Within the palm of the hand lie the wrist flexor tendons that act to flex the fingers and assist in making a fist. Each finger has 2 tendons that run up the front of the finger and are contained within a tunnel called a flexor sheath. This sheath is lined by a lubricating tissue called synovium and allows the tendon to slide within the sheath without resistance. Thickenings of this sheath, called pulleys, hold the tendon down against the bone and prevent bowstringing of the wrist flexor tendons.
Injuries to the wrist flexor tendons are usually a result of a cut or a pull or avulsion from the bony attachment site. This injury creates bleeding throughout the sheath. This bleeding forms scar tissue within the sheath and ultimately inhibits normal gliding of the tendons. In an effort to restore normal tendon function the physician will perform a direct repair of a tendon but this must be accomplished before the onset of the scarring, which is usually within 2-3 weeks of the injury. Results of surgery attempted after that time are usually not successful as the sheath has scarred and the gliding effect has diminished.
With a cut or avulsion of the tissue, the tendon is no longer properly attached within the hand yet on the opposite end the muscle continue to contract which ultimately results in a retraction or shortening of the wrist flexor tendons which progressively increases over time.
Wrist and hand flexor tendon disruptions can be repaired either directly, if within the correct time frame. Generally the repair involves a small incision from the tip of the finger to the point that the tendon may be retrieved. The tendon is then reattached back to the injury site using either a button or bone anchor. Post operatively the hand is splinted and activity/therapy is severely limited for 3-4 months according to the extent and nature of the repair.
In the event a repair has not been undertaken within the appropriate time frame to accomplish a direct repair, late repair options may need to be considered. Late repair options include avoiding any treatment which would result in inability to bend/flex the finger, chronic unalleviated pain at the injury site and increased potential for carpal tunnel syndrome due to chronic swelling in the palm.
Secondly, removing or resecting the retracted wrist flexor tendon may be helpful simply to aid in pain relief. Additional options include fusion of the end joint in the finger which requires splinting for approximately 6 weeks post operatively. Some pain may permanently persist.
Finally a more aggressive approach known as a wrist flexor tendons graft may be attempted. These procedures are usually performed by Hand Surgeons due to the complexity of the procedure. In the event you may be in need of this procedure, your surgeon will outline for you the nature of the procedure, post operative course, risks and benefits. The procedure usually involves the use of a tendon graft that is taken from the forearm and reconstructed to provide functional use of the injured finger.
Post operatively splinting for a prolonged period of time will be required. During this time the patient will undergo hand therapy to regain use of the hand.
For more information on how the wrist and hand flexor injury specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!
Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC