Hand tendon repair: recovery, splinting, exercises and what to expect

Flexor tendons allow you to bend your fingers and thumb. Bradford Teaching Hospitals explains that they run from the forearm through the wrist and across the palm and are essential for making a fist and for the hand to function normally. Hull University Teaching Hospitals adds that as the muscles contract the tendons slide through the fingers, thumb and palm.

When a flexor tendon is cut, even partly, the hand cannot work properly. Hull says a damaged tendon needs to be repaired for the hand to function. The aim of surgery, according to Bradford, is to restore normal movement. The leaflets focus on flexor tendons on the palm side of the hand; the leaflets do not cover other tendons, such as those that straighten the fingers.

Swelling is a normal reaction to surgery, but both leaflets stress limiting it. Hull advises wearing a sling during the day for the first 3 to 5 days, keeping the hand elevated when walking around, elevating it on pillows at night and at rest, and continuing elevation until swelling settles. Bradford says not to allow the hand to hang by your side, to rest it above the level of your heart where possible using a cushion for support, and to move the elbow, shoulder and neck regularly to prevent stiffness in these joints.

Within the first week you are usually seen by the hand therapy team. Bradford says a splint covering the hand and forearm is made to protect the surgical repair, which is weak and at risk of rupture with movement and activity.

Hull says it is vital not to remove the splint until advised by your doctor or hand therapist. Bradford advises wearing it 24 hours a day, checking the skin regularly for red or sore areas and telling the therapist if there are concerns, keeping the wound dry until fully healed, covering the arm and splint with a plastic bag when bathing, and not placing the splint in hot water or near a heater as this affects its shape and fit.

If the splint becomes uncomfortable or shows signs of rubbing, Bradford says to contact the plastics clinic or therapy department.

Tendons are complex and vulnerable after repair, which is why the exercise programme is individual. Hull says the hand therapist will teach exercises and you should follow instructions carefully. You should not do exercises the therapist has not shown you, force your fingers or thumb to straighten, or use your hand functionally until advised.

Bradford says that moving the thumb and fingers will not stop the tendon healing and that bending and straightening within the splint helps regain movement and reduce swelling. Its programme asks you to bend the fingers halfway into the palm for the first 3 weeks, aiming for a full fist 6 weeks after repair. Your own therapist may follow a different protocol, which takes precedence.

Scar massage with a simple moisturising cream, started once stitches are out and the wound is dry, helps the scar become more mobile so that it does not limit finger movement, according to Bradford.

Both leaflets give a guide, noting that it varies with the individual injury and your hand therapist will advise.

Hull lists three main risks. Infection may show as the area becoming hot, red, painful or swollen, unusual or new leakage from the wound, a foul smell or feeling feverish or unwell. Tendon rupture is signalled by sudden loss of movement of the finger or thumb, or feeling or hearing a crack. Adhesions happen when the repaired tendon becomes stuck in scar tissue, which is why early supervised exercises are taught.

Bradford says to contact the plastics clinic or therapy department immediately if you are suddenly unable to bend your fingers, if the hand becomes more swollen, reddened or blistered, or if there are signs of infection such as spreading redness, throbbing pain, fever, or foul or coloured discharge. Hull says to contact the plastics trauma clinic, your GP or a walk-in centre for suspected infection.

Bradford warns that you are at risk of rupturing the tendon and needing further surgery if advice is not followed.

Both leaflets frame recovery as a process over about 12 weeks, after which most people can return to heavy or manual work and contact sports, with the caveat that individual timings vary. Hull says tendons heal by forming a scar, rather like a cut on the skin. Because stiffness and scar-tissue sticking are the commonest problems, the therapy programme is considered as important as the surgery.

The leaflets are general guides. Your surgeon and hand therapist may use a specific regime, and written instructions from your own team should be followed where they differ.