Hand Tendon Repair

Overview

Tendons are strong, rope-like cords that connect the muscles in your arm to the bones in your hand. They are what let you bend and straighten your fingers. A hand tendon repair is an operation to stitch a cut or torn tendon back together so your finger can move again. There are two main groups: flexor tendons, which curl your fingers into a fist, and extensor tendons, which straighten them out. Damaged tendons do not heal well on their own, because the two cut ends tend to pull apart. That is why an operation is often needed, usually within a few days of the injury.

Yes. Hand and wrist tendon injuries are a common reason people need emergency hand surgery. Cuts from glass, knives, and tools are the usual cause.

Anyone can injure a hand tendon, but it is most common in working-age adults, especially people who work with sharp tools, glass, or machinery, and people who play contact sports. Some tendon tears happen without a cut, in people with inflammatory arthritis such as rheumatoid arthritis, or after a sudden jolt to the fingertip.

Symptoms

Common symptoms

• A cut or wound on the palm side of your hand, fingers, or wrist
• Being unable to bend one finger or the tip of a finger
• Being unable to straighten a finger, or the fingertip drooping
• Pain, swelling, or bruising around the injury
• The finger resting in an odd position and not moving when you try
• Numbness or tingling near the cut, if a nerve was also injured
• A weak grip or trouble holding things

Symptoms in children

• Young children may simply cry, hold the hand still, or refuse to use it rather than say what is wrong
• A small cut may be the only visible sign, so it can be easy to miss
• Children's tendons are small and delicate, so they are usually checked by a hand specialist
• Recovery in children is often very good, but they need help keeping splints and dressings in place

Symptoms in older adults

• Tendons can become thinner and weaker with age, and skin heals more slowly
• Arthritis in the hand can make stiffness after surgery more likely, so hand therapy matters a lot
• Older adults may need more time and support during rehabilitation, but good results are still very possible
• Other health conditions may affect the type of anaesthetic used, so the surgical team will review these

Causes

Main causes

• Cuts from glass, knives, sharp tools, or metal edges
• Crush injuries, such as a finger caught in a door or a heavy object falling on the hand
• Power tool and machinery injuries, including saws and drills
• Sports injuries, especially to the fingertips
• Tendon tears without a cut, which can happen in inflammatory arthritis such as rheumatoid arthritis
• A sudden stretch or jolt to the end of a finger, which can tear the straightening tendon (sometimes called a mallet finger)

Risk factors

• Working in jobs that involve sharp tools, glass, or machinery
• Doing DIY or gardening without protective gloves
• Contact sports such as rugby, football, or basketball
• Inflammatory arthritis or other conditions that weaken tendons
• Some long-term medicines and medical conditions can make tendons more fragile — ask your doctor if this applies to you
• Previous hand injury or surgery

When to see a doctor

See a doctor urgently if:

• Go to an urgent care centre or emergency department the same day if you have a cut to the hand, fingers, or wrist and cannot fully bend or straighten a finger
• Get medical help straight away for any deep cut to the hand, even a small one, because the wound may be deeper than it looks
• Seek same-day advice if a fingertip suddenly droops or will not straighten
• Get urgent help for a wound that is very painful, hot, swollen, or leaking pus, or if you feel feverish

Book a routine appointment if:

• Book a routine appointment if you have ongoing stiffness, aching, or a weak grip after a hand injury
• See your doctor or hand therapist if a follow-up splint or dressing is uncomfortable or does not fit well
• Talk to your care team if you feel your recovery has stalled or you are unsure about your exercises
• Ask about a scar that feels tight, raised, or is limiting movement

Diagnosis

A doctor will examine your hand carefully. They will look at the wound, test each finger by asking you to bend and straighten it, and check feeling and blood flow in your fingers. Sometimes it is hard to tell from the outside whether a tendon is cut, so the wound may be looked at more closely under a local anaesthetic. Your doctor will also ask how the injury happened and about your general health.

Tests that may be done

• A physical exam checking movement, feeling, and circulation in each finger
• Cleaning and examining the wound, sometimes in a treatment room or operating theatre
• X-rays to look for broken bones, glass, or other objects left in the wound
• Ultrasound or an MRI scan in some cases, especially for tendons that are torn without a cut
• Blood tests if there is a chance the wound is infected or if an underlying condition is suspected

What to expect at your appointment

You may be given a local anaesthetic to numb the hand while it is examined, so you should not feel pain during the check. If a tendon injury is found, you will usually be referred to a hand surgery team. In many cases surgery is arranged within a few days, and sometimes the same day. Bring a list of your medicines and any allergies, and ask a friend or family member to come with you if you can.

Treatment

The aim of treatment is to join the torn tendon ends back together and then protect the repair while it heals, while keeping the hand moving enough to avoid stiffness. A cut tendon usually needs an operation. Some partial tears and some tendon injuries without a cut can be treated with a splint alone. In every case, hand therapy — a guided exercise programme — is a central part of getting movement back.

