If the tendons on the palmar side of your hand are flexor tendons, then the back of your hand and fingers are your extensor tendons. They help to open your fingers.
The anatomy of them can be pretty hard to completely understand but through a whole system of a large tendon, then smaller tendons, they work to help you open your fingers fully.
If you can close your fingers but you can’t open them, it creates a whole other problem.
Causes and symptoms of extensor tendon lacerations
An extensor tendon laceration is an injury to the tendons that attach the muscles of the forearm to the bones of the fingers and thumb on the back of the hand. These injuries can be caused by trauma, such as a deep cut or a crush injury.
The symptoms of an extensor tendon laceration include pain, swelling, difficulty straightening the fingers, and a visible gap or depression where the tendon has been severed.
What are the examples of extensor tendon lacerations?
People usually cut the back of their hand in so many weird accidents. For example, I had a client who was sharpening his knife and for a split second, got distracted and the knife came down and sliced his extensor tendon at the middle knuckle.
I had another client who had a knife accident where the clean knife was on the counter, something dropped and knocked it up and flipped cutting him on the back of his hand through 2 tendons.
Yes…it can be weird. We also treat plenty of people after work accidents to the back of the fingers and hands.
So, what happens if there is a laceration to the extensor tendons?
Extensor tendons, once cut, need to be repaired surgically. The hand and arm is broken up into 7 zones, and based on which zone you had the accident and the repair, determines the protocol required for hand therapy.
After hand surgery, it can be hard to know what you are supposed to do next. Especially since hand surgeries can be painful, the stitches are still in, and you might feel extra uncertain about when to start therapy because of what the surgeon may have said at the beginning.
The hand therapy required after plays a huge role in managing the scare, regaining motion, and returning you back to full motion without residual deformities.
Since the zone plays a huge role on what you are allowed to do, here are some general tips that you may find helpful if you or someone you know had extensor tendon laceration and repair.
5 tips to avoid additional pain and stiffness after an extensor laceration
- Seek out a certified hand therapist to work with and get clear on when to get started can help you avoid additional pain and risk for another surgery.
- Know the location of the cut – as a certified hand therapist, I know what protocol I can use based on the location. If it’s the back of the hand, we can start earlier very specifically. But if it’s the back of the middle knuckle, we can’t start early but we can make sure we move all the other fingers so they don’t get stuck.
- Get fitted for a custom fitted splint. The size depends on the location of the surgery.
- Move the fingers and joints that you are allowed to move. You should not have a splint that blocks other fingers unless you cut the big extensor tendon on the back of the hand. This can be difficult as you want to go to an experienced therapist who can give you direction.
- Working the scar is important to allow movement of the tendon and not about making the hand look pretty.
The role of hand therapy in recovery
Extensor tendon surgeries can be very painful, but the sooner you get started the better to avoid unnecessary stiffness and adhesions of the scar to the tendon preventing the tendons from being able to glide.
During the initial stages of therapy, the focus is on gentle range of motion exercises and scar management. The goal is to prevent stiffness and promote healing of the repaired tendon. As healing progresses, therapy will typically involve more advanced exercises to improve strength, dexterity, and function of the hand and wrist.
It is important to follow the rehabilitation program closely and attend all scheduled therapy sessions. The duration of therapy will depend on the extent of the injury and the individual’s progress in healing and regaining function. In some cases, hand therapy may continue for several months after surgery to ensure a full recovery.
It is important to note that delaying or avoiding therapy can lead to complications, such as stiffness, weakness, or decreased range of motion. Therefore, it is essential to start therapy as soon as possible after an extensor tendon laceration to ensure the best possible outcome.
The consequences of delaying or avoiding therapy
I’ll never forget one of my clients – he cut the extensor tendons in the middle of his forearm but didn’t get started in therapy until 4 weeks after surgery.
He didn’t know. He was told by his surgeon to get hand therapy but you are told so many things after surgery, it’s hard to know what is true. Because he didn’t come in right away, the kept the post-op bully dressing. It blocked a lot of his fingers, which resulted in a very stiff hand. Requiring very painful hand therapy.
Great news…he did amazingly well because he was committed to not having to get another surgery. A year later, I hired him to redo the floors of my clinic and his hands looked amazing….almost like nothing happened.
The moral of the story?
Hand surgery and therapy is hard…but you don’t have to experience it alone. If you are scared…just give us a call and request to speak with the specialist. We’re happy to give you clarity on what your next steps are. If you are not ready for therapy, we’ll tell you. If you are ready for hand therapy, we’ll let you know.
PS. If you know someone who’s had surgery, grab my guide on what to consider after hand surgery….grab my free guide here.
Written by Hoang Tran
About the author – Hoang Tran; an expert in physical & occupational therapy
Hoang Tran is a certified hand therapist, the owner of Hands-on Therapy Services, and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck, and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!).
The aim of her Miami occupational therapy practice is to bring patients back to full functionality, without pills, injections, or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care.
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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.