06 / RECONSTRUCTION
Tendon & Nerve Repair
Tendons transmit movement; nerves carry signals for sensation and muscle control. An injury can involve one or both. Assessment establishes what is damaged, whether repair is appropriate and what rehabilitation will require.
Understand the pathway01 / WHAT THIS TREATMENT ADDRESSES
Understand what can change.
Flexor & extensor tendons
Flexor tendons bend the fingers; extensor tendons straighten them. A divided tendon may need repair, while some closed injuries can heal with carefully supervised splinting. Injury location changes the treatment.
Peripheral nerve injury
A bruised nerve and a cut nerve have different prospects. Observation may be appropriate for some closed injuries. A divided nerve may need repair; complex damage can require reconstruction or coordinated specialist care.
02 / WHEN TREATMENT IS CONSIDERED
A reason to intervene.
A reason to be careful.
A new inability to bend or straighten a finger, or loss of feeling after injury, needs prompt assessment. Small skin wounds can conceal deeper damage. The decision considers tendon continuity, sensation, circulation, contamination and associated fractures. Do not wait for a wound to heal before having new weakness or numbness checked.
03 / BEFORE THE PROCEDURE
A clear plan before the day.
Examination assesses individual tendons, nerve function and blood supply. Imaging may clarify associated injury; nerve tests are useful in selected cases and may be repeated over time. Repairability depends on the injury and timing. The team will explain whether direct repair, staged reconstruction or referral is the appropriate pathway.
Bring your questions.
Review medicines, allergies and health conditions with the team. Follow your own instructions about fasting and medication changes; do not stop prescribed treatment on your own.
Ask what help, transport and time away from work you may need.
04 / THE PROCEDURE
A PATIENT GUIDE / THREE KEY STAGESPrecision in every step.
One deep finger flexor tendon is shown on the palm side, continuing towards the distal phalanx. A selected interruption in the palm is highlighted, followed by a simplified repair concept. This is not a suture technique; protection and prescribed therapy are essential.
- Flexor tendon (palm side)
- Example interruption
- Repair / continuity concept
- Distal tendon attachment
The extensor pathway is on the back of the hand. It continues into a branching mechanism that straightens the finger joints. A dorsal hand interruption and a simplified repair are shown; treatment and splinting differ by injury level.
- Extensor tendon (back of hand)
- Example interruption
- Repair concept
- Extensor mechanism over the finger
An enlarged peripheral nerve segment shows its outer sheath and internal bundles. Interrupted ends are brought together in a direct repair concept where this is appropriate. Nerve fibres must then regrow over time. No nerve graft or immediate full recovery is implied.
- Peripheral nerve sheath
- Nerve fibres / fascicles
- Injured ends
- Continuity supported by repair
Define the injury
Assess the damaged structures and the condition of the surrounding tissues.
Restore continuity
Where appropriate, tendon ends are repaired or nerve continuity restored. A gap, tissue loss or an older injury may require a different reconstruction plan.
Protect & retrain
A tailored splint and hand-therapy programme balance protection with carefully controlled movement. Rehabilitation is part of the treatment.
05 / ANAESTHESIA & THE DAY
The plan is personal.
Anaesthesia and discharge arrangements depend on the injury and the planned repair. Local, regional or general anaesthesia may be considered. More complex injuries can require admission or staged care. Before leaving, make sure you understand the splint, wound review and therapy arrangements.
06 / RECOVERY
PROTECT → MOVE → STRENGTHENProgress has
its own pace.
These are guideposts, not personal clearance dates. Your operation, healing and clinical review determine the next step.
Tendon repair
First days / week
Protection & therapy planning
A protective splint is used. Early therapist input sets the permitted exercises; do not improvise a programme.
First 6 weeks
Controlled movement
The repair remains vulnerable. Splint use and carefully prescribed movement vary by tendon and injury zone.
About 6–12 weeks
Progressive rehabilitation
Loading advances only when cleared. Healing strength and free tendon glide develop gradually.
Around 3 months & beyond
Functional progression
Heavier activity may be considered after review. Complex injuries, stiffness or adhesions can extend recovery.
Nerve repair
First weeks
Protect the repair
Splinting may protect the repair while the outer nerve tissue heals.
During rehabilitation
Care for reduced sensation
Protect numb skin from heat and pressure. Therapy supports joint motion and sensory retraining where appropriate.
Following months
Monitor reinnervation
Signals recover slowly as nerve fibres regrow. Distance from injury to the target matters.
Long-term follow-up
Assess useful recovery
Recovery can continue for years and may remain incomplete. Further treatment is considered according to progress.
07 / RETURN TO LIFE
Back to the things
that matter.
- Work
- Modified duties must protect the repair. Even comfortable movement can overload a tendon before it is ready.
- Driving
- Splints, weak control or reduced sensation can make driving unsafe. Resume only after individual review and when all vehicle controls can be managed safely.
- Sport & therapy
- Therapy guides movement and loading. Premature force risks rupture; too little appropriate movement can encourage stiffness and adhesions.
08 / RISKS & CONSIDERATIONS
A balanced
decision.
Risks include infection, stiffness, scar adherence and persistent weakness. Tendon repair can rupture or adhere to surrounding tissue. Nerve injury can leave incomplete sensation, weakness, cold sensitivity or a painful neuroma. Secondary procedures may be considered when healing or function remains limited.
09 / THE GOAL
Useful function.
Realistic expectations.
The aim is to recover useful movement and sensation while protecting healing structures. The original damage, delay, repair level, associated injuries and rehabilitation all influence the result. Recovery is rarely uniform across different tendons and nerves.
10 / YOUR QUESTIONS
Before you decide.
Why is hand therapy so important?
A repair needs both protection and the right amount of movement. Your therapist adjusts exercises and splinting to your exact injury and stage of healing.
Does repaired nerve tissue work straight away?
No. Nerve fibres have to regrow and reconnect with their targets. Useful recovery can take many months or longer and may be incomplete.
What if movement suddenly changes after repair?
A sudden loss of previously available movement, or increasing wound pain, redness, drainage or fever needs prompt contact with the surgical team. Do not force or repeatedly test the hand.
CLINICAL READING
Sources & further reading.
General patient guidance to support a consultation. Your own surgical plan and discharge instructions take priority.
- NHS · Hand tendon repair
- Cambridge University Hospitals · Extensor tendon rehabilitation
- BSSH · Nerve injury
- Cambridge University Hospitals · Peripheral nerve surgical repair
- Hull University Teaching Hospitals · Tendon repair rehabilitation
- Anatomy reference · Flexor tendon repair
- Anatomy reference · Extensor tendon repair
- Anatomy reference · Peripheral nerve repair
- Royal College of Anaesthetists · Preparing for surgery
- Chelsea and Westminster Hospital · Before hand surgery
A CONSIDERED NEXT STEP
The right treatment starts
with the right diagnosis.
Understand your options, discuss the trade-offs and plan a recovery that fits your life.
PROF. DR. SAMI HASSAN / HEALTHPOINT