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What Is Extensor Tendon Repair?

Extensor tendon repair is surgery used to reconnect a torn or cut tendon that helps straighten the fingers, thumb, hand, or wrist. Extensor tendons lie close to the skin on the back of the hand and are vulnerable to laceration and traumatic injury. The repair method depends on the tendon zone, injury pattern, tissue quality, and whether the tendon has pulled away from bone. Sutures, anchors, pins, grafts, or other techniques can be used according to the injury.

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What Is Extensor Tendon Repair?

Extensor tendon repair is surgery used to reconnect a torn or cut tendon that helps straighten the fingers, thumb, hand, or wrist. Extensor tendons lie close to the skin on the back of the hand and are vulnerable to laceration and traumatic injury. The repair method depends on the tendon zone, injury pattern, tissue quality, and whether the tendon has pulled away from bone. Sutures, anchors, pins, grafts, or other techniques can be used according to the injury.

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Why Is Extensor Tendon Repair Performed?

Surgical repair is commonly needed when an extensor tendon is completely divided and the tendon ends cannot heal in proper contact. Surgery can also be required when the tendon is avulsed from bone, associated with an unstable fracture, or part of a complex open hand injury. Some closed extensor injuries, such as many uncomplicated mallet fingers, are treated with splinting instead of surgery. The treatment plan depends heavily on the exact anatomical zone and whether the joint remains aligned.

How Is Extensor Tendon Repair Performed?

The surgeon cleans and explores the injury, identifies the tendon ends, and repairs associated damage to bone, joint, nerve, or blood vessel structures when present. A lacerated tendon can be reconnected with specialized sutures while preserving appropriate tendon length and alignment. Avulsed tendons can require reattachment to bone with an anchor, tunnel, or other fixation method. Complex delayed injuries can require tendon grafting, tendon transfer, or staged reconstruction rather than direct primary repair.

What Is Recovery Like After Extensor Tendon Repair?

The repaired tendon is protected with a splint or custom orthosis because excessive force can pull the repair apart. Hand therapy commonly begins early with a controlled motion program designed for the tendon zone and strength of the repair. Too little motion can promote adhesions and stiffness, while too much motion can cause gapping or rupture. Functional recovery often takes several months as tendon gliding, joint motion, and strength gradually improve.

What Are the Risks and Complications?

Possible complications include infection, stiffness, scar sensitivity, tendon adhesions, reduced motion, weakness, and repair rupture. The repaired tendon can heal too tightly or become stuck to surrounding tissues, limiting finger movement. Injuries near joints can also produce deformity or contracture when the extensor mechanism does not regain balanced function. Additional hand therapy, tenolysis, tendon reconstruction, or another operation can be needed when function remains limited.

Frequently Asked Questions About Extensor Tendon Repair

What do extensor tendons do?

Extensor tendons transmit force from muscles to straighten the fingers and thumb and contribute to extension of the wrist.

Does every extensor tendon injury need surgery?

No. Some closed injuries can heal with continuous splinting. Complete open lacerations and unstable avulsion injuries are more likely to require surgical repair.

Why is hand therapy important after extensor tendon repair?

Controlled motion helps reduce stiffness and tendon adhesions while protecting the healing repair. The therapy program must match the injury zone and repair strength.

Can an extensor tendon repair rupture?

Yes. Excessive force before healing is mature can cause the repair to fail, which is why splinting and activity restrictions are important.

References

Hand Extensor Tendon Lacerations. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK554431/. Date Accessed August 12, 2026.

Extensor Tendon Injury: Signs & Treatment. American Society for Surgery of the Hand. https://www.assh.org/handcare/condition/extensor-tendon-injury. Date Accessed August 12, 2026.

Hand tendon repair. NHS. https://www.nhs.uk/tests-and-treatments/hand-tendon-repair/. Date Accessed August 12, 2026.

Management of Extensor Tendon Injuries. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC3293224/. Date Accessed August 12, 2026.

Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand: a systematic review of controlled trials. PubMed. https://pubmed.ncbi.nlm.nih.gov/24293953/. Date Accessed August 12, 2026.