Flexor Tendon Laceration
Flexor tendon laceration occurs when a deep cut on the palm side of the fingers, hand, wrist, or forearm severs through the skin into the flexor tendons, causing immobility in affected fingers.
Flexor tendons are very close to the surface of the skin, a deep cut in the forearm, wrist, palm will most likely hit a flexor tendon. Like a rubber band, tendons are under tension as they connect the muscle to the bone. If a tendon is torn or cut into two pieces, the ends of the tendon will pull far apart, making it impossible for the tendon to heal on its own. If the cut damages nearby nerves, this will result in numbness on one or both sides of the finger. More damages to the blood vessels may lead to no bloody supply to the fingers and will require immediate surgery. In cases where the flexor tendons are partially cut of torn, the finger may still be able to bend, which make these tears more difficult to diagnose.
In addition to cuts on the arm, hand, or fingers, certain health conditions or sports activities may weaken or cause injuries to the flexor tendons.
- Rheumatoid arthritis weakens the flexor tendons making them more prone to tear without warning or injury. One might simply notice their fingers unable to bend without any prior injury or impact.
- Sport: football, wrestling, rugby, or tock climbing that requires extreme arm and hand strength could cause the tendons and/or their sheaths to be stretched or torn.
- “Jersey finger” is a common sport injury when one player grabs another’s jersey and a finger (usually the ring finger) gets caught, causing the tendon to pull off the bone.
The most common signs of a flexor tendon injury include:
- An open injury, such as a cut, on the palm side of your hand, often where the skin folds as the finger bends
- An inability to bend one or more joints of your finger
- Pain when your finger is bent
- Tenderness along your finger on the palm side of your hand
- Numbness in your fingertip
When you have a serious cut to your hand or fingers, apply ice immediately. Tightly wrap your hand with a clean cloth or bandage to slow down the bleeding. Elevate your hand by keeping it lifted above your heart. See a doctor as soon as possible when your finger is jammed or cut, and you cannot bend or straighten your fingertip. Your doctor may first clean and treat any wounds that are not deep. You may receive a tetanus shot or antibiotics to prevent infection.
During the examination, your doctor will test your finger strength where he/she may have you try to bend your injured finger while holding the other fingers down flat. To determine whether any nerves or blood vessels have been injured, your doctor may test your hand for sensation and blood flow to the fingers. Your doctor may also order an x-ray to see if there is any damage to the bone.
After examining your hand, your doctor may place your hand in a splint for protection. As mentioned above, when the tendon is severed, it will not heal on its own and must be repaired by a doctor. Surgery is usually performed within 7 to 10 days after an injury. In general, the sooner surgery is performed, the better recovery will be. If your injury is restricting blood flow to your hand or finger, your doctor will schedule an immediate surgery.
Tendons tear in different ways, such as straight across, at an angle, or pulled right off of the bone. Therefore, your surgeon has many different methods to repair them. All the methods for repair, however, involve special sutures. Surgery is usually performed on an outpatient basis and after your doctor will apply a dressing and a plastic splint to protect the repair. Your fingers and wrist will be placed in a bent position to keep tension off the repair.
Recovery from Surgery
- It can take up to 2 months before the repair heals and your hand is strong enough to use without protection, and it may take another month before your hand can be used with any force.
- Soon after surgery, you will begin physical therapy. Specific exercises will help you gradually regain motion and function. Stiffness after surgery is common, but it usually improves to therapy.
- Splint wear and proper exercise as prescribed by your therapist are as important to recovery as the surgery itself.
Treatment for Partial Tears
Recent evidence suggests that partially torn tendons do not require surgery for good results. The same splinting and exercise programs that are used for surgery patients can be very effective for patients with partial tears without the need for surgery. However, nonsurgical treatments should only be performed after your doctor has examined the extent of the injury.
Advancing research and experience in the treatment of flexor tendon injuries have drastically improved patient outcome to this challenging condition. Despite extensive therapy, some patients have long-term stiffness after flexor tendon injuries. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion. Overall, flexor tendon surgery results in good return of function and high patient satisfaction.
Mount Nittany Halth. (2018). Tendon rupture finger. Retrieved from https://www.mountnittany.org/articles/healthsheets/37248OrthoInfo. (2020). Diseases and conditions: Flexor tendon injuries. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/flexor-tendon-injuries/