Tendon and Nerve Injuries

Overview

The tendons and nerves of the hand are arranged in close, layered anatomy just under the skin. Even a small laceration to the palm, fingers, or forearm can cut critical structures - flexor or extensor tendons, digital nerves, or larger peripheral nerves. These injuries require surgical repair to restore function.

Dr de Hoog manages a range of tendon and nerve injuries, both acutely (following trauma) and electively (for longstanding unrepaired injuries or failed previous surgery).

Common injuries

Tendon injuries:

• Flexor tendon lacerations - usually from a sharp cut to the palm or fingers; can disrupt finger bending
• Extensor tendon lacerations - from cuts to the back of the hand or fingers; disrupt finger straightening
• Mallet finger - a tendon avulsion at the fingertip causing a dropped end joint, often from a sporting impact
• FDP avulsion (“jersey finger”) - the flexor tendon pulling off the bone at the fingertip, typically during contact sport

Nerve injuries:

• Digital nerve lacerations - small sensory nerves in the fingers; loss of sensation on one side of a finger
• Median, ulnar, and radial nerve lacerations - larger nerves in the wrist and forearm with major motor and sensory consequences
• Nerve compression or stretch injuries - sometimes from trauma, sometimes chronic

Diagnosis

Diagnosis is made through careful examination - testing which tendons and nerves are working and which aren’t. Imaging (ultrasound or MRI) is occasionally used, particularly for partial injuries or when the history is unclear. Most acute injuries are diagnosed clinically at first presentation.

Surgical treatment

Tendon and nerve repairs are technically demanding operations that require magnification, fine instruments, and careful technique.

• Tendon repair - the cut ends are sutured back together with specialised sutures designed to allow early, controlled movement
• Nerve repair - the nerve ends are aligned and joined with very fine sutures under magnification. Longer nerve gaps may require a nerve graft
• Timing matters - acute injuries are best repaired within 1-2 weeks for tendons, and within 6 weeks for nerves, but delayed reconstruction is often still possible

Procedures are performed at Townsville Day Surgery or Mater Hospital Pimlico, depending on complexity. Most are done as day surgery under regional anaesthetic.

Recovery

Recovery from tendon and nerve injuries is longer and more demanding than most hand surgery, because the repaired tissues need to heal while also being protected and mobilised carefully:

• Weeks 1-6 - splinting to protect the repair; structured hand therapy begins early with specific protected movement protocols
• Weeks 6-12 - gradual return to active movement and light load
• Months 3-6 - progressive strengthening
• Months 6-12 - for nerve injuries, sensation and muscle function continue to recover slowly over 12 months or longer

Hand therapy is essential throughout, and is available through NQ Hand Care Clinic at the same North Ward location. The quality of the long-term outcome often depends as much on the therapy as on the surgery.

Risks

• Stiffness - the most common complication, especially after flexor tendon repair
• Re-rupture - tendon repairs can fail if mobilised too aggressively or loaded too early
• Incomplete nerve recovery - nerve repairs rarely restore fully normal sensation, particularly in adults
• Adhesions - scar tissue around a repair can limit tendon gliding
• Infection - uncommon
• Complex regional pain syndrome - rare but recognised