FAQ: Tendon Repair
Injuries to extensor tendons (tendons on the back side of hand and arm) often results from cuts or when there is significant jamming force hitting the fingers causing the tendons to rip or rupture from their bony attachment. This leads to functional impairments as well as anatomic deformities.
Extensor tendons are tendons that sit just under the skin, going down the back side of the arm into the hands and fingers. They function to straighten the wrist, fingers and thumb.
Extensor tendon injuries often cause functional impairments as well as anatomical deformities. Functional impairments result in an inability to straighten/raise your wrist or straighten your fingers in your hand. The most common anatomical deformities in extensor tendon injuries is mallet fingers or boutonniere deformity.
- There are multiple ways to treat an extensor tendon injury depending on the age of the injury, mechanism of injury and the location of the injury
- Splinting – the injured finger is placed into a splint to straighten the finger and allow the ruptured tendon to scar down and restore the function of the finger
- Surgical repair – when the end opposing ends of the cut/ruptured tendon is brought back together and sutured. After surgical repair, you often need to be placed into a cast to protect the surgical repair.
- Pin – you may need a steal pin placed across a joint space in additional to splint/casting to stabilize a joint in order to help the tendon heal.
Depending on the location of the injury, the mechanism of your injury and age of injury, you may need a surgical correction or pinning of the finger to help restore function to the injured hand/finger.
Surgical repair attempts to bring the two ends of the ruptured/cut tendon back together in hopes that it can restore the function and dexterity in the finger. This surgery attempts to bring the two ends of the ruptured/cut tendon back together in hopes that it can restore the function and dexterity in the finger.
Common surgical risk include non-union of severed tendon, injury to nearby nerves and vessels, and wound infections. The most common complication to this surgical intervention is extension lag and loss of flexion. This is often due to the scarring that occurs from the surgical repair. Additionally, there could be a loss of ability to flex the finger or a diminished angle of flexion as a result of scaring from the surgery.
For a more comprehensive list of possible complications, you can find the information on Dr. Colin Hong’s website at: http://www.drcolinhong.com/learn/risks-and-complications/extensor-tendon-repair.
Non-surgical options include splinting or casting of the injured hand/finger depending on the type and complexity of injury. If the tendon rupture includes a fracture of a carpal bone and there is instability of the fracture or dislocation, your surgeon may elect to have your hand placed into a cast after realignment with further splinting if appropriate. However, depending on the age of the injury, the most appropriate management may vary.
Depending on the location of the extensor tendon injured different surgical techniques are applied to repair the injured tendon and help restore the function lost due to the tendon injury.
Other surgical repairs may include a tendon transfer to help facilitate function or tendon graft if the ends of the injured tendon cannot be approximated. Tendon grafts are harvested from another tendon in the arm or from the ankle (palmaris longus and plantaris tendon respectively).
Surgery is recommended as soon as possible as delaying management may cause more scarring in the area of injury, making it harder for conservative management with splinting as well as making the surgery more difficult technically.
Management for extensor tendon injuries is recommended as soon as possible. Delaying management may cause more scarring in the area of injury, making it harder for conservative management with splinting as well as making the surgery more difficult technically.
If you chose not to have any management for an extensor tendon injury, it is likely that you have sustained loss of function as well as anatomical deformity in the finger/hand injured.
Depending on the age of the injury, choosing to delay management can result in the inability to manage the injury conservatively (without surgery/pinning) and further delay may also make the surgery technically more difficult with a higher chance of failure or the need for more complex surgical repair of the injury.
Your surgical repair in the hand is performed with an open incision in the skin.
Bone grafts and plates are needed when there are complex injuries to the hand where there is a loss of bone or unstable fractures in the bones of the hand. The need for this type of management is dependent on the type of injury sustained to the hand.
Depending on the size (diameter) of the tendon injured and location of injury, the harvest tendon will usually come from your forearm or your lower leg area.
