Extensor Tendon Injuries

What is an extensor tendon injury?

Extensor tendons are muscle tendons located at the back of the hand and fingers, which help to straighten the wrist, fingers and thumb. Injuries to the extensor tendons can result in the inability to straighten one or more of the joints in your hand.

Extensor tendon injuries typically occur from a cut on the back of the fingers, hand, wrist or forearm. The extensor tendon can also be torn from the bone by a direct blow to the finger, forcibly bending the finger and overstretching the extensor tendon. A common extensor tendon injury is a mallet finger – a tear of the tendon from its attachment site on the last bone of the finger, causing the end joint of the finger to droop.

How do I know if I have an extensor tendon injury?

Signs and symptoms of an extensor tendon injury may include:

• An open injury, such as a cut, on the back of the hand, wrist, or forearm
• An inability to straighten one or more joints of the finger on your own
• Pain when you attempt to straighten the finger
• Swelling and/or bruising over the back of the finger

How is an extensor tendon injury diagnosed?

Your specialist Doctor will obtain your health history and perform a physical examination. A radiological investigation may be ordered (e.g. X-rays, CT scans) to ascertain the extent of damage to the bones of the hand, wrist or forearm.

How is an extensor tendon injury treated?

It is important to seek early treatment for an extensor tendon injury as there is a high possibility of tendon injuries requiring surgical treatment. Extensor tendon injuries may be treated both surgically and non-surgically, depending on the severity of the injury.

Non-surgical Treatment

Extensor tendon injuries involving mild or partial tears of the tendon may be managed without surgery. Your specialist Doctor may refer you to a Hand Therapist, who will fabricate a customised splint for your finger/wrist. This splint will help to support your finger/wrist in an optimal position so that tendon healing can occur. It is often vital that the splint is worn at all times for at least 6 weeks, with the finger/wrist joints immobilised completely during this period of time. Once your specialist Doctor ascertains that the extensor tendon is healing adequately, your Doctor will refer you to our Hand Therapist to start gentle finger/wrist exercises.

Surgical Treatment

Surgery is usually required for extensor tendon injuries that are more severe, such as a severe tear or complete cut of a tendon. The tendon is repaired by sutures during surgery and your specialist Doctor will refer you to our Hand Therapist for a customised splint to immobilise the affected wrist/finger for a period of 6 to 8 weeks after the surgery in order to protect the tendon repair while it heals. Once your specialist Doctor ascertains that the extensor tendon and/or fracture are healing adequately, you will be able to see our Hand Therapist to start gentle finger exercises.

Hand Therapy

Joint stiffness, muscle tightness and loss of function of the finger, hand and wrist are common problems in the early stages of recovery from an extensor tendon injury. As such, daily activities such as self-care (e.g. dressing, showering, brushing of teeth), work activities and leisure pursuits (e.g. baking, sports, gym activities) are often affected. Hand therapy plays a pivotal role in the recovery of finger, hand and wrist movements, strength and function after an extensor tendon injury. Most extensor tendon injuries take around 3 to 4 months to heal before you are able to return to your normal daily activities, and full recovery from these injuries can take up to a year.

If you require protective immobilisation for your finger/ wrist, your specialist Doctor may refer you to our Hand Therapist for a customised splint. Once you are able to start therapy for your finger, hand and wrist, our Hand Therapist can then help you in your recovery through treatment options such as:

• Advice and education pertaining to your condition
• Wax therapy
• Ultrasound therapy
• Exercises to improve finger/wrist joint and muscle movements
• Management of swelling
• Scar management
• Strengthening exercises
• Soft tissue mobilisation and release
• Pain relief/management
• Functional retraining of the finger, hand, and wrist
• Personalised home exercise program