Operations on the tendons of the hands and fingers: indications, performance, recovery

Why surgery is needed

Ligamentous injuries accompanied by tendon rupture are among the most severe.
Tendons consist of a special tissue formed from tenocytes, cells that do not have the ability to regenerate. Therefore, if they rupture, the problem can be corrected without losing the functionality of the ligamentous apparatus only through surgical intervention. In this case, it makes no sense to apply a fixing bandage or plaster. At the same time, timely contact with a traumatologist is important. Over time, the tendon endings at the rupture sites thicken, join the adjacent tissues, and 2–3 months after the injury, they are very difficult to isolate and connect to each other. That is, the sooner you see a doctor, the higher the chances of restoring full functionality of the limb.

Indications and contraindications for surgery on the tendons of the hands

Surgery on the hand tendon is indicated for any injury accompanied by a violation of its integrity - a cut wound caused by a knife, a piece of glass, etc., a gunshot wound, crushing of soft tissues with fractures of the fingers and destruction of the tendons, careless use of pyrotechnics.

Emergency intervention is necessary when fingers or individual phalanges are torn off. Planned surgery is performed when:

• Synovial cysts;
• Tunnel syndrome;
• Contracture changes in the hand;
• Healed injuries of the flexor or extensor tendons of the finger;
• Cicatricial deformities.

Tendons are very strong due to longitudinally oriented collagen and elastic fibers, and their most vulnerable place is the zone of transition to the muscle belly or the place of attachment to the bone. They will not be able to grow together on their own, since the contraction of muscle fibers leads to a strong divergence of its edges, which cannot be compared without surgery.

The cells that form tendon tissue are not capable of active reproduction, so regeneration occurs through scarring. If the operation is not performed, then by the end of the first week after the injury, loose connective tissue with numerous vessels will appear between the ends of the tendon, fibers will appear in the second week, and after a month, a dense scar will appear.

The tendon restored due to the scar is not able to fully provide the motor function of the fingers, which reduces muscle strength and the coordinated work of the flexors and extensors of the fingers.

Prolonged contraction of muscles that are not held by an intact tendon leads to their atrophic changes, which after 6 weeks become irreversible, and after three months or more it will be extremely difficult for the surgeon to isolate the free tendon ends.

A contraindication to surgery on a tendon of a finger or hand may be an extensive wound with suppuration, microbial contamination of soft tissues, or the patient’s serious condition - shock, coma, severe bleeding disorders. In such cases, surgical treatment will have to be delayed, postponing it until the patient’s condition has stabilized.

Tendon reconstruction at the GMS clinic

At the surgical traumatology center at GMS Hospital, surgical treatment is performed by experienced orthopedic traumatologists using modern microsurgical technologies. Specialists will thoroughly examine the damaged area and select the most effective intervention tactics.

We focus on obtaining maximum results, trying to achieve complete restoration of the functionality of the damaged area. The use of modern arthroscopic struts when applying a tendon suture provides the following advantages:

• targeted accuracy of intervention;
• minimal trauma to surrounding tissues;
• absence of bleeding and surgical complications;
• performing the intervention in an outpatient setting;
• fast recovery.

The prognosis of the operation directly depends on the nature of the injury, its severity, the statute of limitations and the qualifications of the trauma surgeon. When a tendon ruptures, the muscle contracts and the tendon end slips out of the wound. Finding it and connecting it in the least traumatic way, while maintaining the functionality of the ligamentous and muscular apparatus, is a very difficult task that GMS Hospital traumatologists have been successfully coping with for many years.

conclusions

Tendon pathologies or tendinopathy are a serious problem in modern orthopedics. The frequent incidence of illness in athletes and representatives of a number of professions, long periods of temporary disability, and the insufficient effectiveness of existing therapeutic methods force doctors to look for new areas of treatment.

To obtain the maximum effect, the authors recommend a course of 5 procedures, while the power of the device must be increased gradually, from session to session. The technique does not require anesthesia or special preparation, does not cause side effects, and is economically available for use in an outpatient setting.

Cost of tendon repair services

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Dear Clients! Each case is individual and the final cost of your treatment can only be found out after an in-person visit to a GMS Hospital doctor. Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

Plastic cards MasterCard, VISA, Maestro, MIR are accepted for payment. Contactless payment with Apple Pay, Google Pay and Android Pay cards is also available.

Bloodlessness of intervention

Fast healing and short rehabilitation period

Minimal trauma to surrounding tissues

Targeted intervention accuracy

Make an appointment We will be happy to answer any questions Coordinator Oksana

Indications for surgical treatment are:

• tear - damage to half or most of all tendon fibers;
• complete break;
• consequences of old injuries - limited muscle functionality, etc.

