Ruptured Extensor Tendon in the Right Thumb: Treatment Options

Rupture of the extensor tendon of the right thumb?

Hello, Doctor! I have suffered a rupture of the extensor tendon in my right thumb due to sports.
Initially, I did not notice it, but later I found that I could not extend my thumb.
After visiting the outpatient clinic, I learned that it has been over a month.
Some doctors have indicated that it is difficult to repair, and even if repaired, it may rupture again.
They suggested maintaining the current condition.
Since I teach and frequently use a whiteboard and computer, my arm tends to become sore.
I would like to seek your advice on rehabilitation.

Ms. Chen, 50~59 year old female. Ask Date: 2020/07/28

Dr. Wang Shouji reply Orthopedics

Hello, old tendon ruptures of the finger flexor tendons that are re-sutured often result in common sequelae, such as stiffness affecting finger flexion.
Given that your work often requires gripping a pen, the ability to flex is much more important than the ability to extend.
I also recommend maintaining the current condition.
If you still wish to proceed with the suturing, I suggest consulting a hand surgery specialist.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2020/07/28

More Info

Ruptured extensor tendon injuries, particularly in the thumb, can be quite challenging to manage, especially when they occur due to sports activities. The extensor tendons are crucial for the extension of the fingers and thumb, allowing for a wide range of motions necessary for daily activities, including writing and typing. When a rupture occurs, it can lead to significant functional impairment, as you've experienced with your inability to extend your thumb.

Given that your injury has persisted for over a month without improvement, it is essential to consider the treatment options available. The management of a ruptured extensor tendon typically depends on the severity of the injury, the specific tendon involved, and the time elapsed since the injury occurred.

1. Conservative Management: If the tendon is partially torn or if surgery is deemed too risky or unnecessary, conservative management may be recommended. This could include:
- Splinting: A splint can help immobilize the thumb and allow for some healing. This is particularly important if you are experiencing pain or discomfort during activities.

- Physical Therapy: Once the initial pain and swelling have subsided, physical therapy can help improve range of motion and strength. A therapist can guide you through exercises that are safe and effective for your condition.

2. Surgical Repair: If the tendon is completely ruptured and you wish to regain full function, surgical intervention may be necessary. The surgery typically involves:
- Tendon Repair: The surgeon will attempt to reattach the torn ends of the tendon. This can be done using sutures or other fixation methods.

- Rehabilitation Post-Surgery: After surgery, a rehabilitation program will be crucial. This often includes a period of immobilization followed by gradual reintroduction of movement and strengthening exercises.

3. Considerations for Surgery: If surgery is performed, there are risks involved, including the potential for re-rupture, especially if the tendon is under significant stress during the healing process. Given your occupation as a teacher and the extensive use of your hands, it is vital to discuss with your surgeon the implications of returning to work and how to manage your activities post-surgery.

4. Alternative Treatments: In some cases, alternative treatments such as corticosteroid injections may be considered to reduce inflammation and pain, but these do not repair the tendon itself. They may provide temporary relief but should not be seen as a long-term solution.

5. Consultation with a Specialist: It may be beneficial to seek a second opinion from an orthopedic surgeon or a hand specialist. They can provide a more tailored approach based on your specific injury and lifestyle needs.

In conclusion, the management of a ruptured extensor tendon in the thumb requires careful consideration of your functional needs and the severity of the injury. Whether you opt for conservative management or surgical intervention, working closely with healthcare professionals will be essential to ensure the best possible outcome. It is also important to communicate your concerns about returning to your teaching duties and how to manage your symptoms effectively during the healing process.

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