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Flexor Tendon Injuries (Hand)

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Introduction

A flexor tendon injury occurs when the tendon is cut or ruptures.  The flexor tendons attached at the palm side of your fingers and thumbs.  They allow your finger and thumb joints to bend, grasp items, and perform fine coordinated movements.  The muscles that control these tendons are in the forearm.  Lacerations, other trauma, and rheumatoid arthritis are the primary causes of flexor tendon injuries.

Flexor tendon injuries can cause loss of movement, pain, and swelling.  Flexor tendon injuries require surgical repair.  Splinting and hand therapy rehabilitation usually follow surgical treatment.

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Anatomy

Your hand is composed of many bones that provide structure for your wrist and fingers.  Your fingers and thumbs are made up of bones called phalanges.  The bones are connected with strong ligament tissues.  Tendons are strong fibers that attach your muscles to your bones and allow movement.  Your hand also contains nerves, blood vessels, and fat.
 
Your flexor tendons begin in your forearm and continue to the palm side of your fingers and thumb.  Each finger has two flexor tendons and your thumb has one.  They are located just underneath the skin.  Sheaths thickened in areas by fibrous pulleys guide the flexor tendons and keep them close to your phalanges during motion.  The flexor tendons allow your fingers and thumbs to bend, grasp items, and perform fine coordinated movements.  The nerves in your fingers (digital nerves) travel parallel and along both sides of the flexor tendons.
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Causes

Deep cuts are the main cause of flexor tendon injuries.  They may also occur during sports, such as football, wrestling, rugby, and rock climbing.  Rheumatoid arthritis can cause flexor tendons to rupture.  The outward injury often appears simple, but is usually complex when involving the tendons and possibly the nerves.
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Symptoms

A flexor tendon injury can cause your finger joints to feel painful and swollen.  It may be difficult or impossible for you to move your finger.  You may not be able to bend your finger joints.  Nerves are located very close to the flexor tendon.  If the nerves are injured, your finger may feel numb.
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Diagnosis

Your doctor can diagnose a flexor tendon injury by reviewing your medical history and examining your wrist, hand and fingers.  You should tell your doctor if you sustained an injury.  Your doctor will carefully move your finger joints.  Your doctor will test the sensation and blood flow to your fingers.  X-rays can identify bone injuries. 
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Treatment

Flexor tendon injuries do not heal well without surgical repair.  When a flexor tendon separates, the two pieces pull away from each other, making it impossible for the tendon to heal without surgery.
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Surgery

There are many ways to surgically repair flexor tendons.  Certain types of injuries need specific types of surgery.  Your hand surgeon will stitch the ends of the tendon together and repair damaged nerves, blood vessels, or bones.  A splint will immobilize your hand to allow the flexor tendon to heal after surgery.
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Recovery

Hand therapy rehabilitation and continued splinting follow flexor tendon repair surgery.  Hand therapy will help you regain strength, flexibility, motion, and functional use of your hand.  Recovery from flexor tendon surgery is very individualized and rarely is full normal motion regained.  Therapy protocols vary and will depend on the nature of your injury and repair.  Splint protection is generally required for six weeks. Healing continues for three months after repair.  Your doctor will let you know what to expect.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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At The Center for Orthopaedic Surgery and Sports Medicine in San Antonio, TX, our board-certified and fellowship-trained physicians specialize in general orthopedics; total joint replacement; surgery of the hand, wrist, and elbow; arthroscopic surgery of the knee and shoulder; sports medicine; and fractures.