The most common causes of tendon rupture are cut, punctured or chopped wounds, as well as injuries to the extremities when caught in a moving mechanism. Damage is also possible as a result of a closed injury.

Make an appointment with a traumatologist if you are concerned about:

• pain that intensifies when trying to move a hand, finger, or other injured area;
• limitation of range of motion;
• inflammation at the site of injury - swelling, swelling, redness, fever.

The severity of clinical signs depends on the degree of tendon damage; with a complete rupture, there is a sharp limitation of voluntary movements, severe pain, decreased joint stability, etc.

Treatment of tendon inflammation

The main inflammatory diseases of the tendons: tendinitis, tenosynovitis, tenosynovitis, enthesitis.

• Tendinitis. The inflammatory process of tendinitis affects the tendon close to the joint, usually where it attaches to the bone. The main cause of tendonitis is constant and monotonous loads on the same group of tendons and, as a consequence, the development of microtraumas.
• Tenosynovitis and tenosynovitis. With tendovaginitis, inflammation affects not only the tendon tissue itself (which characterizes tendonitis), but also the inner (synovial) membrane of the tendon sheath.
• Enthesitis. Inflammation develops where the tendon or ligament attaches to the bone. As a rule, the cause of the disease is excessive physical activity or traumatic exposure.

Basic methods of treating inflammation:

• Immobilization
• Drug therapy (analgesics, anti-inflammatory and restorative drugs)
• Physiotherapy
• Physiotherapy

The first rule that must be observed when treating tendon inflammation is complete rest. The affected area is immobilized using an elastic bandage, plaster splint, orthoses.

All medical procedures should be carried out only after consultation with a doctor - incorrectly carried out therapy when treating tendons can only aggravate the inflammatory process.

Preparation, diagnostics

Diagnosing a tendon rupture is not difficult. Because it is accompanied by movement disorders characteristic of one or another muscle lesion. To visualize the site of damage and determine the degree of its severity, the following is prescribed:

• radiography in different projections;
• CT or MRI with layer-by-layer tissue scanning;
• Ultrasound;
• arthroscopy.

Before applying a tendon suture, you will need to take blood and urine tests and consult with an anesthesiologist.

Rules for performing exercises for full recovery

An important place in the rehabilitation of fingers after a tendon rupture is given to movements that must be performed in a hand bath filled with warm water.

The patient is asked to alternately squeeze the sponge or collect small objects from the bottom. This procedure has a relaxing effect on the ligaments, and due to the resistance of the water, the effect of such simple movements increases significantly. The water temperature should be no more than 34-35 degrees, since higher temperatures may cause swelling of the fingers and difficulty in performing movements.

In the later period of healing of a rupture of the distal phalanx, it is recommended to perform simple, targeted movements. The patient can be asked to glue something together and wind threads onto a spool. You can speed up the restoration of the functioning of a damaged tendon through sculpting, knitting and wood burning.

How is tendon repair performed?

Applying a tendon suture is the simplest, safest and most effective (provided that the operation is performed by an experienced doctor) way to restore damage. Basic requirements for a tendon suture:

• the seam should be as simple as possible;
• when applying a suture, it is necessary to use as little suture material as possible;
• the suture should not disrupt the tendon blood supply;
• the seam should reliably fasten the ends of the tendons, without the possibility of them breaking apart.

There are different methods for applying a tendon suture, depending on the location of the rupture, the general condition of the adjacent tissues, for example, the suture according to Cuneo, Rozov, etc. Depending on the time of application, the following types of sutures are distinguished:

• primary - applied in the first hours after the injury;
• secondary (early and late) - applied several weeks after injury.

The doctor isolates the ends of the tendons at the site of the rupture, tightens them, suturing them in a way that will ensure the maximum result in this situation. In addition, during the intervention, the traumatologist restores not only the tendon, but also its sheath. After manipulation, a sterile bandage is applied to the wound. The operation is performed under local, epidural or general anesthesia.

You have questions? We will be happy to answer any questions Coordinator Tatyana

Literature review

Ukrainian scientists compared the effects of shockwave therapy and traditional treatment in patients with patellar tendonitis. The study included 54 volleyball athletes suffering from jumper's knee. Pain syndrome in all subjects on the VAS scale was in the range of 45-75 points.

The first group of volleyball players (27 people) received only shock therapy - they were given 4 sessions with an interval of 1 week. The second group, also consisting of 27 people, was prescribed traditional treatment. After completing the course, all athletes from the first group noted complete relief (in 16) or a significant decrease in the intensity of pain (in the remaining 11). In the second group, the pain completely disappeared in only 6 athletes, and five did not notice any result.

