Orthopedics-Online

Tendon tear on the finger

definition

A tendon tear is the tear of a tendon as a result of rapid overload. The tendon cannot adapt to the load and is injured as a result. Tendons are the connecting elements between muscles and bones and therefore have an important function in the muscle force required for movement, which is "transferred" to the bone for this purpose. On the fingers, there are so-called extensor tendons on the back of the hand and flexor tendons on the inside of the palm.

Both sides can be affected by injuries. In terms of numbers, however, tears of the extensor tendons predominate. One reason for the numerical superiority is that the flexor tendons are more protected than the extensor tendons by the surrounding muscle and fat tissue.

root cause

Tendons often tear near a joint, since the one there Starting point a weak spot represents. The fingers, with the exception of the thumb, have 3 points of articulation: the base of the finger, the middle and the end of the finger.

Avulsed extensor tendons Even the smallest accidents can occur at the end of the finger, i.e. near the fingertips. Especially in ball sports, such as soccer, handball or basketball, the tendons tear very quickly when the ball hits the fingertip and the fingertip suddenly flexes.

Natural wear and tear and calcium deposits in the tendons, which occur with increasing age and with years of stress, should also be mentioned as a risk factor promoting tendon tears.

Extensor tendons The middle and wrist joints of the fingers are also often injured in ball sports, but also in falling on the hand or in martial arts, especially boxing.

Flexor tendons are most commonly affected by cuts.

Symptoms

In healthy people, there is a balance between the tensile forces that the flexor and extensor tendons exert on the fingers. So the finger is naturally straight. If an extensor tendon tears, it can no longer transfer force from the bone to the muscle, i.e. it cannot stretch the affected finger. The force of the flexor tendons predominates and consequently the affected finger flexes, whereby it remains in the flexed position and cannot be stretched at will.

Further symptoms, especially when the capsular apparatus is impaired, are swelling, overheating and tenderness. As already mentioned, the affected finger is restricted in its movements. Occasionally a faint popping sound is heard when the tendons tear.

Torn tendons are often associated with intense pain that sets in quickly after the accident. The pain is usually described as sharp. As quickly as the pain came, it can also subside. However, tenderness on pressure usually persists longer due to accompanying swelling and occasionally bleeding.

Pain that occurs when the finger is compressed, i.e. pressure on its longitudinal axis, suggests a bony injury rather than a tendon tear. With the latter, the transverse pressure in particular causes problems.

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Diagnosis

The first way to diagnose a ruptured tendon of the fingers is through a clinical examination by the doctor. The mobility and stability of the joint and capsular apparatus are checked. These are usually limited in the case of torn tendons.

During a active movement of the affected finger Not more possible If the tendon ruptures, the finger can passively be brought into the normal position, but cannot be held there by the person concerned.

Often a tear or destruction of the finger tendons is already visible without an examination. If the flexor tendons are injured by incisions, these, in combination with immobility of the finger, can already be suspected.

When the extensor tendons are injured, the flexor tendons are overweight typical finger deformitiesthat serve as signposts.

At Torn extensor tendon at the Distal phalanx, i.e. in the area of the fingertip, it kinks. The rest of the finger can still be stretched. Because of its resemblance to a hammer, the injured finger is called "Hammer fingers“.

A Avulsion of the extensor tendon at the Central joint leads to "Buttonhole deformity". When the extensor tendon is torn, it is pushed to the side and the middle finger joint is pushed through the buttonhole between the resulting tendon gap like a button. In this injury, the finger is bent in the middle finger joint.

In the worst case and with severe injury patterns, not only does the tendon tear. In some cases, a small piece of the bone to which the broken tendon attached breaks off as a result of the great force applied. If a bone tear is suspected, further imaging procedures such as an X-ray or CT image may be useful.

therapy

Therapy with a splint

In the case of tears in the extensor tendons at the end joints of the fingers, conservative therapy using a splint is usually used. In most cases, surgery is not necessary.

The finger is fixed in its normal position by means of a rail (Stack’s rail). Only the affected end joint is included in the fixation, while the healthy middle phalanx is still fully mobile. In this way, loss of movement due to unnecessary fixation of healthy parts is counteracted.

The splint may only be removed for cleaning once a week and remains in place for about 8 weeks until the tendon tear has healed. The finger must always remain in the extended position. You can do this by placing it on a flat surface, such as the edge of a table. It is therefore advisable to seek help. Under no circumstances should you move your finger to check whether the tendon has already grown, as it can massively impair the healing process and stretch it out.

Over 90% of extensor tendon injuries can be healed with splint therapy. Torn extensor tendons on the median and metacarpal joint must always be assessed individually by the attending physician.

Taping

The treatment of a torn tendon in the finger can often be conservative. To do this, the tendon is usually immobilized for several weeks using a finger splint. They can grow together in peace.

