What Is an Extensor Tendon Repair?

A tendon is a flexible but inelastic cord of strong tissue that lies next to the bone; they attach a muscle to bone. Extensor tendons of the upper limb are located on the back of the hands, wrists, and fingers. They allow individuals to straighten their fingers and thumbs. 

Extensor tendon repair surgery repairs torn or damaged extensor tendons on the back of the fingers.

These tendons are attached to the muscles in the forearm. As these tendons continue over the fingers (digits), they become flat and thin. In the fingers, these tendons are joined by smaller tendons from the muscles in the hand. It is these small muscle tendons that allow finer movements and coordination of the fingers.

Extensor tendons can be injured by a minor cut or jamming of the finger, causing the thin tendons to rip from their attachment to the bone. If untreated, an extensor tendon injury may make it difficult to straighten one or more joints. 

Cuts on the back of the hand can injure the extensor tendons. This can make it difficult to straighten the fingers. 

Below are a few common extensor tendon injuries:

• Mallet finger: This happens when an extensor tendon is cut or torn from the bone. It is common when a ball or other object strikes the tip of the finger or thumb and forcibly bends it.
• Boutonnière deformity: It is described as the flexed (bent down) position of the middle joint of the finger. This can happen from a cut or tear of the extensor tendon.

Surgical repair of a lacerated or torn extensor tendon is called extensor tendon repair. An extensor tendon repair surgery can be performed under either regional or general anesthesia. 

The goal of any extensor tendon repair surgery is to re-establish the integrity and durability of the damaged tendon, thereby renewing as much of the previous function as possible. A tendon repair is not usually regarded as an emergency surgery but is generally performed as quickly as possible after the injury—usually within a few days.

• If a tendon is damaged because of a wound, the wound is thoroughly cleaned.
• A surgeon makes an incision (cut) on the hand to make the wound larger and stitches the two ends of the ruptured tendon together.
• The surgeon closes the wound with stitches and fits a rigid splint (support to protect your hand) made of plaster to stop moving your hand and damaging the repaired tendons.
• Sometimes, a tendon is too short for the surgeon to sew it back together as it is. In this case, the surgeon will graft an extra piece of the tendon between the ends to make them meet.
• The surgeon usually takes a healthy tendon tissue for the graft from another part of the person’s body.
• If a person requires a tendon transfer, the surgeon removes a tendon that is close to the severed tendon and sews it into the place of the broken tendon to restore function.
• The surgeon usually takes tendons from areas where the body has two tendons but can manage with just one.
• If nothing else has been damaged, an extensor tendon repair surgery can take approximately 30 minutes to complete. If there is a tendon graft involved, this procedure may take approximately 120 minutes.

There are three stages of extensor tendon healing after a surgery:

• Swelling/Inflammation: For the first three to five days, the area may feel swollen while the body works to heal itself.
• Early repair: During the next three to six weeks, the range of motion will start to return, but the area may feel slightly stiff.
• Later repair: After 10-12 weeks, the swelling will reduce, and the tendon will be easier to move.

In most cases, a person can go home shortly after the tendon repair surgery. The medical team will recommend physical therapy or occupational therapy to help bring back the range of motion slowly and safely. A person should not start the exercises until a doctor says it is safe to do so.

It is essential to keep the area elevated to prevent pain and swelling for the first few days.