Extensor Tendon Repair Recovery
Extensor Tendon Repair (Zone-dependent)
What the operation does
The extensor tendons run along the back of the hand and fingers and straighten them. They are flat, thin, and lie almost directly on bone with very little tissue over them. When one is cut or torn, the ends are brought together and stitched, and the finger is then held straight in a splint while it heals.
Why splinting matters more than exercises at first
An extensor tendon heals under the pull of the muscles that bend the finger, which are far stronger than the ones that straighten it. Left free, the finger curls and the repair stretches out — so the splint holds it straight and does the protecting. For the first weeks the splint is the treatment, and the exercises are for everything except the injured finger.
If yours is a mallet finger
The most important version to get right. Where the tendon has come off the very end of the finger, leaving the fingertip drooping, the splint holds that last joint dead straight continuously — day and night, including in the shower — for around six to eight weeks. Letting the tip bend even once, for a moment while changing the splint, can undo the healing and effectively restart the clock. Learning to change the splint with the finger supported flat on a table is worth being shown properly.
How this differs from a flexor repair
Both are tendon repairs and both need protecting, but the shapes differ. A flexor tendon is round and runs inside a tight sheath, so the risk is it sticking inside that tunnel. An extensor tendon is flat and lies on bone, so the risk is it sticking to the bone beneath. Extensor repairs generally recover better and faster, and rupture is less of a preoccupation than after a flexor repair.
Adhesions
Still the main problem. A tendon that heals but sticks to the bone underneath cannot glide, so the finger will not fully bend or fully straighten even though the repair is sound. That is what the movement work from the second phase is preventing, and why isolating each joint in turn matters more than moving the whole finger as a unit.
Which zone was injured
Worth asking, because it changes everything. Injuries over the back of the hand and wrist generally do well and regain good movement. Injuries over the finger joints themselves are harder — the tendon there is a thin, broad sheet rather than a cord, and the results are less predictable. A cut over the middle joint can also lead to a boutonniere deformity, where the middle joint bends and the tip hyperextends, and that needs specific splinting.
The extensor lag
A common finding afterwards — the finger straightens fully when someone else straightens it, but you cannot quite hold that last few degrees yourself. It reflects the repair healing very slightly long, which happens easily with a thin tendon under the pull of stronger opponents. A small lag rarely causes practical difficulty.
Getting the bend back
Slightly counterintuitive: after weeks splinted straight, the difficulty is usually regaining the BEND rather than the straightening. That is why blocking exercises and tendon gliding lead the middle phases, working one joint at a time rather than curling the whole finger.
Working with a hand therapist
Most people having this repair see a specialist hand therapist, who will make or adjust the splint, set the exercises, and progress you based on how the finger behaves. Their instructions come before anything general, and the splint fit in particular is worth going back for if it becomes loose.
The wound and what else was injured
Many of these follow a cut on the back of the hand, and the wound may have been contaminated. Because the tendon lies so close to the joint, cuts here can also enter the joint itself, which is checked and washed out. If the injury came from a punch that struck a tooth, tell your care team — those wounds carry a particular infection risk and are treated differently.
Swelling
The back of the hand swells readily and swelling stiffens fingers, so elevation above heart level in the first weeks makes the whole recovery easier. Rings should come off early and stay off until swelling settles.
Wearing the splint at night
Often continued for several weeks after daytime splinting stops, because the finger curls during sleep and that is when a healing extensor repair quietly stretches out. It is a small thing that protects the result.
Driving and work
Driving generally waits until you are out of the splint and can grip the wheel securely — commonly around six to eight weeks. Desk-based work is often possible earlier, and typing with a finger splint is usually manageable. Manual work involving gripping commonly waits two to three months.
How the first year usually unfolds
Four weeks splinted straight with the rest of the arm kept moving. Four to six weeks brings protected movement of the finger. Six to ten weeks brings active bending and straightening, and most of the range returns here. Two to four months brings grip strengthening. Four to twelve months settles the final movement, with any extensor lag improving slowly.
Staying in touch with your care team
Which tendon, which zone, and whether the joint was involved all change this recovery. Your surgeon and hand therapist know those details. If something about your recovery is worrying you or does not match what is described here — particularly the fingertip starting to droop again after the splint comes off — contact your care team rather than waiting.
Exercises for Extensor Tendon Repair
An illustrated, phase-by-phase exercise program for this procedure. View the Extensor Tendon Repair exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.