MANUAL MINORS
Extensor tendon injuries of the hand are common due to the vulnerability of these structures, which lie just beneath the skin. These tendons are responsible for extending the fingers and the wrist.
Injuries can be caused by direct trauma, such as cuts or lacerations, or by indirect trauma that causes tendon tears. Given their role in hand mobility, extensor tendon injuries can severely impact function if not diagnosed and treated properly.
Diagnosis
The diagnosis of extensor injuries is based on the patient’s clinical history, especially in cases of direct trauma. Clinically, there is often an inability to extend one or more fingers or the wrist. A visible deformity may also be observed in the affected area, such as “mallet finger” (when the extensor tendon at the distal joint is injured).
Functional tests include assessing active extension of the fingers and wrist, checking for strength and range of motion. In some cases, imaging studies such as ultrasound or X-rays may be required to rule out fractures or bony avulsions.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Mallet Finger | Inability to extend the distal phalanx | Recent trauma to the distal phalanx, fixed flexion at the joint |
Sagittal Band Injury | Inability to extend the finger without dislocation | Lateral dislocation of the extensor tendon over the MCP joint |
Boutonnière Deformity | Flexion at the PIP joint, extension at the DIP joint | Extensor tendon rupture at the PIP joint |
Complete Tendon Rupture | Total inability to extend the wrist or fingers | Complete absence of active extension |
Metacarpal or Phalangeal Fracture | Pain, swelling, possible deformity | X-ray confirmation of fracture |
Emergency Management
Initial management includes immobilising the affected hand and fingers with an extension splint to prevent further tendon damage. In open wounds, it is necessary to irrigate and clean the injured area to prevent infection, and prophylactic antibiotics may be required.
Local anaesthesia should be administered to facilitate exploration and determine whether there is a complete or partial tendon rupture. For closed injuries, such as mallet finger, a specific splint can be applied to keep the joint extended while consulting with a hand surgery specialist.
Definitive Treatment
Definitive treatment depends on the severity of the injury. Minor or partial extensor tendon injuries can be managed with immobilisation for several weeks using an extension splint.
However, complete ruptures or injuries associated with fractures often require surgical repair to restore tendon continuity. In chronic or improperly treated injuries, reconstructive surgery may be necessary. Rehabilitation with physiotherapy is crucial to restoring range of motion and strength following treatment.
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