Immediately after surgery, you will be placed in a cast to protect the repair. This cast may stay on for 4 weeks. Afterwards, depending on the injury, you will either be placed into a dynamic splints or may need serial splinting in order to slowly introduce motion to the injured joint. In the long term, with physiotherapy and stretching, the range of motion and strength of the joint for most patients improve to about 80% of their previous function
Symptoms may reoccur if you re-injure the hand or cause a second rupture. As the strength of the tendon is now weaker. The exact reoccurrence rate is unknown. Symptoms may reoccur if you re-injure the hand or cause a second rupture as the tendon is now weaker. The exact reoccurrence rate is unknown.
The incision will likely be above the region of the rupture tendon and can range in length depending on the amount of tendon retraction there is from initial injury.
Your scar will depend on the extent and complexity of the injury. If there the tendon rupture/laceration is associated with fractures, the repair maybe more extensive and the scar will be larger. If possible, incisions are made along natural creases and planes to hide the incision after healing for aesthetic purposes.
The duration of surgery is dependent on the complexity of the injury and surgical repair.
This surgery typically does not need a blood transfusion as there is minimal blood loss and is performed in outpatient basis. However, if your injury is chronic and requires a complex surgical intervention in the operating room, your blood type will be tested for in case there is more blood loss than usual, and a transfusion is required. Obtaining blood type for complex operating room cases is standard procedure for all cases.
You will likely need to be casted after surgery for 4-6 weeks. Depending on the complexity of injury, it may be appropriate after a couple weeks for you to be placed into a splint for serial splinting (to progressively change the degree support you require) or placed into a dynamic splint.
Pain after surgery can vary depending on the complexity of the injury and surgical repair.
We usually recommend you to take Acetaminophen (Tylenol) and/or Ibuprofen (Advil/Motrin) after surgery. You may need some prescription pain medication which will be prescribed for you after surgery.
Usually, there is no tubes or drains placed after surgery if the repair is in the hand. Larger and more extensive repairs in the arm may require a drain placement. The drain is usually left in place for 2-3 days.
You will need physical therapy after surgery, as this is the most essential part to the recovery process. Physical therapy session will start after the cast is removed and you may need several sessions for the following weeks to month of surgery.
You likely will not need any crutches/boots ater surgery, unless the repair is in your leg.
Usually, this is an outpatient procedure and you will not need to stay in the hospital. Howecer, if the surgery is extensive, you may need to stay overnight.
It will likely take 6-8 weeks with physiotherapy to regain the range of motion and can take up to 4-6 months before the repaired tendon is back to full strength. But it can take up to six months to regain the full range of movement. In some cases, it may never be possible to move the affected finger or thumb as much as before it was damaged.
You will be placed in a cast, your arm is protected for further injury, but it is recommended that you stay away from contact sports and water activities. After your cast is removed and you begin to regain strength, your level of activity will be modified.
Depending on the injury and repair, some patients are able to drive. However, with the cast on, some individuals find it cumbersome and difficult to drive safely. Additionally, it is recommended that you do not drive while taking any prescription pain medication.
Most patients will take a week off work, but some people elect to return to work prior to that. If your cast does not interfere with your work, you can return to work 1-2 days after your surgery. However, if your workplace requires significant manual dexterity, you might need to modify the work you do during the recovery process.
If your procedure is an outpatient procedure performed in the ambulatory clinic, you will be receiving local anesthetics to numb/block sensation in the hand for a short duration. However, if your repair is extensive and it is done in the operative room, you may need general anesthesia where you a put to sleep.
If your procedure is complex and requires general anesthesia, you will need to see an anesthesiologist for evaluation prior to surgery.@@@If your procedure is complex and requires general anesthesia, you will need to see an anesthesiologist for evaluation prior to surgery. This will be set up after your initial consultation and surgical date is set.
Your medication list will be reviewed prior to surgery. However, you should also review your medication with your family doctor as well.
Generally, blood thinners should be stopped prior to surgery. However, different types of blood thinners should be stopped for different durations prior to surgery. Your family physician should be consulted as to when and if you should stop your medication prior to surgery.
Typically, no other tests is required prior to surgery as extensor tendon injury is diagnosed by symptoms experienced by the patient. However, certain individuals on specific types of blood thinners may need a blood test immediately prior to surgery.
