Acute injuries to the flexor and extensor tendons of the hand

Acute injury to the flexor and extensor tendons in the hand and forearm is common and requires careful assessment and management. A sound knowledge of the functional anatomy, allied with good surgical technique, is essential. Flexor tendon injuries are often associated with neurovascular injury, which must be examined for. Extensor injuries may involve intra-articular damage, particularly with ‘fight-bites’: these can result in infection and poor outcomes if missed.Techniques for the management of tendon injuries vary according to the site of the injury within the hand and whether the injury is open or closed. The principles of surgical management and repair in the different ‘zones’ are described.Hand surgeons work closely with hand therapists to develop protocols for rehabilitation and splintage. Common postoperative regimens for flexor and extensor tendon repair are described.Tendon injuries result in a prolonged period of reduced functionality and disability, with significant socioeconomic consequences for the patient. The best outcomes must be achieved to minimize long-term disability and the requirement for secondary surgery.