Extensor Tendon Injuries
What is an extensor tendon?
Extensor tendons, located on the back of the hand and fingers, allow
you to straighten your fingers and thumb (see Figure 1). These tendons
are attached to muscles in the forearm. As the tendons continue into the
fingers, they become flat and thin. In the fingers, these tendons are
joined by smaller tendons from the muscles in the hand. It is these
small-muscle tendons that allow delicate finger motions and
coordination.
How are extensor tendons injured?
Extensor tendons are just under the skin, directly on the bone, on
the back of the hands and fingers. Because of their location, they can
be easily injured even by a minor cut. Jamming a finger may cause these
thin tendons to rip apart from their attachment to bone. After this type
of injury, you may have a hard time straightening one or more joints.
Treatment is necessary to return use to the tendon.
How are extensor tendon injuries treated?
Cuts that split the tendon may need stitches, but tears caused by
jamming injuries are usually treated with splints. Splints stop the
healing ends of the tendons from pulling apart and should be worn at all
times until the tendon is fully healed. Your doctor will apply the
splint in the correct place and give you directions on how long to wear
it. Sometimes a pin is placed through the bone across the joint as an
internal splint.
What are the common extensor tendon injuries?
Mallet finger refers to the droop of the end joint where an extensor
tendon has been cut or separated from the bone (see Figure 2). Sometimes
a piece of bone is pulled off with the tendon, but the result is the
same: a fingertip that cannot be straightened. Whether the tendon injury
is caused by a cut or jammed finger, splinting is necessary. Often the
cut tendon requires stitches. Splinting is done to keep the fingertip
straight until the tendon is healed. The size of the splint and length
of time you will have to wear it is determined by the type and location
of your injury. The splint should remain in place constantly during this
time. The tendon may take four to eight weeks, or longer in some
patients, to heal completely. Removing the splint early may result in
drooping of the fingertip, which may then require additional splinting.
Your physician will instruct you to remove the splint at the proper
time.
Boutonnière deformity describes the bent-down (flexed) position
of the middle joint of the finger from a cut or tear of the extensor
tendon (see Figure 3). Treatment involves splinting the middle joint in
a straight position until the injured tendon is fully healed. Sometimes,
stitches are necessary when the tendon has been cut. If this injury is
not treated, or if the splint is not worn properly, the finger can
quickly become even more bent-down and finally stiffen in this position.
Be sure to follow your physician’s instructions and wear your
splint for a minimum of four-to-eight weeks. Your doctor will tell you
when you may stop wearing the splint.
Lacerations or cuts on the back of the hand that go through the
extensor tendons cause difficulty in straightening the finger at the
large joint where the fingers join the hand. These injuries are usually
treated by stitching the tendon ends together. Splinting for a tendon
injury in this area may include the wrist and part of the finger.
Dynamic splinting, which is a splint with slings that allows some finger
motion, may be used for injuries of this kind. The dynamic splint allows
early movement and protects the healing tendon.
What can I expect as a result of my extensor tendon injury?
Extensor tendon injuries may cause the tendon to attach itself to
nearby bone and scar tissue. Many factors can affect the seriousness of
the injury, including fracture, infection, and individual differences.
The scar tissue that forms may prevent full-finger bending and
straightening even with the best treatment. To improve motion, therapy
may be necessary. Surgery to free scar tissue may sometimes be helpful
in serious cases of motion loss. Your physician will explain the risks
and side effects of the various treatments for extensor tendon
injuries.
Figure 1: Extensor tendons, located on the back of the
hand and fingers, allow you to straighten your fingers and thumb.
Figure 2: The mallet finger deformity causes a droop of
the fingertip. This is caused by injury to the extensor tendon at the
last finger joint.
Figure 3: The boutonnière deformity with
progressive flexion, or bending, of the middle joint may result in a
stiff finger in this position if not treated. The end joint also
hyperextends (bends backward) from the altered force across the
finger.
© 2006 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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