The Hand And Forearm Flexor Tendon Injuries
The
muscles that bend or flex the fingers are called flexor muscles.
These flexor muscles move the fingers through cord-like extensions
called tendons, which connect the muscles to bone. The flexor
muscles start from the elbow and forearm regions, turn into
tendons just past the middle of the forearm, and attach into
the bones of the fingers.
In the finger, the tendons pass through fibrous rings called
pulleys, which guide the tendons and keep them close to the
bones, enabling the tendons to move the joints much more effectively.
Deep
cuts on the palm side of the wrist, hand, or fingers can injure
the flexor tendons and nearby nerves and blood vessels. The
injury may appear simple on the outside, but is actually much
more complex on the inside.
When
a tendon is cut, it acts like a rubber band, and its cut ends
pull away from each other. A tendon that has not been cut completely
through may still allow the fingers to bend, but can cause pain
or catching and may eventually tear all the way through. When
tendons are cut completely through, the finger joints cannot
bend on their own.
Treatment On Flexor Tendon Injuries
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. Because the cut
ends of a tendon usually separate after an injury, it is not
likely that a cut tendon will heal without surgery.
Your
doctor will advise you on how soon surgery is needed after a
flexor tendon is cut. There are many ways to repair a cut tendon,
and certain types of cuts need a specific type of repair.
In the finger, it is important to preserve certain pulleys,
and there is very little space between the tendon and pulley
in which to perform a repair. Nearby nerves and blood vessels
may need to be repaired as well.
After surgery, and depending on the type of cut, the injured
area can either be protected from movement or started on a very
specific limited-movement program for several weeks. Your doctor
may prescribe hand therapy for you after surgery. If unprotected
finger motion begins too soon, the tendon repair is likely to
pull apart. After four-to-six weeks, the fingers are allowed
to move slowly and without resistance. Healing takes place during
the first three months after the repair.
In
most cases, full and normal movement of the injured area does
not return after surgery. If it is hard 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. Scarring
of the tendon repair is a normal part of the healing process.
But
in some cases, the scarring can make bending and straightening
of the finger very difficult. Depending on the injury, 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.
- Therapy
On Hand After The Surgery
If
a program of controlled, limited motion is selected as therapy
for the first several weeks after surgery, it is important to
work closely with a hand therapist and your surgeon to understand
the therapy and follow set guidelines.
The
tendon repair might pull apart if your hand is used too soon
or if therapy guidelines are not followed. In addition to regaining
motion of the finger after a tendon injury, therapy will be
helpful in softening scars and building grip strength.
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