Extensor Tendon Repair
What is an extensor tendon repair?
Extensor tendon repair is a surgical or non-surgical treatment used to restore function of the extensor tendons of the hand or fingers, which allow you to straighten (extend) the wrist, fingers, and thumb.
Injury to these tendons leads to loss of active extension, finger droop, or deformity (e.g., mallet finger, boutonnière deformity).
What are the anatomical structures involved in an extensor tendon repair?
Extensor tendons which are located on the back side of the hand and fingers.
- Extensor digitorum (ED) – extends fingers 2–5
- Extensor indicis (EI) – independent index finger extension
- Extensor digiti minimi (EDM) – little finger extension
- Extensor pollicis longus (EPL) – thumb IP extension
- Extensor pollicis brevis (EPB) – thumb MCP extension
- Extensor retinaculum – fibrous band preventing bowstringing
Extensor Mechanism of the Finger
- Sagittal bands – stabilize tendons over first joint of the finger
- Central slip – extends the middle joint
- Lateral bands – extend the end joint
- Terminal tendon – inserts into distal finger
Injuries are classified by zones (I–VIII), which guide treatment and rehab.
What are the causes of extensor tendon injury?
Common causes can include lacerations (knives, glass, machinery), crush injuries, sports trauma, avulsion injuries (e.g., mallet finger), rheumatoid arthritis, degenerative rupture, and human/animal bites
What are symptoms of an extensor tendon injury?
- Inability to actively extend finger(s) or wrist
- Drooping of finger or fingertip
- Pain, swelling, and bruising
- Deformities (mallet finger, boutonnière deformity)
- Weak grip and impaired hand function
How is an extensor tendon injury diagnosed?
An extensor tendon can be diagnosed by a physician through physical examination, completion of zone-specific testing, assessment of X-rays (rule out fractures or avulsion), ultrasound or MRI (if unclear), and wound exploration (open injuries).
What are treatment options of an extensor tendon injury?
Non-surgical management would be indicated with a partial tear or a closed injury to the hand/finger. Surgical repair would be indicated when there is a complete tendon rupture, open lacerations, failed conservative treatment, or an associated fracture. Surgery is ideally performed within 7–10 days. Generally, with a strong surgical repair, the patient will be able to move quickly after surgery within a guided range. A Certified Hand Therapist (CHT) will discuss care plans with the surgeon based on repair strength and other factors.
Rehabilitation
Rehabilitation for an extensor tendon repair is crucial for a good outcome. Rehabilitation depends on injury zone and repair strength. Guidelines will be provided by the surgeon and implemented by hand therapists. Generally, patients can return to normal activity and sports within 3-6 months. Extensive rehabilitation requires professional guidance to avoid rupturing the tendon, which may lead to further surgical intervention.
The rehabilitation process and timeline will vary based on multiple factors such as instability, delayed healing, or other guidelines from the surgeon. It is important that you see a therapist that specializes in Orthopedic care of the Upper Extremity such as a Certified Hand Therapist, to ensure proper progression through the rehab process to avoid re-injury.
