Tendon Injuries and Lacerations

Background

A tendon is a strong fibrous tissue that attaches muscles to bones, generating force, allowing us to move our bones and joints. There are two types of tendons in the hand, flexor (bending fingers) and extensor (straightening fingers) tendons. Flexor tendons are more commonly lacerated, or cut, than extensor tendons. These can occur due to cuts to the hand or other injuries such as a direct blow. Typically, when these lacerations of tendons occur, other structures are injured such as nerves and bones. These structures typically require repair for the hand to function correctly.

Causes

  • Lacerations or cuts to the hand or wrist from sharp objects such as knives, glass, saw
  • Animal or human bites
  • Crush injuries such as jamming a finger in a door or machinery accidents 
  • Sports injuries like grabbing an opponent’s jersey or rock climbing
  • Rheumatoid Arthritis advancement can cause tendon rupture

Symptoms

  • Inability to bend or straighten the injured finger/fingers
  • Numbness and tingling
  • Pain
  • Open injury/laceration

Prevention

  • While there are no fool proof ways to avoid a traumatic tendon injury, general precautions can help:
    • Use caution when using your hands in everyday activities, especially when using sharp objects
    • Splinting when diagnosed with Rheumatoid Arthritis to prevent tendon rupture
 

Diagnostic Tests

  • Diagnosis is typically made by physical evaluation by a physician including range of motion and laceration assessment
  • X-rays may be done to assess for fractures
  • MRI can help determine if partial or full tear of a tendon or nerve is present

Medical Treatment

  • Typically, following preventative measures, treatment is started conservatively including avoiding positions and motions that increase pain and symptoms and modifying activities to help decrease symptoms. 
  • Rest, ice, splinting, anti-inflammatory medications, and occupational therapy for exercises and education. 
  • If conservative treatments fail, surgery may be considered to decrease pressure on the median nerve in the carpal tunnel. Consultation with a hand surgeon may be necessary to discuss the appropriate treatment plan.

Hand Therapy Interventions

  • Typically, hand therapists work closely with treating physician for the appropriate interventions and protocols to follow
  • Fabrication of custom splint to protect the healing tendon, whether non operative or post operative
  • Maintaining and restoring range of motion in fingers and wrist, following appropriate protocol
  • Wound management
  • Modalities such as moist heat, ice, ultrasound, paraffin, infrared laser, NMES stimulation
  • Scar management if post operative
  • Sensory re-education if nerve injury present
  • Activity modification to avoid use of the injured hand
  • Increasing functional use of hand over time (6-8 weeks for light activities and 10-12 weeks for heavier activities)

Hand Injuries

Carpal Tunnel Syndrome

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Finger Sprain

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Rheumatoid Arthritis

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Tendon Injuries & Lacerations

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Trigger Finger

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Hand Fracture

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Mallet Finger

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Swan Neck Deformity

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Skier's Thumb

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Dupuytren's Contracture

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Osteoarthritis

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