eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Extensor Tendon Repair

Author: Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Coauthor(s): Nancy S Kwon, MD, MPA, Assistant Professor of Clinical Surgery, Consulting Staff, Department of Emergency Medicine, New York University School of Medicine and Bellevue Hospital Center
Contributor Information and Disclosures

Updated: Mar 29, 2009

Introduction

The extensor tendons of the hand are in a relatively superficial position; thus, they are highly susceptible to injury from lacerations, bites, burns, or blunt trauma. Extensor tendon injuries are commonly diagnosed in the emergency department (ED). Certain injuries can be repaired in the ED1 , others should be repaired by a hand surgeon.

The dorsum of the hand, wrist, and forearm are divided into 8 anatomic zones to facilitate classification and treatment of extensor tendon injuries.2

Zones of hand.

Zones of hand.

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Zones of hand.

Zones of hand.

  • Zone 1 (distal interphalangeal [DIP] joint)
  • Zone 2 (middle phalanx)
  • Zone 3 (proximal interphalangeal [PIP] joint)
  • Zone 4 (proximal phalanx)
  • Zone 5 (metacarpophalangeal [MCP] joint)
  • Zone 6 (dorsum of hand)
  • Zone 7 (wrist)
  • Zone 8 (dorsal forearm)

Extensor tendon injuries may require operative intervention, depending on the complexity of the injury and the zone of the hand involved.3 For treatment of injuries to specific zones of the hand, see the Technique section. The goal of repair is to restore tendon continuity and function. Optimal preparation and technique is critical to minimize adhesions and scar tissue formation and to ensure the best possible outcome.

Indications

Indications for extensor tendon repair include the following:

  • Tendon laceration greater than 50%
  • Tendon laceration less than 50% with significantly decreased strength compared with contralateral finger
  • Tendon laceration associated with significant overlying skin loss, joint space penetration, or bony fracture

Repair can be accomplished immediately in the emergency department or after a delay of up to 7 days following the injury.4 If repair is delayed, irrigate and debride the wound, approximate the skin loosely with interrupted sutures, and place the hand in a volar splint.5

Contraindications

Extensor tendon repair should not be attempted in the emergency department or acute care setting in any of the following circumstances. In these cases, the repair should be performed by an experienced hand surgeon, preferably in the operating room. 

  • Skilled physician unavailable
  • Contaminated injury, particularly open zone 5 "fight bite" injury
  • Presence of bony fracture, open joint space, or significant overlying skin loss (requires an orthopedist or hand surgeon for repair)

More on Extensor Tendon Repair

Overview: Extensor Tendon Repair
Treatment & Medication: Extensor Tendon Repair
Multimedia: Extensor Tendon Repair
References
Further Reading
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References

  1. Calabro JJ, Hoidal CR, Susini LM. Extensor tendon repair in the emergency department. J Emerg Med. 1986;4(3):217-25. [Medline].

  2. Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg [Am]. Sep 1983;8(5 Pt 2):794-8. [Medline].

  3. Hanz KR, Saint-Cyr M, Semmler MJ, Rohrich RJ. Extensor tendon injuries: acute management and secondary reconstruction. Plast Reconstr Surg. Mar 2008;121(3):109e-120e. [Medline].

  4. Hart RG, Uehara DT, Wagner MJ. Emergency and Primary Care of the Hand. American College of Emergency Physicians; 2001:175-88.

  5. Tang JB. Tendon injuries across the world: treatment. Injury. Nov 2006;37(11):1036-42. [Medline].

  6. Kostopoulos E, Casoli V, Verolino P, Papadopoulos O. Arterial blood supply of the extensor apparatus of the long fingers. Plast Reconstr Surg. Jun 2006;117(7):2310-8; discussion 2319. [Medline].

  7. Newport ML, Tucker RL. New perspectives on extensor tendon repair and implications for rehabilitation. J Hand Ther. Apr-Jun 2005;18(2):175-81. [Medline].

  8. Tang JB. Tendon injuries across the world: treatment. Injury. Nov 2006;37(11):1036-42. [Medline].

  9. Fitoussi F, Badina A, Ilhareborde B, Morel E, Ear R, Penneçot GF. Extensor tendon injuries in children. J Pediatr Orthop. Dec 2007;27(8):863-6. [Medline].

  10. Doyle JR. Extensor Tendons: Acute Injuries. In: Green DP, ed. Operative Hand Surgery. Vol 2. 3rd ed. New York, NY: Churchill Livingstone; 1993:1925-51.

  11. Hutson AM, Rovinsky D. Extensor Tendon Repair. In: Reichman & Simon. Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2003:551-7.

  12. Sokolove PE. Extensor and Flexor Tendon Injuries in the Hand Wrist, and Foot. In: Roberts JR, Hedges RJ, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 2004:927-41.

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Further Reading

Wheeless' Textbook of Orthopaedics: Extensor Tendon Lacerations

Hart RG, Uehara DT, Wagner MJ. Emergency and Primary Care of the Hand. American College of Emergency Physicians; 2001:175-88.

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Keywords

extensor tendon repair, tendon repair, tendon laceration, extensor tendon zones, distal interphalangeal joint, middle phalanx, proximal interphalangeal joint, proximal phalanx, metacarpophalangeal joint, dorsum of hand, wrist, dorsal forearm, fight bite, zone 1, zone 2, zone 3, zone 4, zone 5, zone 6, zone 7, zone 8 

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Contributor Information and Disclosures

Author

Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Nancy S Kwon, MD, MPA, Assistant Professor of Clinical Surgery, Consulting Staff, Department of Emergency Medicine, New York University School of Medicine and Bellevue Hospital Center
Nancy S Kwon, MD, MPA is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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