Diagnostics
The first way to diagnose a torn tendon in the fingers is a clinical examination by the doctor. During this examination, the mobility and stability of the joint and capsule apparatus are checked. These are usually limited in the case of torn tendons.
While active movement of the affected finger is no longer possible, in the case of a torn tendon, the finger can be brought passively into the normal position, but cannot be held there by the person affected. Often a tear or destruction of the finger tendons is already visible without an examination. If the flexor tendons are injured by cuts, these, in combination with immobility of the finger, can already be suspected.
In the case of injuries to the extensor tendons, the forceful predominance of the flexor tendons leads to typical finger deformities, which serve as a guide. If the extensor tendon at the end of the finger, i.e. in the area of the fingertip, is torn, it will snap off. The remaining finger can still be stretched.
Because of its similarity to a hammer, the injured finger is called the “hammer finger”. A tear of the extensor tendon at the middle joint leads to a “buttonhole deformity”. If the extensor tendon is torn, it is pushed to the side and the middle finger joint forces itself like a button through the buttonhole between the resulting tendon gap.
The finger is bent in the middle finger joint in this injury. In the worst case and with severe injury patterns, not only the tendon tears.In some cases, a small piece of the bone to which the broken tendon was attached breaks off due to the great force applied. If a bone break is suspected, further imaging procedures such as an X-ray or CT image may be useful.
Therapy
Torn extensor tendons in the finger end joints are usually treated conservatively with a splint. Surgery is not necessary in the majority of cases. The finger is fixed in its normal position with a splint (Stack’s splint).
Only the affected end joint is immobilized, while the healthy middle finger joint remains fully mobile. In this way, the loss of movement due to unnecessary fixation of healthy parts is counteracted. The splint may only be removed once a week for cleaning and remains in place for about 8 weeks until the torn tendon has healed.
The finger must always remain in the stretching position. This is achieved by placing it on a flat surface, such as the edge of a table. It is therefore recommended to seek help.
Under no circumstances should you check by moving your finger to see whether the tendon has already grown, as this can massively impair the healing process and cause it to drag on. Over 90% of extensor tendon injuries can be healed by means of splint therapy. Torn extensor tendons in the middle and base joints of the finger must always be assessed interindividually by the treating physician.
The therapy of a torn tendon in the finger can often be performed conservatively. For this purpose, the tendon is normally immobilized for several weeks with a finger splint. This allows the tendon to grow together at rest.
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 sutured together in an operation, the splint can be replaced with tape after an initial immobilization phase.
Even if the tendon is already fully able to bear weight again, complaints such as pain may still occur. Especially when the affected hand is under heavy strain, the finger can be taped to support it. More about this:
- Taping fingers – How it works
- Kinesiotape
Surgery for a torn tendon in the finger should be considered especially in the case of complicated injuries.
People who have to work a lot with their hands professionally should also consider a timely operation. This is especially true for craftsmen, competitive athletes, musicians, etc. But also those who work a lot on the computer can benefit from the operation.
On the other hand, those who can also work with the conservative immobilization of the finger without any problems should first have an uncomplicated injury treated conservatively. If the therapy is not successful, surgery can usually still be performed. Extensor tendon injuries are not usually treated surgically.
In some cases, a small surgical procedure under local anesthesia with subsequent splinting of the finger is necessary. Injuries to the flexor tendons should be treated surgically within a few hours of injury. The tendon stumps are sutured using thin sutures that can remain there and dissolve on their own over time, allowing them to 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 treating physician. Afterwards, it is not yet possible to put full weight on the finger.
For this reason, the affected person should wear a special splint (Kleinert splint) for about 6 weeks until the injury has healed. If bone has been torn out or fractured, depending on the size of the bone fragment and the extent of the fracture, in some cases it may be necessary to fix the bone fragment at its original location using wires or screws to allow healing. If the bone is displaced by only a few millimeters, in some cases a conservative, non-surgical splint treatment is attempted first.