Rice. 3. SWT in the treatment of “jumper’s knee”

Russian scientists studied the effect of shockwave therapy for epicondylopathy of the elbow joint. A group of 84 patients was divided into 3 subgroups, each of which underwent shock waves sessions with different operating modes of the shock wave generator. The greatest therapeutic effect was obtained in the subgroup where the power of the device increased gradually, starting from a minimum level. At the same time, a lasting effect was obtained only after the 5th procedure.

At the end of the course of shockwave therapy, complete relief of pain was observed in 90% of patients. Moreover, after 12 months, 94% of patients noted the absence of pain, which indicates the cumulative effect of shock waves on the body.

Another group of Russian researchers compared traditional treatment of patients with plantar fasciitis and the effect of shock wave therapy. All patients were divided into 2 groups:

• Group 1 (22 patients) received injections of Diprospan and UVT on the area of ​​the heel tubercle in the amount of 3 procedures.
• Group 2 (also 22 patients) was prescribed only Diprospan injections.

At the end of treatment, a more pronounced effect was noted by patients from group 1 - the pain went away in all of them after the 3rd session of injections of the drug and shock wave therapy. In group 2, pain was relieved only after the 5th injection. Relapse of the disease after 1.5 years was observed only in 4 patients from group 1 and in 19 patients from group 2.

Features of the rehabilitation period

The duration of the recovery period depends on the type of surgery. If the operation was performed using an open approach, healing takes an average of 10–14 days; after arthroscopy, it takes about 3–5 days. Rehabilitation measures are aimed at quickly restoring the functionality of the tendon, muscle and joint apparatus. Full return of motor functions may take 1–4 months, depending on the degree of damage (whether the ligaments or flexor muscles were injured, or one or more tendon bundles had to be surgically restored) and the technique used. During rehabilitation, you must carefully follow the doctor’s recommendations in order to achieve complete restoration of the functionality of the tendon apparatus in a short time.

Big toe ligament injuries

With injuries to the first metatarsophalangeal joint or big toe, pain and swelling may initially be relatively mild, but during the first 24 hours they usually intensify, and the next day the athlete comes to training already limping.

In order to choose the most optimal treatment tactics and one way or another assess its prognosis, doctors use a special classification.

Grade 1 injuries are characterized by overstretching of the capsule and ligaments of the first metatarsophalangeal joint.

Patients complain of pain along the plantar and inner surface of the first toe, swelling is minimal, and there are no hemorrhages (bruises).

Movement in the joint is slightly limited, and athletes usually retain the ability to put weight on the foot and continue training, although with some pain.

Grade 2 injuries are characterized by partial rupture of the capsule and ligaments of the first finger.

The pain is more intense, swelling and hemorrhages are pronounced. Painful sensations and defensive reactions lead to some limitation of movements in the joint.

Athletes complain of moderate pain and lameness. They cannot train at a normal level.

Grade 3 injuries are complete ruptures leading to severe pain, swelling and hemorrhage.

Locally, there is severe tenderness along both the plantar and dorsal surfaces of the big toe and the first metatarsophalangeal joint.

Third degree damage leads to rupture of the plantar plate. In many cases, this type of injury is characterized by dislocation of the big toe at the first metatarsophalangeal joint, followed by spontaneous reduction.

A pronounced restriction of movement in the joint almost always develops. Athletes in such situations cannot load the inner surface of the foot and, of course, cannot continue training.

X-ray of the foot in a direct projection of a professional football player with signs of pronounced migration of the sesamoid bones.

Chronic damage to the ligaments of the first metatarsophalangeal joint is a consequence of acute injury, which at one time was missed or did not receive due attention from both doctors and the athlete himself.

This condition is characterized by long-lasting pain in the metatarsophalangeal joint and contracture of the big toe.

Due to the lack of plantar stabilizers of the joint, dorsal subluxation of the big toe develops.

Against the background of scar changes in the first metatarsophalangeal joint, hallux rigidus can form, manifested by a pronounced limitation of the mobility of the big toe.

In cases of severe injuries to the ligaments of the first finger, standard radiography is performed to exclude possible bone injuries, be it avulsions of the joint capsule with bone fragments, fractures of the sesamoid bones, dehiscence or migration of the sesamoid bones.

We consider MRI as the most informative method for visualizing ligamentous and osteochondral injuries.

MRI allows one to clearly see all types of injuries and more accurately localize possible ligament and capsule ruptures and plan surgical intervention.

MRI for severe damage to the ligaments of the first finger. A, MRI shows signs of ligament rupture and displacement of the sesamoid bone. B, MRI shows evidence of complete rupture of the medial collateral ligament while maintaining the integrity of the similar lateral ligament.