Introduction <p>Hand and forearm tendon injuries are common and can result in functional impairment, disability, and socio-economic burden, particularly among adult males engaged in manual labor or machine operation. Children are also affected, often from glass or sharp-object injuries. This study examined patterns of tendon injuries at a tertiary hospital in Ethiopia, focusing on demographics, mechanisms, tendon zones, and associated factors.</p> Methodology <p>A retrospective hospital-based cross-sectional study was conducted on the pattern of tendon injuries in the hand and forearm at a tertiary hospital from January 1, 2020, to December 30, 2021.</p> Results <p>Among 128 patients, 88.3% were male, with a mean age of 27 years. Right-hand dominance was noted in 96.9% of cases. Machine-related injuries were most common (36.7%), while glass and knife injuries predominated in children. Extensor tendon injuries (54.7%) exceeded flexor injuries (42.2%), with Zone VI and Zone V most affected, respectively. Associated injuries were reported in 73 (57%) cases, including fractures, nerve, vascular, and combined injuries. Handedness and occupation were significantly associated with injury side: right-handed individuals had a 42% higher risk of left-hand injury (AOR = 1.42, <i>p</i> = 0.006), whereas daily laborers had a 26% lower risk (AOR = 0.26, <i>p</i> = 0.036).</p> Conclusion <p>Tendon injuries mainly affect young, working-age males, with machine trauma as the leading cause. High rates of associated injuries indicate the need for comprehensive management. Handedness and occupation influence injury laterality, emphasizing the importance of preventive strategies for high-risk occupational groups and workplace safety improvements.</p> Type of study/level of evidence <p>Retrospective, Level III</p>