Extensor tendon injury
What is a extensor tendon injury?
An extensor tendon injury occurs on either the so-called end member (third phalange) or mid-phalanx (second phalange) as well as the first phalange of a human finger.
This leads to a tear of one of the two extensor tendons running along the extensor sides of the fingers. In the area of the wrist, the extensor tendons are surrounded by the so-called tendon sheaths and are thereby protected more sustainably. In the area of the fingers this is no longer the case, which is why it can come even with a small force in the household or in sports to this injury.
Although the affected finger joint may be bent, but then no longer stretched. There is a swelling that accompanies pain. The affected finger joint hangs hammer-like down. This is the case especially with extensor tendon injury on the third phalanx.
The causes of extensor tendon injury can be manifold. In addition to injury to the tendon in the home and in sports, accidents in the craft sector can be the cause.
These include cuts or saw injuries that result in a severance of the extensor tendon. The bite of animals, especially dogs, can lead to extensor tendon injury.
Typical symptoms & signs
- affected finger can no longer be stretched
- if necessary, the phalanx hangs down
Diagnosis & History
Imaging procedures, such as X-rays, are usually only used in the diagnosis of extensor tendon injury when bony structures are also injured because the tendons are not visible on the images.
Therefore, in a cut saw or bite injury, all the fingers of the injured hand are examined for a split-seam tear. If the end member of a finger is affected, there is a so-called covered extensor tendon injury. Only in this case is an X-ray image useful in diagnostics.
An extensor tendon injury leads to relatively severe pain in the first place. These occur in the respective region, but in many cases also spread to the neighboring regions. In most cases, the patient can no longer stretch or lift his finger, which can lead to hereditary restrictions in everyday life.
The phalange itself hangs down, so it can also cause aesthetic discomfort. If the pain due to the injury also occur permanently, it may possibly cause mental discomfort or even depression. An early diagnosis and treatment of this injury has a very positive effect on the course of the disease. The treatment is usually done with the help of medications and various therapies.
However, long-term use of analgesics can damage the stomach and should therefore be avoided. With the therapies the movement of the finger is restored. As a rule, complications do not occur and in most cases no surgical intervention is necessary. The life expectancy of the patient is not affected by the extensor tendon injury.
When should you go to the doctor?
If there is a fall, an accident or a force of violence on the hand and the fingers to complaints and irregularities, a doctor should be consulted. If pain or restriction of the mobility of the fingers is perceived as a result of physical activity or other physical activity, it must be checked whether it is a temporary or permanent phenomenon. If the symptoms persist for several hours, days or weeks, a doctor is needed. Further investigations are also necessary as soon as an increase in irregularities occurs. If the symptoms disappear after a restful night's sleep or a sufficient cooling of the hand, usually no doctor is needed. In these cases, it is a reaction of the organism, which has arisen due to an overload.
In the future, the limits and needs of the body should be responded to in good time, as otherwise permanent damage or impairment may be imminent. If the fingers can no longer be fully stretched, or if the person concerned is unable to form a fist, a doctor should be informed of the observations. Swelling, changes in the appearance of the skin or a decrease in the usual strength in the hand should also be examined and treated. In case of existing pain taking an analgesic drug should take place only after consultation with a physician.
Treatment & Therapy
The treatment of extensor tendon injury depends on the type and severity of the injury. The age of the tear also plays a role. It is important to sew completely torn ends of the tendons back within a very short time. If this is not possible, the tendon can also be restored by tendon intersections or wire sutures.
For the patient, it is therefore important to visit a doctor as soon as possible. The ends of the extensor tendons do not retract like the flexor tendons, so the extensor tendon injury can usually be sutured under local anesthesia. If the extensor tendon injury occurs in the final limb of the finger, an overstretching of the otherwise downwardly hanging finger-end limb is achieved by the application of the so-called Stack's rail.
This allows the two tendon ends grow together again. The center joint remains movable up to 90 degrees throughout the immobilization phase. Patients may initially stretch the affected phalanx at first ten degrees less than their other fingers after the healing phase. After a few weeks to months, however, there is a regression of the scar tissue on the tendon, so that the stretchability improves again.
Generally, the injured phalanges are immobilized for about six to eight weeks. In most cases, the fingers can then immediately be moved again and loaded normally without the need for physiotherapeutic applications. If this does not succeed easily, exercises with the physiotherapist or with the ergotherapist are meaningful. Healing disorders caused by infections and bleeding are extremely rare in extensor extensor injury.
Since extensor tendon injuries usually occur through accidents in the home or in sports and at work, they can be prevented only conditionally. When working with cutting or sawing tools, it is always important to wear appropriate protective clothing and especially safety gloves, in order to reduce the risk of injury and to exclude the involvement of the tendons in case of a cut injury.
Follow-up after suturing the injured tendon is not considered easy. So the extensor tendon must be immobilized for a few weeks, until it has healed. However, if the injured finger is immobilized in a stretched position for six weeks, severe movement disorders may occur. For this reason, a special after-treatment is required.
A special rail is used, which prevents the maximum bending of the fingers. Using an elastic band at the same time ensures that the fingers stretch and still relieve the injured extensor tendons. This prevents the rail from closing the fist. The elastic band attached to the splint pulls the injured tendon into a stretch.
This gives the patient the opportunity to make diffractive movements to a certain point. The tendon therefore does not remain in the sedated position, which in turn counteracts the risk of joint stiffness. The patient seeks out an occupational therapist three to four times a week for follow-up treatment. In protective position there is moving the individual finger joints.
After about six to eight weeks, the patient is allowed to gradually release the protective splint and gently begin active exercise. From the 8th week, more intensive exercises are possible and the rail does not need to be put on at night. After twelve weeks, strengthening exercises take place.
You can do that yourself
In everyday life relieving the hand in the performance of all tasks is particularly important. In order to avoid a situation of excessive demands, breaks must be taken in good time. The gripping function should not be overstressed. In the exercise of sporting activities, the performance of professional tasks or in the household, it must be ensured that the human organism has limits in its fulfillment.
In addition to a sufficient break, the use of home remedies can be used to support regeneration. For example, the horse's ointment helps to improve general well-being and to relieve symptoms. In case of strong irregularities it is necessary to immobilize the hand.
Characteristic of the disease are severe pain. These can lead to an immense impairment in everyday life, as they lead not only to the physical disorders but also to states of mental stress. Mental techniques often help in overcoming adversity. They promote the inner balance and often provide a necessary balance. In dealing with the disease, therefore, relaxation techniques such as yoga or meditation can be used.
Diseased people should be assisted by people from the social environment for the execution of certain physical activities, as soon as they themselves can not do this to a sufficient extent. Often, therefore, a restructuring in the everyday management to recovery is required.