Extensor Tendon Rupture - Reconstruction and Repair
What is it?
The extensor tendons of the hand allow us to straighten our fingers, opening the hand and allowing us to then grip objects.
What causes it?
Extensor tendon injury or rupture is most commonly caused by trauma such as cuts and crush injuries to the hand. Damage can also be caused by fractures of the wrist and hand; patients with rheumatoid arthritis are particularly at risk of this.
What are the symptoms?
Patients generally present with an inability to fully straighten the thumb or fingers, resulting in a "dropped digit" or deformity. This may occur spontaneously or follow a history of injury or trauma.
The resulting deformity may be cosmetically unsightly and have an affect on the function of the hand.
Do I need any further investigations?
Some patients require x-rays of the hand and wrist to assess for trauma and arthritis. Many patients require an ultrasound scan or MRI to confirm rupture of the tendon and allow for pre-operative planning.
What is the treatment?
To restore the function of the hand surgical treatment is usually required.
If the tendon has been injured acutely then direct surgical repair is often possible. This is performed under general anaesthetic as a day case procedure.
If the problem is long standing or has been caused by chronic inflammation then repair is not possible and reconstruction is necessary; this is performed by "borrowing" one of several spare tendons we have in the hand and rerouting it to the do the job of the injured tendon/ tendons. This is performed under general anaesthetic as a day case procedure.
How long will it take to recover?
Depending on the extent and severity of the tendon injury, recovery takes around 6 weeks.
A temporary plaster splint will be applied to the hand/ wrist after the operation. You will be seen by a hand therapist at 2 days who will remove this, clean and redress the wounds for you. The hand therapist will get you moving your hand very early after surgery to avoid stiffness. The hand and wrist may then be immobilized in another plaster or splint for up to 6 weeks depending on the nature of the surgery.
The stiches are removed at around 10 days and Andy will review you at that point.
Following your 2 week appointment your hand therapist will get you moving your hand more and more and will also advise how to help soften and desensitize the scars.
What are the potential complications?
Any surgical procedure carries risks, however every effort is made to minimize these to ensure the best possible outcome from your surgery.
- Infection - Uncommon and usually treated very successfully with antibiotics
- Delayed healing - Smokers and those with diabetes are more prone to this
- Painful/Tender Scars - the vast majority of patients complain of some discomfort around the scar and thumb, this is know as pillar pain and generally resolves with time. Rigorous wound care and desensitization as directed by your hand therapist help prevent this.
- Damage to surrounding structures - inadvertent damage or stretching to surrounding nerves may cause some numbness around the scars, although this should improve with time.
- Stiffness - Operations to the hand may cause stiffness, this can be minimized by working closely with your hand therapist and getting your hand moving as early as possible.
- CRPS - An uncommon but potentially serious complication of hand surgery leading to pain, swelling and discomfort. It is impossible to predict this problem but working closely with you hand therapist and getting your hand moving early has been proven to significantly reduce the risk of this.
When can I get back to normal activities?
The hand MUST be kept clean and dry for 10 days until the sutures are removed. Depending the site and extent of your surgery you should be able to return to "desk job" type activities within 3-4 week of the operation. Any manual work, heavy lifting or sporting activities should be avoided for at least 6-8 weeks.
You may return to driving in around 4-6 weeks. Please inform your insurance company that you have recent hand surgery to ensure that are happy for you to do so.