In rare cases, the injury can also be taped. However, a tape is often not as stable as a splint, so it does not completely prevent the movement of the finger and thus worsens the chances of success of conservative therapy. However, if the tendon has grown together again or has been sewn together in an operation, the splint can be replaced by tape after an initial immobilization phase. Even if the tendon can be fully loaded again, symptoms such as pain can still occur. The finger can be tapped for support, especially when the affected hand is under heavy strain.

Operation of an extensor tendon avulsion

Surgery for a torn tendon should be considered, especially in the case of complicated injuries.

People who have to work a lot with their hands at work should also consider an operation as soon as possible. This is especially true for craftsmen, competitive athletes, musicians, etc. but those who work a lot on the computer can also benefit from the operation. If, on the other hand, you can also work with the conservative immobilization of the finger without any problems, an uncomplicated injury should first be treated conservatively. If the therapy is not successful, surgery can usually still be carried out.

Injuries to the extensor vision are usually not treated surgically; in some cases, a small surgical procedure under local anesthesia followed by splinting the finger is necessary.

Injuries to the flexor tendons should be treated surgically within a few hours of the injury. The tendon stumps are sutured with thin sutures that can remain there and dissolve over time, and can thus heal. For minor injuries, surgery under local anesthesia is possible. However, this decision must always be adapted to the current situation and is ultimately the responsibility of the attending physician. Afterwards, the finger cannot be fully loaded. For this reason, the affected person should wear a special splint (Kleinert splint) for about 6 weeks for follow-up treatment.

If the bone was torn or broken, depending on the size of the bone fragment and the extent of the break, in some cases it is necessary to fix the bone fragment at the place of origin with wires or screws in order to enable healing. If the bone is only shifted by a few millimeters, in some cases a conservative, non-surgical splint treatment is tried first.

Concomitant capsule injury

The capsule represents a connective tissue covering for the finger joints. Trauma can not only tear a tendon in the finger, but at the same time the capsule can also be affected.

This injury is particularly common in ball athletes who get a ball head-on on their finger so that it bends in the wrong direction. The capsule injury should also initially be treated by immobilizing the finger. Therefore, tendon and capsular injuries can usually be treated at the same time.

Aftercare

Fingers with cuts in which the tendon (s) was severed and surgically treated are then immobilized in a finger splint for about 6 weeks. This is intended to contribute to wound healing that is as uncomplicated as possible. Even with splint therapy alone, the finger should not be fully stressed at the end of therapy after 6 - 8 weeks.

Anti-inflammatory drugs are also often prescribed. These should prevent the development of chronic inflammation on the tendon. At the same time, they have an analgesic effect after an operation. A few weeks after the operation you can also start physiotherapy. First of all, it is important to mobilize the tendon.

A full load capacity of the finger is only achieved after about 12 weeks. If a lot of physical work is to be expected, the splint can be put on again for protection during this time. If the desired result has not been achieved with conservative therapy, an operative improvement can be aimed for at the earliest 3-4 months after the injury.

Taping the injured finger offers a further possibility to stabilize the still unstable finger, especially after the healing phase. Furthermore, it offers the possibility in the future during sport or strong activities that stress the fingers to stabilize them and preventively protect them from renewed injuries.

The tape tapes are used to reinforce and secure the capsule tape apparatus. In the acute phase of injury, splints are the better choice because they are able to fix the finger in the position in which the tendon should grow again. A tap bandage is therefore less recommended at this point. In the simplest case, it is possible to immobilize the finger by fixing it to the neighboring healthy finger by means of several tapes.

How long will you be on sick leave?

How long one is on sick leave with a tendon tear in the finger depends on the one hand on the location of the tendon tear, on the other hand the work itself also plays a role.

Basically, the more you rely on your hands at work, the longer you are unable to work. A craftsman or athlete can be on sick leave for several weeks or months, and those who mainly speak in their job and hardly write can return to work after a significantly shorter period of time. It is important that the torn (and sewn back) tendon is not stressed.

Duration

The injured finger remains 6-8 Weeks in the rail. To complete healing at least pass 12 weeks. The duration of the sick leave cannot be generalized and depends on the extent of the injury, accompanying injuries and the selected form of therapy. In addition, the job must be taken into account as an important factor. If the hands and fingers are heavily used in the activities to be carried out, the duration of the sick leave is extended. The decision about the length is therefore made individually for each person affected by and in consultation with the attending physician.

forecast

Despite successful treatment of a tendon injury you can minor mobility deficits remain. In the case of extensor tendon injuries, a deficit of up to 15° as normal to watch. This means that the finger is still bent by 15 ° in relation to the normal axis and cannot be fully extended into the vertical position.

With a deficit of over 30 ° Corrective surgery should be considered. In about 20% of flexor tendon injuries, after healing, the affected finger is less mobile. Tendons heal very slowlyas they are over no own blood supply and are only supplied by the surrounding fluid. For this reason, full resilience is only achieved after approx. 12 weeks. If left untreated, there is a risk that the tendons will heal in the deformed position, which would result in permanent movement restrictions. In this case, surgical correction is the last resort.