Injury to flexor tendons

What is flexor tendon injury?

The flexor tendons are cords that run through the palm of the hand and allow the fingers to flex. They are connected to the muscles in the forearm. There are two main causes of flexor tendon damage: severance by wounds or rupture by violent stress. Any wound in the palm of the hand is likely to injure the flexor tendons. Tendons can sometimes rupture without wounding, the most frequently cited example being the rugby player who tries to restrain his opponent by the shirt. This can cause the tendon to pull away at the point where it attaches to the bone, a condition known as jersey finger. The main symptoms are the inability to flex one or more finger joints.

What tests are required?

A description of the accident and an examination of your hand by a doctor will usually help identify the diagnosis. X-rays or ultrasound are sometimes necessary to obtain more information. These are short, painless tests.

What treatments are available for flexor tendon injuries?

• Non-surgical

The general rule is to explore all wounds on the palm of the hand in the operating room. There is no non-surgical treatment.

• Surgical

The operation serves to identify and repair any tendon damage. When a tendon is cut, it needs to be sutured with surgical thread. If the section is incomplete, suturing is not always necessary, depending on the degree of tendon damage. In the rare cases where the tendon lesion is already old and has been neglected, it is not always possible to suture it, and a repair in two operations approximately two months apart is necessary.

The procedure is performed on an outpatient basis under locoregional anesthesia (one-arm anesthesia).

• After surgery

Occupational therapy rehabilitation is the most important part of the treatment. Its main objective is to promote tendon repair while preventing tendons from sticking to adjacent structures. Various exercises are taught and practiced during occupational therapy sessions, but above all several times a day at home, to help the tendons slide and the joints move, while gradually increasing the stress on the tendons.

The skin usually heals after two weeks, at which point the sutures can be removed, unless they are absorbable, in which case they will fall out on their own. The splint must be worn permanently for six weeks, except during exercise sessions. Definitive tendon strength is not achieved until the end of the third month. Heavy loads must not be carried before this deadline. The length of time off work depends on the profession, but can easily reach three to four months. Sports activities requiring the use of the operated hand are forbidden for three to four months.

What are the possible complications?

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small. When it is larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to flexor tendon injuries

On rare occasions, the tendon suture may fail to hold and release. A new operation may be required to re-suture. P

A sutured tendon can stick to the canal in which it is supposed to slide, forming adhesions and thus limiting finger mobility, despite rehabilitation sessions. Further surgery may be proposed to loosen these adhesions (tenolysis), at a distance. Following this, further rehabilitation is required for at least a month.