Extensor Tendon Injuries

Common Causes of Extensor Tendon Injuries

• Cuts on the back of the fingers
• Jammed or stubbed fingers
• Crush injuries to the back of the hand or fingers
• Hand trauma or overuse
• Lacerations or broken bones in the fingers
• Nerve compression

Types of Extensor Tendon Injuries

• Mallet finger: Drooping of the fingertip due to a tear or cut of the tendon at the last joint.
• Boutonniere deformity: The middle finger joint bends downwards (flexed position), caused by a tear or cut at the tendon in the middle joint.

What Are the Signs or Symptoms of Extensor Tendon Injuries?

Common symptoms include:

• Pain and swelling at the tip or back of the finger
• Redness and warmth near the injury
• Stiffness in the finger joints
• Inability to straighten the finger or thumb
• Downward drooping of the finger or thumb
• Increased discomfort with activity
• Crepitus (a crunchy feeling over the tendon)
• Finger deformity or loss of function

What If the Condition Is Left Untreated?

Untreated extensor tendon injuries can lead to:

• Permanent damage to the tendon
• Inability to straighten the finger or thumb
• Serious functional impairment
• Permanent deformity or disability

Early diagnosis and treatment are essential to restore hand function and prevent long-term complications.

How Is the Condition Diagnosed?

Doctors typically diagnose extensor tendon injuries using:

• Medical history and physical exam: Assessment of pain, deformity, and ability to move fingers.
• X-rays: To check for associated fractures.
• Ultrasound or MRI: For severe injuries, these imaging studies evaluate tendon integrity and surrounding structures.

Accurate diagnosis helps guide the appropriate treatment plan.

How are Extensor Tendon Injuries Treated?

Conservative Treatment

Mild injuries may heal without surgery using:

• Splinting: Immobilizing the affected finger or hand in proper alignment
• Anti-inflammatory medications: To reduce pain and swelling
• Hand therapy exercises: To restore motion and strength once healing begins
• Rest and ice: For minor injuries to control swelling and discomfort

Conservative treatment is typically for partial tears or minor injuries.

Surgical Treatment

Surgery may be required for severe tendon injuries, including complete tears, lacerations, or cases with motion loss.

Procedure:

• Repairing and suturing the torn tendon
• Pins may be used as internal splints
• Immobilization with a splint postoperatively

Advanced surgical options:

• Tendon reconstruction or transfer (e.g., EIP/EPL tendon transfer)
• Bony avulsion fixation occurs when a tendon pulls off a piece of bone
• Scar tissue release followed by hand therapy for motion loss

Risks and Complications of Surgery

Extensor tendon repair is generally safe, but potential risks include:

• Infection
• Adhesion formation (scar tissue that restricts motion)
• Tendon rupture or repair failure
• Loss of finger flexion or extension
• Weakness in grip

With proper care and rehabilitation, most patients regain functional movement and strength.