Management of Extensor Tendon Injuries in the Hand

Abstract

Although injuries to the extensor mechanism of the hand and wrist are relatively common, their management is often given less attention than that of flexor tendon injuries. This is unfortunate because the extensor mechanism is in many ways more complicated than the flexor tendon system, and restoration of satisfactory function following injury of an extensor tendon remains a frequent challenge. Most extensor tendon injuries in the hand and wrist are the result of laceration, but crush injuries can disrupt the extensor mechanism as well, and tendon failure may also occur in traction during treatment of closed injuries. Primary treatment of most extensor tendon injuries is relatively straightforward, but some closed injuries and injuries with extensive tendon defects can be difficult to treat. The specific repair technique and treatment protocol used in the management of an extensor tendon injury varies according to the level of injury. For most patients, rehabilitation is extensive, and is continued for up to 6 weeks before gradual resistive exercises can be started. Early diagnosis, meticulous surgical technique, and supervised rehabilitation are integral for satisfactory function following an extensor tendon injury. The purpose of this article is to review the relevant guidelines for evaluation and treatment of injuries of the extensor mechanism of the hand, with special emphasis on management of injuries in the eight zones of the hand, wrist, and forearm.

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