Does a ruptured tendon in a finger require urgent medical attention?

Ruptured Finger Tendon Management

A ruptured tendon in a finger requires urgent medical attention within 24-48 hours to prevent long-term complications such as permanent deformity and functional impairment. 1, 2

Diagnostic Evaluation

Early recognition of finger tendon injuries is crucial as they are often missed on initial presentation, leading to worse outcomes 3. The diagnostic process should include:

• Physical examination:

  • Thorough inspection for swelling, asymmetry, and erythema of involved tendons
  • Range-of-motion testing
  • Palpation for tenderness
  • Specific examination maneuvers that simulate tendon loading to reproduce pain 4, 1
  • Assessment for presence of a palpable gap in the tendon

• Imaging:

  • Plain radiographs (3 views) are always indicated as initial imaging to detect any associated fracture fragments 4
  • For suspected extensor tendon injuries, radiographs help assess for bone involvement and determine need for operative fixation 4
  • MRI has 95% sensitivity and 95% specificity for tendon injuries when diagnosis remains unclear 1

Treatment Approach

Treatment should be initiated promptly as delay can lead to functional impairment 4:

Immediate Management

• Relative rest and immobilization of the affected finger in the appropriate position
• Ice therapy for pain relief
• Elevation to reduce swelling
• Prompt referral to hand specialist if complete rupture is suspected

Definitive Treatment

• Extensor tendon ruptures:

  • Mallet finger injuries (disruption of extensor mechanism at distal interphalangeal joint) often require splinting in extension for 6-8 weeks 2
  • Involvement of more than one-third of the articular surface, palmar displacement of the distal phalanx, or an interfragmentary gap >3 mm usually requires operative fixation 4

• Flexor tendon ruptures:

  • Flexor digitorum profundus avulsions (Jersey finger) typically require surgical repair, especially in active patients 2, 5
  • Early surgical intervention (within 7-10 days) provides optimal outcomes

Important Considerations

• Timing is critical: Delay in diagnosis and treatment can lead to tendon retraction, making repair more difficult and outcomes less favorable 3

• Pitfalls to avoid:

  • Misdiagnosing tendon ruptures as simple sprains
  • Inadequate immobilization leading to further damage
  • Prolonged immobilization causing joint stiffness and muscle atrophy 1
  • Failure to recognize injuries requiring surgical intervention

• Rehabilitation:

  • After appropriate immobilization period, controlled mobilization and strengthening exercises are essential for optimal recovery 1
  • Most patients with properly treated tendon injuries can expect full recovery within 3-6 months 4

When to Refer

Immediate specialist referral is indicated for:

• Complete tendon ruptures
• Injuries with significant deformity
• Failed conservative management
• Injuries in high-performance athletes or those with high functional demands 2, 5

While some minor tendon injuries can be managed conservatively with proper splinting and rehabilitation, complete ruptures typically require surgical intervention for optimal functional outcomes. The window for optimal surgical repair is limited, making urgent evaluation essential.