If you are scheduled for surgery in the ambulatory clinic, there are no diet and fluid restrictions prior to or after surgery. However, if your surgery is scheduled to be in the operating room and you’ve seen anesthesiologist for general anesthesia, you will need to stop eating/drinking at midnight the evening prior to your surgery.
You can shower with antibacterial soap the evening prior to or the morning of your surgery. This is only needed if your surgery is scheduled to happen in the operating room.
If you are having surgery in the surgical clinic, you should arrive at your appointment time for surgery. <br>If you are scheduled to have surgery in the operating room, there should be an appointed time for you to arrive in your information package given to you during your consultation with the anesthesiologist.
Please call the office at (416)222-6986 to see your scheduled date and time for your surgery. This surgery is usually performed at two different hospital sites: Mackenzie Health Center or Rouge Valley Centenary Hospital. Once your appointment is set, you will be directed to the correct site.
You will likely need someone to drive you home after surgery as driving with a cast maybe cumbersome at first and require some time before you get used to having the cast on your hand.
- Arrange for personal items you might need during your hospital stay
- Arrange for someone to take care of responsibilities at home and work
- Arrange for someone to take you home from the hospital
- Arrange for someone to stay with you the first night after surgery
- Arrange for someone to help you with your daily routine for as long as you may need after surgery
- Call your doctor if you think of other questions
- Notify your doctor if you get sick within 10 days of your surgery (even minor illnesses like a cold)
- Stop eating and/or drinking as advised by your doctor
- Do not smoke or drink alcohol 24 hours before your surgery
- Make sure you have the doctor’s contact information
- Make sure you have directions to the hospital/office for visitors
- Make changes to your living space that will make it easier for you to access the things you may need while recovering
- Arrange for any special equipment you may need after surgery
The duration of the surgery is determined by the location, extent of injury and the complexity of the surgery. Surgery can range from 30min to several hours depending the surgical intervention implemented.
If your surgery is done in surgical clinic, you are typically awake for the whole procedure. However, if your surgery is complex and require general anesthesia, you will be asleep for the whole procedure and for an additional hour in recovery.
If the surgery is done in surgical clinic, your friend/family member can accompany you in the room during the surgery if they feel comfortable. If you require general anesthesia, you friend/family member will usually be able to come see you in the recovery room after you’ve completely waken up from anesthetics.
Typically for surgery performed in surgical clinic, no medication is needed to prevent blood clot formation. This is usually the same case for patients who have their procedure in the operating room and are discharged the same day of surgery. However, you if you stay in the hospital after surgery and/or if you are unable to mobilize after surgery, we may give you some blood thinners to prevent the formation of blood clots after surgery.
For procedures done under local anesthetics, no antibiotics is needed for surgery. If you require general anesthesia, we generally give one dose of antibiotics prior to surgery. You will not need antibiotics after surgery. If you injury is fresh and complex and the damage to your tendon is due to an open laceration, you may receive a course of antibiotics.
- For procedures done under local anesthetics, no antibiotics is needed for surgery.
- If you require general anesthesia, we generally give one dose of antibiotics prior to surgery. You will not need antibiotics after surgery.
- If your injury is fresh and complex and the damage to your tendon is due to an open laceration, you may receive a course of antibiotics.
- Make sure your identity has been confirmed with name and date of birth
- Make sure you have confirmed the surgery you are having
- Make sure the correct site of your surgery has been marked
- Confirm any allergies and side-effects you might have
- Make sure you understand and have signed the informed consent forms
Unless your surgeon specifically says otherwise, your surgery went according to plan without complications. Success of the surgery depends on post-operative management such continual stretching and exercises when the cast is removed.
Usually, you will not be placed on any antibiotics after surgery. However, if the ruptured/injured tendon is a result of an open laceration, you will be placed on a dose of antibiotics and it is commonly prescribed for 7-10 days.
With the exception of blood thinners, most prescription drugs do not need to be stopped and can be continued throughout the day of the procedure. Blood thinners can be restarted after surgery.
Prevention of blood clot formation is only needed if you are admitted into the hospital after your surgery or if you will be immobilized after surgery (i.e. if you have a tendon repair on the foot/leg). Otherwise, we will no need to implement any preventative measures for blood clots for outpatient procedures.
