Extensor tendon repair is an operation to suture a cut or torn extensor tendon on the back of the hand, wrist, or fingers, restoring the ability to straighten the affected digit or wrist.
An incision is made over the site of injury (or the existing laceration is explored). The cut tendon ends are identified and sutured together using specialised techniques appropriate to the zone of injury. The repair is protected with a splint. The operation takes 30–90 minutes depending on the number of tendons and complexity.
Extensor tendon lacerations require surgical repair because the tendons do not heal spontaneously when divided. Even partial cuts may need repair or protection to prevent complete rupture.
Not appropriate for complete tendon lacerations. Partial lacerations involving less than 50% of the tendon width may be managed with splinting alone.
Urgent assessment of tendon function. X-ray to exclude fracture or foreign body. Surgery ideally within 24 hours, though delayed repair up to two to three weeks is possible.
Restoration of finger or wrist extension. Outcomes are generally good, though some loss of excursion (range of pull) is common. Results depend on the zone of injury and compliance with splinting and hand therapy.
Scar tissue tethering the tendon, limiting glide. The most common complication.
Loss of full flexion due to adhesions around the repair.
Some residual inability to fully straighten the finger.
The repair may fail, particularly with premature loading. Risk approximately 5%.
Wound infection.
Prolonged immobilisation can cause PIP or DIP joint contracture.
Approximately 10–15% of patients need a second operation to release adhesions.
Local, regional, or general anaesthesia.
Splinting protocol depends on the zone of injury — typically a hand-based or forearm-based splint for four to six weeks. Early controlled motion protocols (supervised by a hand therapist) begin within the first week and produce better results than static immobilisation. Active movement from four to six weeks. Strengthening from eight weeks. Full recovery three to six months.
Regular hand therapy appointments. Surgeon review at two weeks and six weeks.
The balance between protecting the repair and preventing adhesions is critical. Early controlled motion under hand therapist supervision produces significantly better results than simple immobilisation.
If adhesions restrict tendon glide despite therapy, tenolysis (a second operation to release the scar tissue) may be needed. This is performed once the wound and tendon have fully healed, typically at three to six months.