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The flexor tendons run from the flexor muscles in the forearm and attach to the small bones of the fingers. These muscles and tendons allow a person to flex fingers (i.e. bring the fingertips into the palm), and make a fist or grip an object.
Most often the flexor tendons are damaged by a cut. If a person sustains a cut on the palm side of the wrist, hand or fingers, these tendons may be partially or completely cut. In the areas where the fingers bend, the tendons are particularly close to the skin and even a minor cut can sever them.
Much like a rubber band, the ends of the tendon will pull away from each other when cut. A partially cut tendon may still allow the patient to bend the finger, but it is usually painful to do so. If left untreated, a partially cut tendon can rupture later. A complete division of the tendon prevents the finger from bending on its own.
After sustaining a cut to the palm side of the wrist, hand or fingers, pain while flexing fingers or inability to flex fingers can signify a tendon injury. Medical evaluation and treatment should be sought.
Transverse lacerations in the fingers or the palm are more likely to be associated with tendon injury. Remember that there are two tendons to each finger. The longer of the two bends the tip while the shorter tendon bends the middle joint. Therefore, the finger may still bend to some degree in the face of a completely severed tendon, if the other remains at least partially intact. As noted above, a partial tendon rupture usually causes painful decreased bending of the digit. The resting posture of the hand is one where all of the fingers are partially curled. A finger with a cut tendon will rest in an abnormally extended (straight) position.
Cut tendons don't heal well on their own (remember the rubber band-like retraction that occurs!). Therefore, surgery to sew the ends of the cut tendon back together, followed by often intensive hand therapy, is usually the best option. Generally, having the surgery as soon as possible after the injury gives the best possible result.
Depending on the type of cut, a patient may need to protect the limb from movement with a splint or cast or may start a special therapy program of limited motion after surgery. A program with a hand therapist may involve custom splints and special exercises that can help the patient regain motion, build grip strength and soften scar tissue. A patient should carefully follow the directions of the surgeon and hand therapist because the tendon repair can pull apart if the hand is used too soon. It usually takes four to six weeks before the fingers are allowed to move slowly and without resistance.
After a flexor tendon injury, most people will not return to totally normal movement in the finger, even with surgery. However, surgery and therapy can usually improve finger movement and maximize the final result.