Self-care at home

• Keep your splint and dressing clean and dry, and follow the instructions you are given about when to change them
• Keep your hand raised on a pillow when resting to reduce swelling
• Follow your hand therapy exercises exactly as instructed — neither skipping them nor doing extra
• Do not lift, push, pull, or grip with the injured hand until your team says it is safe
• Avoid smoking and cut down on alcohol, as both slow healing — ask for help if you want to stop smoking
• Take simple pain relief only as advised by your doctor or pharmacist, and check before taking anything new
• Ask your team before driving, and check with your insurance if relevant

Medical treatments

Treatment usually starts with cleaning the wound and protecting the hand. Most cut tendons are repaired in an operation, often under a regional block (numbing the whole arm) or a general anaesthetic. The surgeon finds the two ends of the tendon and stitches them together using fine, strong stitches that stay inside the hand. You will go home in a splint that holds the hand in a set position. After that, a hand therapist guides you through a staged exercise plan — early gentle movement, then gradual strengthening over weeks to months. Your team will also advise on pain relief and on watching for infection. Always follow the specific instructions from your own surgical and therapy team, and ask your pharmacist or doctor if you are unsure about any medicine.

When is surgery considered?

Surgery is usually recommended when a tendon is fully cut, when the two ends have pulled apart, when a finger cannot bend or straighten, or when a tendon has torn without a cut and is not healing with splinting. It is usually done as soon as safely possible, often within a few days. Some partial tears, and some injuries seen very late, may be treated without surgery or with a different operation, such as a tendon transfer or graft — your surgeon will explain the options for your case.

Living with this condition

For the first few weeks you will wear a splint and will not be able to use the hand fully. Everyday tasks like dressing, cooking, opening jars, and washing your hair can be tricky. It helps to plan ahead: prepare meals in advance, wear loose clothing with easy fastenings, and put often-used items within easy reach. Your hand may be swollen and sore at first, and this usually settles. You will have follow-up appointments and hand therapy sessions, and your splint time and exercise plan will change in stages. Most people need several weeks off work, depending on their job, and should not drive while in a splint or while taking strong pain relief.

Lifestyle tips

• Ask family, friends, or neighbours for practical help in the first few weeks — most people are glad to assist
• Wear protective gloves for DIY, gardening, and any work with sharp tools once you are healed
• Keep your hand raised when resting and gently move your shoulder and elbow to stay comfortable
• Speak to your employer about adjusted duties or a phased return to work
• Be patient with slow progress — tendon healing takes time and small steps add up

Diet and exercise

Eat regular balanced meals with plenty of protein, fruit, and vegetables to support healing, and drink enough water. Avoid smoking, which slows wound healing and raises the risk of complications. While your hand is splinted, stay active in other ways — walking and gentle exercise that does not involve the hand are usually fine. Your hand therapist will give you a specific exercise plan; doing it gently and regularly is much better than doing a lot at once.

Mental health and emotional wellbeing

It is very common to feel frustrated, anxious, or low when you cannot use your hand. You may worry about work, money, or whether your hand will recover. These feelings are understandable and usually ease as movement returns. Talking to someone helps — a friend, your GP, or your hand therapy team. If you feel very low, hopeless, or overwhelmed, please reach out to a crisis support line in your country or speak to your doctor straight away. You do not have to cope alone.

Prevention

Not every hand injury can be avoided, but many can. Wear protective gloves when using sharp tools, handling glass, or doing DIY and gardening. Keep knives sharp and store them safely, and use the right tool for the job rather than improvising. Clear up broken glass carefully and never press down on it. In sports, use appropriate protective gear. If you have inflammatory arthritis, keeping it well controlled with your doctor's help lowers the risk of tendon rupture — never stop or change treatment without medical advice.

Screening programmes

There is no routine screening test for hand tendon injuries. The key is to get any cut or sudden loss of finger movement checked promptly, because early repair gives the best results.

Complications

If left untreated

• The cut tendon ends can pull apart, making a later repair harder
• Permanent loss of the ability to bend or straighten the finger
• Scar tissue can glue the tendon down, limiting movement (this is called an adhesion)
• Stiffness in the finger or hand joints
• The repaired tendon can re-rupture if the hand is used too early or too forcefully
• Wound infection, which can spread and damage tissue
• Numbness or altered feeling if nerves were also injured

Long-term outlook

Most people who have a tendon repair and follow their hand therapy plan get good, useful movement back. Recovery is gradual: the tendon is usually protected for several weeks, gentle movement starts early, and strengthening comes later. It often takes three to six months to feel close to normal, and some stiffness or a visible scar can remain. Results are best when the repair is done early and therapy is followed carefully. If progress seems slow, tell your team — there is often more that can be done.

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