Flexor tendon injury

I carry out surgery for acutely injured tendons (usually as an urgent operation within 3 days of injury) or for delayed reconstruction in patient with rupture of a previously repaired tendon or after a prolonnged delay in presentation after injury.

The flexor tendons connect the muscles of the forearm to the bones in the fingers and the thumb. Flexor tendons can be injured as a consequence of a sharp cut to the forearm or hand from a knife, or from glass, or a as a result of the finger catching in machinery (such as a circular saw). Tendons can also be pulled away from their point of attachment as a result of a sudden force applied to the finger or thumb.

There are two flexor tendons to each finger, and one flexor tendon to the thumb. The flexor tendons pass down smooth walled tunnels (the flexor sheath) attached to the undersurface of the fingers and thumb. The flexor sheath holds the tendon in a mechanically efficient position and prevents the tendon lifting away (bow-stringing) from the bones of the hand during flexion of the fingers and thumb.

The national guidelines for tendon injury are published on the BSSH website: https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/3%20Flexor%20tendon%20final.pdf

Diagnosis

Flexor tendon injury should be suspected when a patient is unable to bend a finger joint, or when the cut to the hand is forceful, or sharp, or deep: cuts from broken glass are often very deep.

Timing of surgery

Flexor tendon repair in the hand should be carried out within a few days of the injury, and should be done be a hand surgeon with regular experience of hand trauma. The operation takes about 60 minutes, but can take longer if multiple fingers are injured, or if other structures, such as nerves or arteries need repair.

Surgery

Cut flexor tendons can be repaired. This usually is usually as a day case. The two ends of the tendon are brought together and the repaired using strong sutures that pass between the two ends. It is imperative that this is done with meticulous care to make the repair adequately strong, and to reduce any disruption to the normal smooth outer surface of the tendon. If the repair site is bunched up, or the tendon is wrinkled, it will tend to catch against the inner surface of the flexor sheath. This can make the fingers and thumb stiff and can contribute to rupture of the repair.

After care

The hand is protected in a splint for upto six weeks. Patients need to attend hand therapy weekly or fortnightly for at least six and usually ten weeks after surgery.

Risks

The repair can rupture, which can require repeat surgery. The wound can become infected, the hand can become stiff and swollen.

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