Hand and wrist tendon and ligament repair

Tendons and ligaments are essential for the function of the hand and wrist. Tendons connect muscles to bones, allowing joints to move and enabling fine motor control and strength in the hands and fingers. Ligaments connect bones to other bones, providing stability to joints and keeping bones properly aligned. Together, tendons and ligaments allow for the complex movements and stability needed for hand dexterity and wrist function.

When tendons or ligaments in the hand and wrist are damaged from sudden injury, repetitive use, or conditions like arthritis, it can lead to pain, swelling, stiffness, and trouble with everyday tasks. If nonsurgical treatments don’t significantly improve pain and function, surgery may be needed.

Your hands and wrists are complex and require specialized care after injury. Penn Medicine brings together highly skilled and experienced orthopaedic hand surgeons, plastic surgeons, and other specialists to provide you with the best options for tendon and ligament repair. With access to the latest research, advanced diagnostics, and innovative treatments, we offer expert care for even the most challenging hand and wrist conditions.

People with severe tendon or ligament damage, such as complete tears or ruptures that haven’t responded to non-surgical treatments, are typical candidates for hand and wrist repair. Commonly, these are people who have suffered hand or wrist injuries from falls, sports, accidents, or overuse. Surgery may be recommended if you have chronic pain or weakness that interferes with your daily activities, such as athletes and workers who need full hand and wrist function for their sport or profession.

Surgery may also be considered for people with tendinitis or similar conditions, like De Quervain’s or trigger finger, that haven’t improved with conservative treatments, or for people with arthritis in the hands and wrist alongside ligament damage.

The need for surgery is determined after a thorough evaluation by a hand specialist, considering factors like the severity of the injury and the person’s age, overall health, and lifestyle needs.

When surgery is the recommended treatment, we opt for minimally invasive procedures whenever possible to allow for smaller incisions and faster healing. Surgical tendon or ligament repair may involve:

• Direct repair: Reconnecting torn tendons or ligaments
• Tendon or ligament grafting: Using tissue from another part of the body to replace severely damaged structures
• Tendon transfer: Rerouting a healthy tendon to restore function
• Reconstructive surgery, for complex injuries: Using a specialized microscope and instruments to reattach nerves and repair bone, tendon, ligaments, and blood vessels

Our surgeons prefer to perform hand tendon or ligament surgery whenever possible using only local anesthesia while the patient is awake. This minimally invasive technique is known as wide-awake local anesthesia, no tourniquet (WALANT). With no need for general anesthesia or sedation, patients experience quicker recovery times, have a lower risk of side effects and complications, and do not require an intravenous (IV) line.

Ligament or tendon surgery recovery time depends on the specific injury, repair procedure, and how quickly you heal. Some typical milestones in the healing process include:

• In the first few days after surgery, some pain and swelling are common.
• For the first three to six weeks, you may be advised to wear a splint to protect the repair and limit your movement to avoid re-injury. Pain and stiffness may still be present.
• From six to eight weeks, you may gradually increase your range of motion through exercises guided by a hand therapist and begin light activities. You may still need a splint, especially at night.
• In eight to 10 weeks, it may be safe to resume driving.
• At eight to 12 weeks, as therapy continues to improve your strength and flexibility, you may start using your hand more frequently in daily activities.
• At three to six months after surgery, you may return to more rigorous activities or sports if your care team feels you are ready. Full range of motion and strength may take six months or more to achieve.

Risks associated with hand and wrist tendon and ligament repair may include:

• Infection
• Persistent pain
• Bleeding
• Blood clots
• Changes in skin sensation
• Poor healing of incisions
• Damage to deeper structures, such as nerves, blood vessels, or muscles
• Repair failure, where the tendon breaks or separates again
• Tendon adhesion, meaning the repaired tendon sticks to surrounding tissue
• Inability to fully restore function, especially with complex injuries

It’s important to follow your postoperative care instructions regarding splinting, wound care, and activity to help avoid complications or reinjury. Your Penn Medicine care team will discuss your specific risks with you and address your concerns.

At Penn Medicine, we’re experienced in treating a wide range of conditions that cause hand and wrist pain. Our specialists address a high volume of hand and wrist cases and are accomplished in both clinical practice and research. You can trust our knowledge and expertise in the latest diagnostic methods and treatments for tendon and ligament injuries.

Our plastic and orthopaedic hand and wrist surgeons are skilled in advanced techniques to restore both function and appearance, and they’re part of a larger care team that supports you throughout your treatment and recovery. Access to our comprehensive care is also convenient. Our specialists, imaging services, and physical therapy are often available at a single location in the southeastern Pennsylvania and New Jersey regions, making it easy for you to coordinate visits close to home.