Tendon & Ligament Injuries
What is it?
Tendon injuries are the second most common injury seen in the hand. These smooth structures aid movement of the digits whilst ligaments stabilise the joints, preventing inappropriate movement.
Tendons within the hand act as strong cords connecting muscles of the forearm to the bones in the hand. Flexor tendons supply the palmar side of the hand and are responsible for flexion of the digits into a fist. Extensor tendons are located on the back (dorsal) aspect of the hand and act to straighten the fingers and thumb.
Why does it occur?
Blunt or penetrating trauma is usually the responsible. A laceration across the hand or digit is likely to damage the smooth tendon beneath. Comparatively, ‘catching’ a finger in a door or ‘stubbing’ it during sport can rupture the supporting ligaments.
What are the symptoms?
Pain and swelling are often present after injury. Dependent on the type of tendon or ligamentinvolved, loss of function and permanent deformity may result. Some deformities are characteristic of a particular injury:
Mallet finger – End of the finger lies in a bent position that can’t be straightened.
Boutonniere deformity – The middle finger joint is bent downwards whilst the end joint is flexed, otherwise known as a ‘swan-neck’ deformity.
How is it diagnosed?
A detailed history and examination may be sufficient in establishing the diagnosis. X-rays and magnetic resonance imaging may be utilised to establish if any bony injury is also present or extent of damage.
How is it treated?
Dependent on the type of tendon or ligament injury, such as mallet finger, conservative measures with a splint and hand therapy may be the chosen first line treatment. The splint will often need to be worn 24 hours a day for a period of several weeks.
Flexor or extensor tendon lacerations will require surgical intervention. The cut ends often retract significantly after the event, needing surgical repair to regain function. This may be conducted under regional or general anaesthetic as a day case procedure. The hand will be immobilised for a few days in a plaster splint to protect the repair until hand therapy review.
The hand therapy team will provide you with a lighter plastic splint and exercise regime to start within a few days of the operation. This is crucial in regaining range of motion and preventing contractures. Gradual return to activities will be guided by the team, as normal tendon strength can take a period of 3 months to return.
The One Team Specialists
Consultant Orthopaedic Knee Hip Specialist BM BCh, BA Hons, FRCS(Tr & Orth)
Knee Specialist FRCS(Orth)
Consultant Orthopaedic Surgeon BSc (Hons), FRCS (Tr & Orth)