General Surgery - Flexor Tendon Injury

• The flexor tendons are strong smooth cords that connect the muscles of the forearm to the bones in the fingers and thumb on the palm side
• They allow you to bend your fingers
• As seen in the diagram above, there are two for each finger and one for the thumb
• The tendons run through tunnels in the fingers and at the wrist

What are the signs of a flexor tendon injury and why is it important to be treated?

Flexor tendons allow you to bend your fingers. It is important to treat any injury to the flexor tendon to allow you to regain function in that hand.

Signs of a flexor tendon injury include:

• A wound across the palm or fingers
• Inability to bend the finger either partially or totally
• Pain on trying to bend the finger
• Your injured finger lies straighter than the other fingers
• Numbness in the injured finger. The nerves lie very close to the tendon and can also be injured

What does the operation involve?

• The operation may involve a local anaesthetic, general anaesthetic or regional anaesthetic (local anaesthetic is injected in your shoulder to numb your arm)
• The cut on your hand will be made slightly bigger in a zig zag pattern to find the two ends of the tendon and these will be stitched together. At the end of the operation, you will have a plaster cast on the back of your hand going from your fingertips to mid forearm. Your fingers and wrist will be in a slightly bent position to protect the repair

What should I expect after surgery?

• You will be seen by the hand therapy team within 3-5 days of your operation
• Your plaster splint will be replaced with a light thermoplastic splint, and you will start a protected exercise programme within a few days of the operation as per the rehabilitation protocol
• The splint will need to be worn all the time for the first few weeks and then as advised by your hand therapist
• The hand therapy after your operation is vital and is as important as the operation itself. Without following the exercises, your tendons can stick together causing stiffness. Hand therapy will allow the tendon to move gently through its tunnel and over time will restore function to that hand
• It takes up to 12 weeks for the tendon to recover

Approximate timescales for returning to activity:

• Driving - 8-10 weeks
• Contact sports/heavy lifting - 12 weeks

Please discuss specific activities with your therapist and they will be able to guide you as each patient and injury is individual.

What are the risks of surgery?

• Bleeding: a small amount of bleeding into the dressing is normal. It is important to keep your hand above heart level and squeeze your fingertip for 5-10 minutes and this should stop. If your dressing becomes soaked with blood, please contact our dressing clinic on the phone number at the back of this leaflet
• Infection: Please complete the course of antibiotics you have been given. This will reduce the risk of infection. If you have any signs of infection such as redness, foul smelling/yellowish discharge, excessive pain, please call the dressing clinic phone number or attend A&E for urgent review
• Tendon rupture: the tendon can snap after repair, especially if you resume activities too soon, please make your therapist aware. This may require an assessment and another operation to stitch the tendon back together again
• Tendon adhesions and/or scarring: If you do not follow your exercise regime properly, the tendons will quickly form scar tissue and stick together causing stiffness. This may require a further operation to remove the scar tissue so that you can move your hand properly

If you have any of the above-mentioned issues, please contact the plastic surgery dressing clinic on 0161 206 5898 (Monday to Friday 8am - 4pm). Please discuss with your hand therapist for movement related issues.