Patients › Hand

Extensor Tendon Repair

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Updated Sep 2026

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific injury. Extensor tendons are the cords on the back of your hand and fingers that straighten them. They sit just under the skin, so cuts, crushes, sports and other injuries can damage them easily. Some tears happen slowly, for example after a wrist fracture, sometimes more than 6 weeks later.

Most recent closed injuries can be treated without surgery, usually with a splint that holds the finger or thumb still while it heals. We generally suggest surgery when an injury is older, when the tendon is fully cut, or when splinting has not given enough improvement. Children often heal well with splinting or a direct repair. The aim of the operation is to join the tendon ends so you can straighten your finger or thumb again, with better strength and movement for daily tasks.

Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your visit we take a history, examine your hand and arrange imaging if needed. We will then talk through the options with you and decide together on the plan that suits your injury.

Before the operation¶

Your surgeon will give you clear instructions so you know exactly what to do. You will need to stop eating and drinking seven hours before surgery. We ask for seven rather than six so you can be brought forward if the theatre list runs early. You may need to pause some medications before the operation, and your surgeon will tell you which ones and for how long. Arrange for someone to drive you home afterwards. Bring a list of your current medications and wear comfortable, loose clothing. Imaging such as an X-ray, ultrasound or MRI scan helps plan the operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist, the doctor who gives the anaesthetic.

On the day¶

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist there. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.

You wake up in the recovery area, where nurses watch over you while the anaesthetic wears off. Once you are stable, you either go to a ward or go home, depending on the procedure and how you are recovering.

What the operation involves¶

The exact steps depend on where the tendon is torn and how old the injury is. Your surgeon will explain your plan before the day.

For a recent cut, the surgeon makes a small opening over the back of the affected finger or hand, finds the two ends of the torn tendon, and stitches them back together. The tendon sits just under the skin, so this is usually a straightforward repair. If the tendon has pulled away from the bone, it can be stitched back onto its attachment point.

For older injuries, the tendon ends may have shortened or frayed like an old rope. In that case there are more options. The surgeon may shorten the tendon and rejoin it, or use a piece of tendon from another part of your hand or wrist as a graft to bridge a gap. Sometimes a nearby tendon that does its own job can be rerouted to take over the work of the damaged one. For long gaps in the back of the hand, a two-stage repair is possible: a soft spacer is placed first to let a smooth channel form, and the new tendon is put in at a second, later operation.

Some repairs are held still in a splint afterwards. Others start gentle movement within days, because early motion can lead to better grip strength and movement. Your surgeon will choose the approach that suits your injury, and you will meet the hand therapy team who guide your splint or exercise plan.

You will go home with dressings over the wound and clear instructions on caring for it.

After the operation¶

You wake up in the recovery area, and once you are stable you move to the ward or go home. Nurses will keep your pain under control and check your hand, dressings and any splint. Keep the dressings clean and dry, and raise your hand on pillows to ease swelling. You may be shown gentle finger movements to start within days, because early motion can lead to better grip strength and movement. Someone should stay with you for the first 24 hours after you get home. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery¶

The first days after surgery bring swelling and some throbbing over the back of your hand or finger. Raising your hand on pillows and keeping your dressings clean and dry helps settle this. The discomfort usually eases over the first couple of weeks as the swelling goes down.

Your hand will be protected while the tendon heals. Some repairs are held still in a splint, while others start gentle movement within days, because early motion can lead to better grip strength and movement. Your surgeon will tell you which approach applies to you. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby directs your exercise program and makes any splint you need. You will see her regularly through the healing phase, and the exercises will build slowly as the tendon gets stronger.

At home you can do most light daily tasks with your other hand while the repaired one heals. You will not drive while your hand is in a splint, and you need to be able to grip and turn the wheel and react quickly before you return. Our guide to driving after upper-limb surgery explains the rules in detail. Sleep is often easier with your hand raised on a pillow beside you.

Milestones come as events rather than dates: when the swelling settles, when you can straighten the finger fully, when you can grip without pain. Recovery varies between people, and your surgeon and hand therapist will guide your timeline.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the finger does not straighten as fully as hoped, or movement stays limited. If you notice this, mention it at your next review. In some cases a further procedure can help, and your surgeon will talk this through with you if it comes up.

Two finger shapes can develop if the tendon heals out of balance. One makes the finger bend down at the middle joint and over-straighten at the end joint. The other does the opposite, with a droop at the end joint. If you see either shape forming, bring it up early, because a splint or another operation may help.

Some injuries near the middle joint of the finger are harder to treat than others. Healing there can be slow and the result may fall short of what you want. Your surgeon will be upfront about this before you decide on surgery.

If you notice sudden weakness or a pop in the tendon after your repair, contact the clinic straight away. The same applies if a finger that was straightening well stops doing so.

One rare cause of tendon trouble is a common antibiotic in the ciprofloxacin family. If you are prescribed this drug at any point, tell the prescriber about your tendon injury.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Call us if you notice increasing redness, swelling or discharge from the wound, or if you feel feverish. Call us if the hand or fingers become numb, or if a finger that was straightening well stops doing so. Go to emergency if you have sudden severe pain, calf swelling or pain, or shortness of breath. These can be signs of a blood clot. If you are unsure, call the clinic and we will guide you.

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