Flexor & Extensor Tendon Injuries in Raleigh, NC
A cut, crush, or sports injury to your hand or finger can sever or tear the tendons that bend or straighten your fingers. Tendon injuries require expert repair — timing and technique are critical for full recovery.
What Is Flexor & Extensor Tendon Injuries?
The hand has two sets of tendons: flexor tendons (running along the palm side) bend the fingers, and extensor tendons (running along the back of the hand) straighten them. When cut or torn, these tendons cannot repair themselves — surgical repair is needed.
Flexor tendon injuries are classified by zone (I–V). Zone II injuries in the finger are the most technically demanding — often called 'No Man's Land' because the flexor tendons pass through a tight, critical pulley system. Extensor tendon injuries are classified by zones I–VIII.
Early controlled motion after repair prevents adhesion formation and is critical to achieving full range of motion.
ⓘ Seek care urgently after any laceration that limits finger bending or straightening. Tendon repair within 12–24 hours of injury achieves better outcomes than delayed repair.
Risk Factors
Several factors are associated with a higher likelihood of developing this condition.
Laceration
Knife, glass, or power tools
Sports Trauma
Jersey finger — FDP avulsion during tackle
Gymnastics
Extensor disruption at fingertip
Crush Injury
Machinery or industrial accidents
Rheumatoid Arthritis
Spontaneous tendon rupture
Ball Impact
Mallet finger — extensor disruption at tip
Diagnosis
Tendon injuries are diagnosed by testing the function of each tendon individually. For flexor tendons: can the patient bend the DIP and PIP joints independently? For extensor tendons: can the patient straighten each joint? X-rays are obtained to rule out associated fractures.
- ✓FDS testing (isolated PIP flexion)
- ✓FDP testing (isolated DIP flexion)
- ✓Extensor function at DIP, PIP, MCP
- ✓Wound inspection for tendon laceration
- ✓X-rays for associated fractures
- ✓Zone classification
Treatment Outcomes & Statistics
Published outcome data to help you make an informed decision. Dr. Chambers will review what these numbers mean for your specific case at your visit.
With expert repair and early controlled motion therapy protocol
'No Man's Land' — requires specialist surgeon and intensive therapy
Primary repair in first 12–24 hours achieves best outcomes
Full motion and strength recovery takes 3–6 months with dedicated therapy
Complication Profile
| Complication | Rate | Severity | Notes |
|---|---|---|---|
| Adhesion formation / stiffness | 20–30% | Moderate | Most common problem; addressed with intensive hand therapy |
| Re-rupture | 5–10% | Serious | Most common in first 3 weeks — crucial protection period |
| Infection (open injuries) | 2–5% | Moderate | Antibiotics; higher risk with contaminated wounds |
| Incomplete motion recovery | 10–15% | Moderate | Tenolysis (adhesion release) occasionally needed at 6 months |
Source: Tang, J Hand Surg 2014; ASSH Flexor Tendon Guidelines
Treatment Options
Dr. Chambers will recommend the best approach based on your severity, goals, and lifestyle. Most conditions are first treated non-surgically.
Splinting (Closed Injuries)
Closed extensor tendon injuries (mallet finger, partial tears without functional loss) can be treated with extension splinting for 6–8 weeks. Truly closed flexor tendon injuries with partial tears may be managed with protected motion splints.
Primary Tendon Repair
Cut or completely ruptured tendons are repaired with strong core sutures and a circumferential running suture. Best results when performed within 12–24 hours. Performed under local anesthesia (WALANT) so tendon gliding can be tested intraoperatively.
Tendon Reconstruction / Graft
Delayed presentation (>3 weeks) or failed primary repair may require two-stage tendon reconstruction using a silicone rod followed by tendon graft. Complex but effective for patients who have missed the primary repair window.
What to Expect During Recovery
Repair & Immediate Protection
Tendon repaired. Dorsal blocking splint applied immediately. No active flexion — passive motion only per protocol.
Early Controlled Motion
Therapy begins within days. Controlled passive and active motion within safe zones. Critical adhesion prevention period.
Active Motion
Progressive active motion introduced. Resistance exercises begin. Most daily activities resumable with caution.
Strengthening
Progressive strengthening. Return to most work activities. Heavy grip and manual labor at 3+ months.
Full Recovery
Full motion and strength. Return to sports and all activities. Tenolysis considered at 6 months if motion inadequate.
Frequently Asked Questions
If you have a laceration on your hand or finger and cannot bend or straighten a joint, you likely have a tendon injury. Even small cuts can completely sever tendons. Test each joint: can you bend the tip independently? The middle joint? Can you straighten fully? If not — seek care urgently.
Ideally no. Primary repair within 12–24 hours achieves the best outcomes. After 3 weeks, tendon ends retract and scar down, making primary repair very difficult or impossible — reconstruction with a graft is then needed. Even getting seen within the first week is significantly better than weeks later.
Full recovery takes 3–6 months with dedicated hand therapy. The first 3 weeks are the most critical — the repair is at highest risk of rupture. After 6 weeks, strength training begins. Most patients return to desk work within 2–4 weeks and full manual activity by 3–4 months.
Tendon Injury? Time Is Critical — Call Now.
Early tendon repair produces the best outcomes. Same-day and same-week appointments available. No referral needed.
Stephen Chambers, M.D.
Dual Board-Certified Hand & Upper Extremity Surgeon · Raleigh Orthopaedic