Tendon and ligament injuries

What is it?

Tendon injuries are one of the most common conditions 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 handFlexor tendons supply the palm side of the hand and are responsible for flexion of the digits into a fist. Extensor tendons are located on the back (dorsal) of the hand and act to straighten the fingers and thumb.

Why does it occur?

A blunt or penetrating trauma is to the hand is the most likely cause of a tendon or ligament injury. A laceration across the hand or a digit is likely to damage the smooth tendon beneath. Catching a finger in a door or stubbing it during sport can rupture the supporting ligaments.

What are the symptoms?

Pain and swelling to the affected area are often common after a tendon or ligament injury. Dependent on the type of tendon or ligament involved, it is possible to lose some ability in the hand, and sometimes permanent deformity may result. Some deformities are characteristic of particular injuries:

Mallet finger – the end of the finger lies in a bent position that cannot be straightened.

Boutonnière 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 medical history and a physical examination may be sufficient to establish a diagnosis. X-rays and magnetic resonance imaging (MRI) scans may be used too, to establish if any bony injury has occurred, and to get a clearer picture of the extent of any damage.

How is it treated?

The best course of treatment will depend on the severity of the condition, and the benefits of the different treatment options will be explained to you.

Non-surgical treatment

Depending on the type of tendon or ligament injury you have, such as mallet finger, more conservative treatments like a a splint and hand therapy may be tried first. The splint will often need to be worn 24 hours a day for a period of several weeks.

Surgical treatment

Flexor or extensor tendon lacerations will require surgery, which 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 while the hand repairs, and before any hand therapy begins. 

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 for you to regain a good range of motion and to  prevent contractures. You will be guided to gradual return to normal activity by the team. Tendon strength can take up to 3 months to return. 

The One Orthopaedics team specialists

Peter Magnussen

Consultant Hand Surgeon, FRCS

Anthony Hearnden

Consultant Orthopaedic Specialist FRCS (Tr & Orth)