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Flexor Tendon Injuries

What is the Flexor Tendon?


The muscles that bend to flex fingers are known as flexor muscles.  Flexor muscles move the fingers with tendons, which are cordlike extensions that connect the muscles to bone.  Starting from the elbow and forearm regions, the flexor muscles turn into tendons just past the middle of the forearm, and attach into the bones of the fingers.  In the finger, these tendons pass through pulleys, which are fibrous rings that guide the tendons and keep them close to the bones.  This enables the tendons to move the joints much more effectively.


What are Flexor Tendon injuries?


Injuries to the flexor tendons, as well as nearby nerves and blood vessels, can occur from deep cuts on the palm side of the wrist, hand, or fingers. Although the injury may appear simple on the outside, it can be much more complex on the inside.  When a tendon is cut, it acts similar to a rubber band. The cut ends of the tendon pull away from each other.  Even though a finger may be able to bend if a tendon has not been cut completely through, it can cause pain or "catching," and may eventually tear all the way through.   Finger joints cannot bend on their own if the tendon has been completely cut through.


How are Flexor Tendon injuries treated?


Tendons are made of living cells.  If the cut ends of the tendon can be brought back together, healing begins through the cells inside as well as the tissue outside of the tendon.  After an injury, the cut ends of a tendon usually separate, making it very unlikely to heal without surgery.


There are many ways to repair a cut tendon, and certain types of cuts need a specific type of repair. It is important to preserve certain pulleys in the finger, and there is very little space between the pulley and the tendon in which to perform a repair.  Nearby blood vessels and nerves may need to be repaired as well.  Depending on the type of cut, after surgery the injured area can either be protected from movement or started on a very specific limited-movement program for several weeks.  Your doctor can advise you how soon surgery is needed after a flexor tendon is cut,  Hand therapy may also be prescribed for you after surgery.  If unprotected finger motion begins too soon, the tendon repair is likely to pull apart.  The fingers are allowed to move slowly and without resistance, after four to six weeks.  Healing takes place during the first three months after the repair.


In the majority of cases, full and normal movement of the injured area does not return after surgery.  If it is difficult to bend the finger using its own muscle power, it could mean that the repaired tendon has pulled apart or is bogged down in scar tissue.  Although scarring of tendon repair is normal, in some cases, the scarring can make bending or straightening of the finger very difficult.  Depending on the kind of injury you have, your doctor may prescribe therapy to loosen up the scar tissue and prevent it from interfering with the finger's movement.  If therapy fails to improve motion, surgery to release scar tissue around the tendon may be required.



Hand therapy after surgery


A program of controlled, limited motion of your hand may be selected as therapy for the first several weeks after surgery.  In this case, it is important to work closely with a hand therapist and your surgeon to fully understand the therapy and follow the set of guidelines.  If your hand is used too soon, or if therapy guidelines are not followed, the tendon repair may pull apart.  Not only does therapy help in regaining motion of the finger after a tendon injury, it also helps in softening scars and building grip strength.



For more information about simple, safe, and effective treatments for Flexor Tendon injuries, or any other conditions of the hands or upper extremities, schedule an appointment with Dr. Sagini by calling 239-337-2003.

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