Ask a Doctor: Tendon Injuries

Hand surgeon David J. Bozentka, MD answers your questions about tendon injuries.

What is a tendon?

A tendon is a cord-like structure that attaches a muscle to a bone.  The muscles that allow you to bend and straighten your fingers start in the forearm, and the tendons attach the muscles to your fingers and wrist.  The tendons on the palm side of the hand that bend the fingers and wrist are called flexor tendons.  The tendons on the back side of the hand and wrist are termed extensor tendons.

How do I know that I have a tendon injury?  

Difficulty in fully bending or straightening your finger or wrist after an injury may be related to damage to a tendon.  Lacerations (cuts) to the hand, wrist or forearm are some of the more common reasons you can injure a tendon.  In addition, an injury without an open wound can cause a tendon to pull away from a bone called an avulsion injury.  A Jersey Finger is a term used for a flexor tendon avulsion injury most commonly occurring in the ring finger.  A player that grabs another player’s jersey that is pulled away can avulse a flexor tendon, causing inability to bend the tip joint of the finger.  Alternatively, a Mallet Finger involves an avulsion injury of the extensor tendon leading to a droop of the tip joint of the involved digit.

What should I do if I suspect a tendon injury?

If you suspect a tendon injury either from a laceration or avulsion, seek medical attention. Open wounds in particular are evaluated in an emergency room soon after the injury.  The wound is cleansed to prevent infection, a tetanus shot may be required, and the extent of injury is determined.  Further treatment may be required by a hand surgeon.  Expedient further assessment is important often within a week.  For example, a flexor tendon that is injured may retract, making repair more difficult if treatment is delayed more than a week or two.

What will the doctor do at the time of my visit?

The physician will take a thorough history to understand the mechanism of injury, your occupation, hand dominance and activity level.  In addition, prior injuries, surgery and medical history will be reviewed.  An x-ray may be obtained to determine if there is an associated broken bone, joint dislocation or associated foreign body.  Further studies such as an ultrasound or MRI may be required to complete the evaluation.  After the work-up is completed, the treatment options are reviewed.

How is a tendon injury treated?

The recommended treatment for a tendon injury is determined by multiple factors including the specific tendon injured, length of time from injury and activity level of the patient. In general, a lacerated tendon is repaired surgically.  An avulsion injury of a flexor tendon is often treated surgically, whereas an extensor tendon avulsion, such as a mallet finger, is typically treated with a splint.

David J. Bozentka, MD, is the chief of Hand Surgery in the department of Orthopaedics at the Perelman School of Medicine at the University of Pennsylvania, and the chief of Orthopaedic Surgery at Penn Presbyterian Medical Center. Bozentka is Board-certified in Orthopaedic Surgery and has a Certificate of added Qualification in hand surgery. He specializes in the diagnosis and treatment of all conditions affecting the hand, wrist and elbow in patients of all ages. His research interests focus predominantly on distal radius fractures and trauma of the upper extremity.

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