Hand lacerations need to be carefully explored in order to determine whether there is an associated tendon laceration. These can be be difficult to find unless a systematic approach is followed:
The laceration should be explored to its base in a bloodless field while the fingers and wrist are moved through their full range of motion (ROM). A tendon laceration can easily be missed if the hand is only visualized with the fingers extended. The area of the tendon that was lacerated can retract into the hand, or not be visible if the area was injured when the fingers were flexed. By extending the finger, the location of the injury may not line up with the wound making it impossible to see unless the fingers are moved through their full ROM.
The fingers and wrist ROM should be tested actively and against resistance as the patient may only experience an increase in pain and have a completely normal ROM if there is only a partial tendon laceration.
If there is a suspicion of a tendon laceration (decreased ROM, or increased pain with resistance when ROM is tested) the laceration may need to be extended in order to completely visualize the tendon if it can not be done through the wound that was created with the original injury.
Future pearls will cover techniques on how to repair tendon lacerations. Stay tuned.
