone by a violent pulling injury to the finger.

What are the causes and symptoms of a flexor tendon injury?

Usually, a flexor tendon injury starts with some type of trauma – either a cut to the palmar surface of the hand or a violent pulling injury to the finger. If you have difficulty bending or flexing your fingers or thumb, if the finger is held out straighter than your other fingers, or if you have pain when trying to bend your finger, you may have a flexor tendon injury.

How is a flexor tendon injury diagnosed?

The diagnosis of a flexor tendon injury is generally made on physical examination. Our hand surgery specialist will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if they suspect a flexor tendon injury. Additional tests, such as x-rays, ultrasound, or MRI may be ordered to help diagnose the injury.

How is a flexor tendon injury treated?

Lacerated flexor tendons will not heal without some form of repair – this is done surgically. Our hand surgery specialist will explain the type of injury you have, and inform you what type of repair needs to be done. Often times, there will be nearby nerves or blood vessels than may also need to be repaired.

Tendon repair can be done under local anesthetic, regional anesthetic (your arm will be put to sleep but you will not require general anesthesia), or general anesthesia. During surgery, the injured tendons will be meticulously dissected and stitches will be placed to repair the lacerated tendon. At the end of the operation, your arm will be placed in a splint or cast.

Our hand surgery team specializes in the techniques of “awake tendon repair”. This technique allows our hand surgeon to test the repair while in the operating room, ensuring that the tendon repair is strong and ready for aggressive physical therapy. This will lead to less scar tissue and earlier return to function and has demonstrated superior outcomes than traditional repair performed under general anesthesia. Our hand surgery specialist will discuss this with you further during your consultation.

Will I need therapy after flexor tendon surgery?

Hand therapy is crucial to the success of flexor tendon repair. Our specialists believe that the successful outcome of any tendon repair is 50% related to how well it is surgically repaired, and 50% how well patients perform therapy. The therapy program after tendon repair is as important as the operation itself, so it is vital to follow the instructions of the therapist closely. The objective is to keep the tendon moving gently to prevent it from sticking to the surrounding tissues, but to also avoid breaking the repair.  For the most part, therapy will start 3-5 days after your operation.

Wide-Awake Local Anesthesia Tendon Repair Videos