What is Flexor Tendons ?
Flexor Tendons are strong, connective tissue structures that connect the forearm muscles to the bones in the fingers and the thumb on the palm side of the hand. These tendons allow us to flex our wrists, hold a tea cup, button our shirts, open jars, and perform daily activities that involve bending our fingers and thumbs.
Anatomy of Hand Tendons
Tendons are bands of fibrous connective tissue that connect muscles to bones. The tendons help in the movement of the fingers, the hand and all other parts of the body.
There are two types of tendons in the hand:
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Extensor Tendons:
The extensor tendons on the upper part of the hand help straighten the fingers.
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Flexor Tendons:
The flexor tendons in the palm of the hand help to bend the fingers.
What Are Flexor Tendon Injuries?
Deep cuts on the lower surface of the wrist, hand, or fingers can cut and injure the tendon and render one or more joints in a finger unable to bend. When a tendon is cut, the cut ends are pulled apart like a rubber band.
Flexor tendon tears can be partial or complete. If the tendons are cut completely, the knuckles cannot bend on their own.
Causes of Flexor Tendon Injuries
Any cut or tear in the arm, hand, or fingers can cause a flexor tendon injury. Other possible causes are:
- Tendon damage from a sports injury usually associated with football, rugby and wrestling
- Tendon stretching where the tendon pulls away from the bone
- When a player’s finger is caught on another player’s jersey or clothing
- Rheumatic joint inflammation
- Adventurous activities such as rock climbing
- Symptoms of Flexor Tendon Injuries
- Inform your doctor if you have any of the following symptoms:
- Cuts to hands or fingers
- Hand Pain
- Hand Inflatable
- Loss of ability to bend the finger
- Hand numbness (sensory loss)
First Aid for Flexor Tendon Injuries
Immediately apply ice to the injured finger. Wrap a sterile cloth or bandage around the injury and keep your finger above your heart level to reduce any bleeding. A tetanus injection may be required.
Diagnosing Flexor Tendon Injuries
See a doctor whenever you experience a finger injury that affects the flexion and extension of your fingers.
Your doctor will review your symptoms and medical history. A physical examination of both hands will be done. During the exam, you will be asked to bend and straighten your fingers. Your fingers will also be examined for sensation, blood flow, and strength. An X-ray may be ordered to check for any damage to the surrounding bone.
Treatment of Flexor Tendon Injuries
A torn tendon cannot heal without surgery because the cut ends are often pulled back after an injury.
There are many options for repairing a cut tendon; The type of repair depends on the type of cut. The purpose of the procedure is to restore the normal function of the joints and surrounding tissues following a tendon rupture.
Flexor tendon repair is usually an outpatient procedure and can be performed under local or general anesthesia.
Your surgeon makes an incision in the skin over the injured tendon. The damaged ends of the tendon are brought together with sutures, ensuring a safe repair. If the tendon injury is severe, a graft may be needed. A graft is a piece of tendon obtained from another part of your body, such as a foot or toe. After repositioning the tendon, the incisions are closed with sutures and a dressing pad is placed on the surgical site. Your surgeon will place your hand in a protective splint to restrict movement.
Flexor Tendon Repair Postoperative Care
Depending on the injury, it is recommended to start hand therapy a few weeks after surgery. This is to improve finger movement.
Flexor Tendon Injury: Frequently Asked Questions
What are flexor tendons and what is their function?
Flexor tendons are long, cord-like structures that connect the muscles of your forearm to the bones within your fingers and thumb. Their primary function is to allow you to bend your fingers and thumb to make a fist or to grip objects.
These tendons run through the palm of your hand and along the front side of your fingers. Because they are under high tension to provide grip strength, any injury to them can significantly impact hand functionality.
What are the signs of a torn or cut flexor tendon?
A flexor tendon injury is usually easy to identify because the primary symptom is the inability to bend one or more joints in your finger. Other common signs include:
- Pain when attempting to bend the finger.
- Tenderness along the palm side of the finger or hand.
- Numbness in the fingertip (as nerves often run alongside the tendons and may also be damaged).
- Swelling and bruising in the palm or finger.
Why is surgery almost always necessary for flexor tendon tears?
Unlike some other tissues in the body, a completely severed flexor tendon cannot heal on its own. This is because the muscles in the forearm act like a rubber band; when the tendon is cut, the muscle pulls the two ends away from each other.
Because the ends are no longer touching, they cannot bridge the gap to heal. Surgery is required to retrieve the retracted ends and sew them back together with high-strength sutures to restore the continuity of the tendon.
What is the recovery timeline after flexor tendon surgery?
Recovery from flexor tendon repair is a delicate process that requires patience. The general timeline includes:
- Weeks 1-2: The hand is kept in a protective dorsal block splint that prevents the fingers from straightening fully, which would snap the repair.
- Weeks 2-6: Controlled “passive” exercises begin with a hand therapist to prevent the tendon from scarring to the surrounding sheath.
- Weeks 6-8: Light active movement is introduced without resistance.
- Weeks 10-12+: Gradual strengthening and return to normal heavy activities or sports.
What is a “Jersey Finger” injury?
A Jersey Finger is a specific type of flexor tendon injury that occurs when an athlete’s finger gets caught in an opponent’s jersey while they are trying to pull away. This causes the tendon to be forcefully pulled off the bone at the tip of the finger.
This most commonly affects the ring finger. Because the tendon often retracts all the way into the palm, prompt surgical intervention is usually required to prevent permanent loss of the ability to bend the fingertip.
How can I prevent complications like stiffness after surgery?
The most common complication after flexor tendon repair is adhesion (scar tissue), which causes the tendon to stick to the surrounding tissue, leading to stiffness. To prevent this, strict adherence to a hand therapy program is essential.
Specialized “tendon gliding” exercises are designed to move the tendon just enough to prevent it from sticking without putting enough stress on it to break the surgical stitches.
