Extensor Tendon Surgery: Zones, Traps, and Early Motion

Extensor tendon injuries are easy to underestimate: a small dorsal wound can conceal a complete laceration, a contaminated MCP joint, or a central slip injury that declares itself later. In this episode of Plastics in Practice, we review the examination, zone-based repair strategy, rehabilitation, complications, and reconstruction of extensor tendon injuries. Key takeaways:• Use the eight-zone map to localize injury and choose a repair and rehabilitation plan; odd-numbered zones lie over joints.• Test beyond simple active extension: juncturae can mask a complete zone-six EDC laceration, the Elson test assesses the central slip, and table-top thumb lift helps isolate EPL function.• Repair lacerations involving more than half of the tendon in zone two, the zone-three central slip, and zone four; avoid unnecessary bulk or shortening in the thin distal mechanism.• Treat a zone-five fight bite as a contaminated joint injury—explore the capsule, debride and irrigate, and defer tendon repair until the wound is clean.• Match rehabilitation to repair strength: zones one and two usually need continuous extension protection for six to eight weeks, while stronger repairs in zones four through eight can support protected early motion. Recent randomized trials support relative-motion extension protocols for selected zone-four to zone-six repairs.[1,2]• Anticipate extensor lag, loss of flexion, adhesions, and tendon rupture; consider tenolysis only after a sustained therapy plateau and use grafts or tendon transfers selectively. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #ExtensorTendonSurgery #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #PlasticsInPractice References:1. Cela-López M, Méndez-Pérez C, Domínguez-Prado DM, et al. Relative motion extension orthosis versus classic immobilization in extensor tendon repairs (zones IV-VI of the hand): a randomized controlled trial. Hand (N Y). Published online February 27, 2026. doi:10.1177/155894472614224832. Hirth MJ, Hunt I, Briody K, et al. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: a randomized equivalence trial. J Hand Ther. 2023;36(2):347-362. doi:10.1016/j.jht.2021.06.006