Extensor Tendon Repair, Zone IV to VI

Patient information

Therapy Department

Introduction

Injury to your extensor tendon

You have injured the tendon(s) on the back of your hand, between your knuckle(s) and your wrist.  These tendons work to straighten your fingers. 

Surgical repair

The injured tendon(s) have been repaired in surgery. The two ends of the tendon(s) have been stitched back together, allowing you to start moving your fingers under the guidance of hand therapy. However, the tendon will not be fully strong until 12 weeks after surgery. 

Your hand and wrist will be in a back slab after your operation. This will be removed at your first appointment with the hand therapist at about 5-7 days after the operation.

Treatment

Splintage

Once your tendon has been repaired, it is important to protect it while it heals. Your therapist will fit you with a custom-made splint worn on your hand. 

This is worn around your fingers. It stops the knuckles from bending fully, protecting the repaired tendon from being overstretched. Your hand splint should be worn all the time for approximately 5 weeks after your operation.

You may also have to wear a wrist support for 3 weeks after your operation. This stops you from bending your wrist forward and increasing the stretch on the repaired tendon. 

Please note – You are at risk of re-injuring your tendon if you remove the splint before you are advised to.

Exercise

It is important to do the exercises that the hand therapist advises within your splint(s). This helps to prevent stiffness in your fingers, reduces swelling, aids healing, and improves the movement and function of your hand. 

Exercise/Advice

Weeks 0 – 3

Complete 10 repetitions of each of the above exercises, hourly

(If your therapist has advised you to wear a wrist support, please complete the above exercises with the wrist support on).

Important information

• You must wear your splint(s) at all times
• Keep your splint(s) clean and dry. When having a bath / shower, cover your splint to keep it dry
• Regularly elevate your operated hand higher than your heart to reduce swelling
• Regularly bend and straighten your elbow to stop it becoming stiff
• You can do light activities in your splint(s) for example: eating, dressing, using phone, typing
• When shown by your hand therapist, massage your scar for about 5 minutes with unscented cream. Do this about 3 times per day. This stops the tendon getting stuck to the scar tissue

Contact the hand unit if: -

• You suddenly cannot straighten your finger(s)
• You are having problems with your splint(s)

Attend the Emergency department if: -

• You have any signs of a wound infection e.g. increased redness/swelling/pain, discharge with a bad odour or discoloured, and/or fever 

Weeks 3 – 4 

Important information

• Continue to wear your hand splint at all times 
• If you have been wearing a wrist support, you can now remove this

Week 5 onwards

Important information

• If you are advised by your therapist, you can start to come out of your hand splint for light activities 
• Wear your hand splint for work and moderate activities e.g. lifting bags
• Gradually aim to be able to fully close your fingers into your palm
• ‘Listen’ to your hand. Do not do activities that cause pain, or over-do it. The tendon is not fully strong until about 12 weeks after surgery

Week 6

You can drive if the range of movement and strength in your hand is sufficient to control the car in an emergency situation.

Weeks 8-10

You may gradually return to full activity. You should wear your splint for heavy activity.

Week 12

You may return to heavy manual activities and contact sports.

References

https://fifevirtualhandclinic.co.uk   

Acknowledgments

Thank you to NHS Scotland for allowing free access / use of their images.