Torn off the extensor tendon of the finger

introduction

The extensor tendon of a finger can tear as a result of an accident or degenerative changes. Such a crack is not uncommon, especially in the context of sports accidents.
A distinction is made between a tear on the distal phalanx of the finger and a complete tear in the tendon near the palm.

root cause

The most common rupture of the finger tendon occurs on the fourth finger, the ring finger. The cause can be a long-standing tendinitis (Tendosynovitis) due to a rheumatic disease. But the extensor tendon can also tear in the course of trauma or when the finger is stretched too much, for example when playing ball games or making beds.

Symptoms

First of all, the patients complain of a significant reduction in strength when extending the affected finger.
Active stretching in the affected joint is then no longer possible. Since there is normally a balance between the muscles on the finger, the flexor tendon predominates in a torn extensor tendon. This makes the injury clearly visible to the outside, as the affected finger is excessively bent.
As a rule, the tear is accompanied by severe, brief shooting pain. Then there is swelling and possibly bleeding on the affected finger.
Especially in patients with a chronic rheumatic disease, the pain is often absent, so that the actual time of the injury is often not remembered.

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Pain

At the moment of the injury there may be a short shooting and stabbing pain in the finger. This is caused by the tear and the snap back of the tendon in the tissue.

Often there is no further pain after the injury event. However, the injury can lead to small concomitant injuries in the tissue, which cause bruising and swelling. Due to the irritation in the tissue, the extensor tendon tear can be tender on pressure a few days after the injury. In the further course, however, the demolition causes no pain. There is only a stretch deficit and a reduction in strength, which is why many sufferers see a doctor late.

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inflammation

When the extensor tendon of the finger is torn off, local inflammatory processes rarely occur. An injury in the tissue can always be accompanied by injuries, bleeding, pain, swelling, reddening and restricted mobility. However, this local inflammation usually subsides within a few days.

Diagnosis

The clinical picture of the injury is usually sufficient to make a suspected diagnosis.
The affected finger is in extreme flexion, the active extension of the finger is no longer possible.
However, passive extension by the doctor should still be possible if the joint is not affected. This is an important diagnostic distinction as the therapy depends on it.
In some cases, the History of the course of the accident contribute to the diagnosis.
To the Joint condition and Broken bones can exclude a X-ray be performed.
The Tendons and muscles of the fingers cannot be seen here, however. These can be done with the help of a tomograph (Magnetic resonance imaging (MRI) or Computed Tomography (CT)).
Even with the help of one Ultrasound it is partially possible to look at the tendons of the fingers.
In addition, the clinical examination should also all other fingers of the hand, as well as the Hand blood circulation and the sensitivity being checked. So can severe vascular or nerve damage excluded become.

therapy

If only a small part of the extensor tendon on the distal phalanx of the finger is torn, surgical treatment is usually not necessary. Usually a splint treatment is enough. However, this should not be removed early in order to achieve a good end result. Conservative treatment usually lasts 6 weeks.
If the joint is intact and the tendon is completely torn, so that healing without surgery is impossible, the extensor tendon of the finger can be surgically restored. First of all, the torn tendons are exposed intraoperatively and their torn ends freshened up.
The further procedure depends on the torn tendon:

• If the tendon of the little finger is affected, its end near the body is connected to the tendon of the ring finger. This procedure is relatively simple and allows early mobilization.
• If the extensor tendons of the little finger and ring finger have been severed, another tendon, the tendon of the metatarsophalangeal joint of the index finger, is severed. Their ends are then sewn so that the function can be restored.
• If the tendon of the middle finger is also torn, it is sewn to the side of another extensor tendon of the index finger.
• If the long tendon of the thumb is affected, a tendon of the index finger can also be used.
• In the rare case that all extensor tendons in one hand are torn, it is possible to use the two flexor tendons of the 3rd and 4th fingers (middle and ring fingers). The tendons must be completely removed and sewn on after the stretching portion of the arm. Then the suture is made on the torn extensor tendons.

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Kinesio tape

Taping the finger is a therapeutic alternative to conservative treatment with a splint.

A tape dressing is placed the length of the finger on the extensor side to splint and stabilize the finger. The flexibility and mobility of the treatment with a tape dressing are significantly greater than with the splint. However, complete immobilization cannot be guaranteed. If the tendon is partially torn, the tape dressing can be used.

In the case of a complete tear-off, however, treatment with the splint should be the main focus for at least the first few weeks. As a preventive measure, an elastic tape bandage can be worn on the fingers during sports to prevent tendon injuries. This stabilizes the fingers and leads to a more conscious exercise of movements, which is associated with a reduced risk of injury.

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Aftercare

A Stracksche splint should be worn for about 6 weeks after the operation. This is a splint for the individual finger and immobilizes this and with it the injured tendon. The rail can then be removed.
In most cases, full extension is not immediately possible because the tendons have been immobilized for a long time. You should then slowly try to stretch the finger again and get the tendon used to the strain. In many cases, after a period of practice, they will return to full function.
Basically, the final result can only be assessed after approx. 5 to 6 months.
In some cases, the finger joint may stiffen in a flexed position so that full extension can no longer be performed.

Duration of healing

In order to achieve complete and stable healing of the tendon, the finger is left in the splint for 6-8 weeks in most cases. During this time, the tendon ends find each other in the overstretched position of the finger and can grow together in order to withstand strong pull in the future. In principle, if the splint is worn for a longer period of time, the tendon grows tighter and more stable. However, prolonged wearing also increases the immobility of the finger and further restricts the ability to move.

As a rule, the splint is worn voluntarily for 8-10 weeks. It should then be kept on at night for a further 2 weeks to avoid jerky or stretching movements at the beginning. Stressful sports should be paused for additional weeks. Physiotherapy and slow exercise can also be started slowly after the 8 week treatment. The complete restoration of mobility is person-dependent and can take place at very different speeds.

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When can you do sports again?

Exercise should only take place after the tendon has healed completely and stably.

After the splint has been worn for 8 weeks, additional weeks of rest must follow. Restoration of movement is also often necessary. This can be done with the help of slow exercises or professional physical therapy within the first 2-3 weeks after removing the splint. A full load of the finger in sport can only be recommended after a total of 12 weeks.

Summary

A tear in the extensor tendon of a finger is not uncommon. It occurs due to sudden strong flexion, for example during ball sports or when making beds.
But the tendon can also tear as a result of degenerative diseases.
In addition to the pain, active extension of the finger is no longer possible, the finger can still be passively extended.
These are clear indications for the diagnosis of an extensor tendon tear.
In most cases, conservative therapy with splint treatment is sufficient for 5 to 6 weeks.
Only more serious and larger avulsions of the tendon need to be treated surgically. Various other tendons of the fingers can then serve as substitutes to restore their function.
the end result can only be assessed after a few months. Some patients may have a lifelong stretch deficit.