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Tendon Repair - Extensor

 
 

What is it?

A tendon is a strong cord which joins a muscle to a bone. It enables the bone to move when the muscle contracts. The tendons that straighten your fingers run over the back of your wrist and hand. Two tendons run to the index and little fingers. There is only one tendon to each of your other fingers. The tendons to one or more of your fingers have torn - or ruptured. This gives you a dropped finger or fingers. Your tendons may have ruptured as a result of rheumatoid arthritis or due to the tendons rubbing on a rough piece of bone.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made on the back of your wrist. The surgeon may need to make an extra cut on the back of your hand. This is so he can find the ends of your torn tendon. Unlike a tendon that has been cut with a knife, the surgeon cannot join the frayed ends of the tendon together again. He may join the end of the ruptured tendon to its intact neighbour. Alternatively he may use one of the "spare" tendons from your index or little finger and stitch it to the end of your ruptured tendon.

If several tendons have ruptured, he may do a combination of both techniques. The tendons are sewn together with fine stitches. The skin wound is then closed up with stitches. You will be in hospital two or three days after the operation.

Any Alternatives

If you leave things as they are, you will not be able to straighten your finger. Plaster casts and splints will not help on their own.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests, to make sure that you are well prepared and that you can have the operation as safely as possible.. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

Your arm will be in a plaster cast from below the elbow to the fingers. Do not press on the plaster for 48 hours. The wound may be painful. You will be given injections or tablets to control this. Ask for more if the pain gets worse. The tendons are repaired with fine stitches. These stitches are not very strong. Too much force too early will pull the tendon ends apart. The tendons must slide in their sheaths while they heal. If they stay still while they heal, the tendons will never slide again. The exercises that you do after your operation are a vital part of your recovery. The physiotherapist will show you what exercises to do. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during that time. Your skin stitches will be taken out when you come to the outpatient clinic 10 days or so after the operation. You will not need a dressing on the wound after that. You will need a plaster cast or splint on the front of your hand for four weeks after your operation. Wash around the plaster for the first 10 days. You can wash the wound area when the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you like. The hospitals will arrange a check up about 10 days or so after you leave hospital. The nurses will advise about sick notes, certificates etc.

After - At Home

Do not let the plaster cast get wet. Do not cut or bang the plaster. Do not put anything down the inside of the plaster (eg coins). Do not use anything to scratch under the plaster. Come back to the hospital if:

  • you have pins and needles or numbness in your fingers.
  • you cannot move your fingers.
  • your fingers go blue.
  • your fingers become very swollen.
  • you have severe pain.

If you are experiencing one or more of these it could be an indication of a problem with the nerves or the blood vessels in or around the area of the operation or of an infection. In this case you should return to thehospital urgently.

Come back to see the plaster technician if the plaster cracks, becomes softor is getting loose. You must not drive whilst your arm is in a plaster cast. You should not drive for six weeks after the operation to allow your tendons to heal fully. How soon you can return to work depends on your job. If you can work one handed, you may be able to return to work two weeks after the operation. This also depends on you being able to get to work. If your job is manual you will be unable to work for three or four months. You may swim six weeks after your operation. You may play most sports 10 weeks after your operation. When you start playing, you will not be able to play for as long as normal and your hand will ache at the end of a game. Your finger movements and strength will continue to improve for up to six months.

Possible Complications

As with any operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Wound infection sometimes happens. You will be given antibiotics to try and prevent this. More serious complications like damage to the blood vessels or the nerves in or around the area of the operation happen rarely and you might need another operation to fix them. The tendon is at its weakest two weeks after it has been repaired. Occasionally, the tendon repair can come apart. If this occurs, you will suddenly be unable to straighten your finger. Go straight to the casualty department and you will be re-admitted for a second repair.

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