If you require general anesthesia, you will need to stop drinking/eating at midnight, the night before surgery. If your surgery is performed in day surgery or surgical clinic, there is no restrictions to eating or drinking
You will need to do breathing exercises only after you have surgery in the operating room. Your nurse will remind you how to do the breathing exercises after your surgery. If your procedure occurs in the outpatient clinic and you do not have general anesthesia, no breathing exercises is needed after surgery.
Usually this is performed as an outpatient procedure, even when your procedure is scheduled to be done in the operating room. However, if your surgery is complex, you may need to stay overnight at the hospital for 1-2 days.
You need to be stable and can demonstrate that your pain is under control before you are discharged. Usually, pain medications is prescribed to you if needed. Additionally, you may experience some nausea after surgery from the anesthetics, thus you have to be able to drink and keep down water prior to being discharge.
For minor surgical procedures we usually recommend that the patient take acetaminophen (Tylenol) and/or ibuprofen (Advil/Motrin). Sometimes for more extensive procedures, you may be given a prescription for stronger pain medications.
Typically you will need to start physiotherapy exercises when the cast comes off your arm. Sometimes, depending on the complexity of injury, you may need to start physiotherapy earlier. This will be organized for you after your surgery.
Your prescription medications will be given to you upon discharge from the hospital or after your surgery.
After surgery, you should be able to resume all your medications. If there are any specific medications you need to avoid, you will be notified by your team.
You can take a shower the evening after your surgery, taking care to not get your cast(s) wet.
You will need to return for a follow up appointment 10-14 days after surgery. You will also be set up for a physiotherapy appointment prior to your discharge.
Yes, you will have sutures/staples/pins that will need to be removed after surgery. The appropriate time for these to be removed depends on your specific condition.
Usually the cast is removed after 4-6 weeks.
Depending on your specific surgical intervention, you may have a cast on your ankle after surgery if there is a tendon harvest from your heal. You may also need crutches to maneuver around after surgery. Additionally for the repair in the hand, you may have a cast for 4-6 weeks followed by splints as you recover.
If you pain is control, your activity can be as tolerated after surgery.
Depending on the complexity of your surgery, you may return to work as soon as 1-2 days after surgery or 3-4 weeks after surgery. You may need some of your tasks at work to be modified for some time during the recovery process.
This is dependent on the complexity of the injury and surgery. It is advised that you have a friend/family member drive you home after surgery. Additionally, driving and operating heavy machinery should be avoided if you are taking any prescription pain medications.
There is no restrictions to sexual activity after surgery.
- Make sure your care providers wash their hands before and after your care
- Do not wait until your pain is severe before you ask for pain medication
- Make sure the call button is within reach before medical staff leave the room
- Sit on the edge of the bed for a few minutes before you stand up to prevent getting dizzy
- Do not get out of bed without help if you feel weak or dizzy
- Do not put weight on your affected foot as long as advised by your doctor
- You have a fever higher than 100.4 degrees Fahrenheit
- You have shortness of breath or chest pain
- You notice increased redness, swelling, warmth, or pain around your surgical incision
- You notice that your incision is separating or you have infected discharge from your incision
- You notice that the skin on your affected foot is pale or has an unusual color
- You are unable to move the toes on your affected foot
- You cannot feel the toes on your affected foot
- You have pain that your existing pain medications cannot control
- Take pain and other medications as prescribed
- Do not drive when you are on prescription pain medications
- Do not soak in a bath or go swimming for ten days after your surgery
- Keep your incision clean and dry
- Keep your foot elevated when sitting or lying down and apply ice to it to reduce swelling as advised by your doctor
- Follow your doctor’s instructions on caring for your cast and foot
- Follow your doctor’s instructions regarding putting weight on the affected foot
- Attend physical therapy appointments as long as advised by your doctor
- Avoid strenuous exercise and heavy lifting as long as your doctor advises
- Follow your doctor’s instructions on resuming normal daily activities
- Follow your doctor’s instructions on resuming sexual activity