What are Tendon Ruptures and Lacerations (EPL, FPL, FDP, FDS, Extensor Tendons)?
Tendon ruptures and lacerations are injuries where the tendons - fibrous cords that connect muscle to bone - are either torn (rupture) or cut (laceration). Tendon ruptures and lacerations in the hand and forearm - such as those affecting the EPL, FPL, FDP, FDS, and extensor tendons - can significantly impair function essential for gripping, grasping, and finger coordination, requiring prompt and appropriate management.
What are the Common Tendons Involved in Hand Function?
Common tendons involved in hand function include the following:
- EPL (Extensor Pollicis Longus) Tendon: Extends the thumb at the interphalangeal joint.
- FPL (Flexor Pollicis Longus) Tendon: Flexes the thumb at the interphalangeal joint.
- FDP (Flexor Digitorum Profundus) Tendon: Flexes the distal interphalangeal (DIP) joints of the fingers.
- FDS (Flexor Digitorum Superficialis) Tendon: Flexes the proximal interphalangeal (PIP) joints of the fingers.
- Extensor Tendons, including EDC, EDM, and EI: Extends the fingers and wrists.
What are the Causes of Tendon Injuries in the Hand?
The common causes of tendon injuries in hand include the following:
- Lacerations: These are sharp injuries from knives, glass, or tools.
- Ruptures or Tears: These can be spontaneous (rheumatoid arthritis, steroid use) or traumatic (fracture, tendon attrition).
- Avulsion injuries: These occurs from a sudden forceful pulling (common in sports).
What are the Symptoms of Tendon Ruptures and Lacerations in the Hand?
Symptoms of tendon ruptures and lacerations in the hand include the following:
- Sudden pain at the injury site
- Inability to flex/extend the affected finger or thumb
- Loss of grip strength or dexterity
- Swelling and tenderness over the tendon path
- Open wound with possible exposed tendon
- Snapping or popping sensation at time of injury
- Numbness or tingling if nerves are also affected
How are Tendon Ruptures and Lacerations of the Hand Diagnosed?
Tendon ruptures and lacerations of the hand are diagnosed through a combination of medical history, physical examination, and imaging. The physician evaluates how the injury occurred and performs a detailed hand exam to assess finger and thumb movement, grip strength, and tendon integrity. Specific tests help identify which tendon is affected. Visual signs such as swelling, deformity, or an open wound are also noted. Imaging studies like ultrasound or MRI may be used to confirm tendon damage, while X-rays help rule out associated bone injuries.
How are Tendon Ruptures and Lacerations of the Hand Treated?
Treatment for tendon injuries of the hand - including those involving the EPL, FPL, FDP, FDS, and extensor tendons - aims to restore tendon continuity, preserve function, and prevent complications like stiffness or adhesions. The approach depends on the type, location, timing, and severity of the injury.
Treatment Options:
Non-Surgical Treatment (for partial tears or minor injuries):
- Splinting or casting to rest the tendon and allow healing
- Physical or occupational therapy to restore movement and strength
- Anti-inflammatory medications for pain and swelling
Surgical Treatment (for complete ruptures or deep lacerations):
- Tendon repair: Suturing the torn ends together
- Tendon grafting: Using another tendon if the original is severely damaged
- Tendon transfer: Replacing the function using a nearby healthy tendon
- Surgery is typically followed by hand therapy to prevent stiffness and improve function
