WHAT YOU SHOULD KNOW
Tendons that move the fingers can sometimes rupture with a sudden force but more often are cut by sharp lacerations. Lacerations may be partial or complete. If complete, the function of that tendon will be lost forever unless the tendon is repaired. There is a limited period of time after injury during which repair is possible. Examination right away by an expert in hand trauma is needed to prevent serious long-term problems with hand function.
The patient can almost always recall the specific event when the injury happened and frequently will have noticed the function of the finger that no longer works right after the injury.
The specific function of the tendon will be tested to determine if the loss is partial or complete and any other related losses that may have happened such as nerve lacerations.
None are needed.
|NON-OPERATIVE||SURGICAL REPAIR||SURGICAL RECONSTRUCTION|
|CONSISTS OF||4 weeks of splinting||Sewing together the original tendons||Grafting or transfers with other tendons|
|FEATURES||Only good for some extensor tendon ruptures||Only possible if treatment done within so many weeks of injury||Need to borrow other tendons to use for the reconstruction|
|ADVANTAGES||No surgery||Prevents loss of function||Can solve problem at any time point after injury|
|DISADVANTAGES||Only few injury patterns can be treated this way||Requires patient commitment to 3 months of rehabilitation||Requires patient commitment to up to 6 months of rehabilitation and possibly more than one surgery|
After the tendons have been sewn together, transferred, or grafted they still have to bond or heal together. In the mean time they are only connected by the strength of small threads. The wrong type of movements will cause the sutures to break and the tendons to come apart again. If no movement is done the tendons will develop unwanted scar tissue and have no useful function. Starting immediately after surgery it is necessary to begin a pattern of specific rehabilitation movements performed every hour on the hour. A splint protects against moving too far during the first 6 weeks. During the second 6 weeks more vigorous exercises are allowed. By the end of 3 months the hand works about as well as it is going to and patients are allowed to resume all their normal activities in life. When reconstruction is necessary, there may be 2 surgeries spaced 3 months apart; each one has a 3-month course of rehabilitation afterwards.