Question 1

What are flexor tendons and why do they matter?

Accepted Answer

Flexor tendons are strong cords that connect muscles in your forearm to bones in your fingers. When forearm muscles contract, they pull on these tendons which bend (flex) your fingers - allowing you to make a fist, grip objects, type, write. Each finger has TWO flexor tendons: FDP (flexor digitorum profundus) bends fingertip joint, FDS (flexor digitorum superficialis) bends middle joint. If both cut, you lose all finger flexion. If only FDP cut, can't bend fingertip. Unlike skin or bone, tendons do NOT heal without surgery - the cut ends retract and scar separately. Without surgery, permanent loss of finger flexion.

Question 2

What is Zone 2 or 'no man's land'?

Accepted Answer

Zone 2 is the area from mid-palm to fingertip DIP joint - historically called 'no man's land' because flexor tendon injuries here had terrible outcomes (60-70% poor results with old techniques). Why so difficult? In this zone, BOTH flexor tendons (FDP and FDS) run through tight fibrous tunnels (A2 and A4 pulleys) with almost no space. When repaired, tendons must glide smoothly through pulleys to allow finger motion. But: scar tissue (adhesions) easily forms, gluing tendons to pulleys and preventing motion. Modern techniques (4/6-strand repair, early passive motion protocols) improved outcomes to 70-80% good/excellent, but Zone 2 still has worst results of all zones. Zone 1 (fingertip) and Zone 5 (wrist/forearm) have better outcomes as more space and less critical anatomy.

Question 3

Will my finger ever be completely normal again?

Accepted Answer

Honestly, no - expect some permanent deficit even with excellent surgery and therapy. REALISTIC EXPECTATIONS: 1) Good outcome (70-85% chance): can make a fist, grip objects, perform most activities. Finger flexion 80-90% of opposite side. Small permanent loss (5-20 degrees less flexion, or 5-10 degree flexion contracture). Strength 80-90% of normal. 2) Fair outcome (10-20%): noticeable loss of motion, difficulty with fine tasks, may need revision surgery (tenolysis to release adhesions). 3) Poor outcome (5-10%): significant stiffness despite therapy, cannot fully close fist, limited functional use. Factors for best outcomes: early repair (under 1 week), modern multi-strand technique, excellent hand therapy compliance, non-smoker, Zone 1 or 5 injury (not Zone 2).

Question 4

Why is hand therapy so important after flexor tendon repair?

Accepted Answer

Hand therapy after flexor tendon repair is NOT optional - it's as important as the surgery itself. Without proper therapy, repair will fail due to adhesions (scar tissue gluing tendon down). The challenge: need to balance two competing goals: 1) PROTECT repair from rupture (requires immobilization), 2) PREVENT adhesions (requires motion). Solution: controlled passive motion protocols. Therapist moves finger (passive) to glide tendon and prevent adhesions, but patient doesn't use muscles (active) which would stress repair. This requires specialized hand therapists trained in these protocols. Studies show: compliant patients have 80-85% good results, non-compliant patients have 50-60% good results. Missing appointments or not doing home exercises is the most common cause of poor outcomes.

Question 5

What happens if the tendon repair ruptures?

Accepted Answer

Tendon repair rupture occurs in 5-10% of cases. CAUSES: too aggressive early motion, patient actively flexes finger before allowed (4-6 weeks), repair done under too much tension, poor suture technique. SYMPTOMS: sudden loss of finger flexion (could bend, now can't), possible 'snap' or 'pop' felt/heard. OPTIONS: 1) Early rupture (first 2-3 weeks): immediate re-repair usually successful if caught early. 2) Late rupture (after 4-6 weeks): re-repair difficult as tendon ends retract and scar, may need tendon graft. 3) Patient preference/surgeon assessment: some elderly patients with late rupture accept limited function rather than undergo grafting. Prevention: strict compliance with therapy protocol, protective splinting, NO active flexion until cleared (week 4-6), no forceful gripping for 8-12 weeks.

Medical Disclaimer

Cut Flexor Tendon (Hand/Finger Tendon Injury)

📖What is Cut Flexor Tendon (Hand/Finger Tendon Injury)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention