As with the extensor tendon apparatus, a division of the flexor tendons into multiple zones has been established based on the distinct anatomic differences responsible for different prognoses of otherwise identical tendon injuries, 28. The surgeon makes an incision on the skin over the injured tendon. If a flexor tendon is cut in half, the end connected to the muscle is often pulled back into the palm no way to heal on its own. The sdft provides a springlike store of energy in the galloping horse and is subject to strains close to its mechanical limits, making it susceptible to overstrain injuries. A severe cut that injures the tendons will mean that flexing fingers will be not possible. From the department of surgery, university of louisville school of medicine, louisville, kentucky 1001 doctors office building, louisville, kentucky 40202 trauma. Partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. When cut, the tendon acts like a rubber band, and the end pulls away from one another. Flexor tendon injuries are not common in most sporting venues. The results of flexor tendon injuries many times remain unsatisfactory to the injured person even if an experienced hand surgeon performed the surgical intervention, since in many cases a normal function cannot be fully restored.
When tendons are cut completely through, the finger joints cannot bend on their own see figure 2. This injury occurs most often in athletes involved in contact sports, such as american football or rugby. To quickly treat the pain brought on by a flexor tendon injury, first aid can be applied in the form of ice. Acute traumatic tendon injuries of the hand and wrist are commonly encountered in the emergency department. Therapy for flexor tendon injuries is provided on site at the university of michigans hand program by our team of occupational and physical. Our experts suggest ed physicians may repair extensor tendons cut 50% if ends are easily visible and easily opposed. Flexor tendons general there are 2 tendons acting on each finger to bend or flex the finger.
Nov 30, 20 partial laceration partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. Clinical professor of surgery, university of louisville clinical professor of surgery, university of. There is a very precise type of suture that we use, theres a very precise technique of suturing the tendon leads to better recovery, says dr. In some cases, an additional surgery to remove scar tissue around the tendon is required to improve motion to the affected fingers. Pdf epidemiology of flexor tendon injuries of the hand in a. Therapeutic manipulation for flexor tendon injuries youtube. The incidence of acute traumatic tendon injuries in the.
A direct flexor tendon injury must be suspected in all patients who present with an inability to flex one or more digits. Gupta after 25 year long experience, flexor tendon injuries are not very threatening even though they are considered to be serious injuries. An overview of the management of flexor tendon injuries. Flexor tendon injuries account for 1% of total crush hand. While flexor tendon injuries have less impact on hand function, because there are several others to assist when one is damaged, there is only one extensor tendon responsible for the function of the second through the fifth finger. Pdf epidemiology of flexor tendon injuries of the hand. Flexor tendon injuries, however, can be very challenging to treat. How to care for your flexor tendon injury duration. Of the two flexor tendons, the superficial digital flexor tendon sdft is more commonly injured than the deep digital flexor tendon ddft. Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair.
Anatomy and pathology of the achilles tendon tracy macnair 1 anatomy and pathology of the achilles tendon tracy macnair 2 achilles. Use a single horizontal mattress suture and splint the hand. The damaged ends of the tendon are brought together with sutures to achieve a secure repair. Because the tendon has severed or torn, it will not grow back unless the torn ends are touching. Mar 01, 2002 as with the extensor tendon apparatus, a division of the flexor tendons into multiple zones has been established based on the distinct anatomic differences responsible for different prognoses of otherwise identical tendon injuries, 28.
Flexor tendons can be injured, for example, by a deep cut, if severe the cut could also damage surrounding structures such as nerves and vessels. A jersey finger happens when a finger is caught on another players jersey or clothes and the tendon is pulled off from the tip of the bone. Small lacerations or puncture wounds can partially or. Flexor tendon injuries usually occur as a result of a cut to the palm side of the hand. Therapeutic exercises for flexor tendon injuries duration. Flexor tendons run from the forearm to the ends of the fingers across the palm side of the hand. This blog tracks the recovery of a flexor tendon laceration in zone v. Flexor tendon repair therapy protocol 5 of 5 education for light activityuse of newly splintfree hand criteria for advancement absent flexor lag. Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries.
Flexor tendon injuries hand specialists western mass. The injury is often overlooked by players and trainers and misdiagnosed as a jammed or sprained finger, but requires more urgent management than these. Hand rehabilitation after flexor tendon injury repair. Since the first flexor tendon repair was described by kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 7090%. The most profound symptom of flexor tendon injuries is the inability to bend one or more of the joints of a finger. All flexor tendon and all complex extensor tendon injuries should be splinted and seen by plastics in.
Secondary repair of flexor tendon injuries request pdf. Flexor tendon injuries musculoskeletal system human. Once seen by a doctor, a flexor tendon injury may be treated with a splint. When flexor tendons are completely cut, the finger cannot be bent. These findings suggest that tendonbone healing does not follow the same time course as the healing of intrasynovial flexor tendon repairs. However, depending on the mechanism and extent of injury, other injuries may also be present. A tendon that has not been cut completely through may still allow the fingers to bend, but can cause pain or catching, and may eventually tear all the way through. Fds flexor digitorum superficialis, superficial tendon flexes the pip joint fdp flexor digitorum profundus deep tendon flexors all joints in the finger. Therapeutic manipulation for flexor tendon injuries soohan kim. Flexor tendon injuries are caused by either overstrain of the tendon or direct trauma. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion. Flexor tendons are quite prone to injury due to their location below the skin and lack of flesh in the hand. A doublearmed straight needles 30 suture is placed in the proximal tendon stump and passed through the bone hole.
Flexor tendon injury is one of the common as an increased incidence of industrial injuries due to rapid industrialization of our country. Prolong phase iii until 1012 weeks postoperatively responsive flexor lag. Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Why i want to do all my flexor tendon repairs wide awake feat. They work like a bicycle brake cable to bend your fingers, sliding in and out of the finger as it straightens and bends. Anatomy and pathology of the achilles tendon tracy macnair. Compressions should also be implemented to the inflicted area so the flow of blood will slow to the damaged area on the finger. Flexor tendons are required to glide large distances to allow the digits full composite flexion and extension, running within a tight pulley system to maximize their efficiency fig.
He asserts, tendons that govern the bending movement of the fingers are called flexor tendons and a deep cut on the surface of the skin anywhere on the forearm, wrist palm side of the hand or at. Early postoperative mobilization of flexor tendon injuries using a modification of the kleinert technique. Tenderness, bruising, or swelling may be present on the palm side of the hand along the affected digit. If more than 1 cm of fdp stump is available for suture, primary tenorrhaphy is usually done because shortening of the fdp tendon by greater than 1 cm may result in a quadrigia effect.
There are many ways to repair a cut tendon, and certain types of cuts need a specific type of repair. Therapy for flexor tendon injuries is provided on site at the university of michigans hand program by our team of occupational and. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Klein flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Your doctor will advise you on how soon surgery is needed after a flexor tendon is cut. The tendons run up the front of the finger in a tunnel flexor sheath which is lined by synovium, a lubricating tissue which allows the. The repair of flexor tendon injuries is a challenge that hand surgeons commonly face, and one that can have an important impact on patients quality of life and hand function. Nearby nerves and blood vessels may need to be repaired as well. Progress to phase iv by week 8 unresponsive flexor lag.
After surgery, the area of the injured tendon must be protected from movement. Pain may be more pronounced when the finger is bent. The most common cause of a flexor tendon injury is a deep cut to the palm or the fingers. Flexor tendons run from the flexor muscles in the forearm to the finger bones along the palm side of the hand. Therapy is an important prerequisite in these injuries aided by the mental strength of the patients themselves. Flexor tendon repair therapy protocol 2 of 5 o active digital extension with wrist flexed o fds blocking to uninvolved digits and tendons o fdp blocking to uninvolved digits, if fdp is not involved o 10 times, each, every 2 hours. Progress to phase iv by week 6 postoperative phase iv 816 weeks. Therefore, an injury to this tendon has a greater impact on hand function. Restoration and salvage flexor tendon injuries harold e. Flexor tendon injuries are complicated lesions which more often than not are accompanied by nerve injuries as well. Patient information flexor tendon repair amazon s3. Flexor tendon injuries brandon orthopedic associates. If the tendon is lacerated, and the distal tendon stump is less than 1 cm long, fdp tendon advancement and primary repair to bone is usually indicated.
Flexor tendon repair therapy protocol sideline orthopedics. The impacts of tendon injuries and treatment options. Laceration of the fdp tendon distal to the insertion of the fds tendon or avulsion from its insertion at the base of the proximal aspect of the distal phalanx is by definition an injury in zone i of the. Tamura n, nukada t, kato t, kuroda t, kotoyori y, fukuda k, kasashima y.
The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries. Rupture of the flexor digitorum profundus fdp tendon from its distal attachment is commonly known as jersey finger. Flexor tendon graft for late management of isolated rupture of the profundus tendon. The damaged ends of the tendon are brought together with sutures to achieve a secure. Partial laceration partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. In all cases, a doctor will explain the operation to. If a tendon is partially cut, the finger may still bend a little. Because the cut ends of a tendon usually separate after an injury, a cut tendon can not heal without surgery. Tie the suture over felt and a button another alternative is to use suture anchors but they are weaker than the button as noticed by silva et al 1998 when possible, the tendon attachment should be supplemented by sutures through the adjacent.
The incidence of acute traumatic tendon injuries in the hand. Deardorff, md, an orthopaedic surgeon with carondelet orthopaedic surgeons, a division of signature medical group, discusses flexor tendon. Flexor tendon injuries free download as powerpoint presentation. Tie the suture over felt and a button another alternative is to use suture anchors but they are weaker than the button as noticed by silva et al 1998 when possible, the tendon attachment should be supplemented by sutures through the adjacent sheath or. Diagnosis of a flexor tendon injury will include a physical exam of the injured region, an assessment of the functioning of the affected area, and often an xray. Hand therapy and rehabilitation for flexor tendon injuries. The tendons of the hand run from the flexor muscles in the elbow and forearm to the bones of the fingers. It covers occupational therapy techniques and instruction on what these patients need. They control the ability to bend fingers down to the palm for example to make a fist, grip, or pinch objects. Anything from minor cuts to major hand trauma can result in a flexor tendon injury. Flexor tendon injury musculoskeletal medicine for medical.
Oct 02, 2015 therapeutic manipulation for flexor tendon injuries soohan kim. The flexor tendon repair is usually an outpatient procedure and can be performed under local or general anesthesia. Open injuries demand immediate wound care and evaluation as to the integrity of the flexor apparatus. When this happens it becomes impossible to bend your fingers. While flexor tendon injuries have less impact on hand function, because there are several others to assist when one is damaged, there is only one extensor tendon responsible for the function of the. The flexor tendons are smooth, flexible, thick strings which bend your fingers they look a bit like clothesline rope. If the tendon injury is severe, a graft may be required. The flexor tendons are responsible for allowing your fingers to bend. Injuries can also occur in sports or due to arthritic conditions. Jersey finger, fdp avulsion flexor tendon repair, 2 months old lesion. In all cases, a doctor will explain the operation to you and answer any questions you may have.
Justin mirza, orthopedic physicians at mirza orthopedics, outline some common symptoms of. For 50% if ends are easily visible and easily opposed. Justin mirza, orthopedic physicians at mirza orthopedics, outline some common symptoms of flexor tendon injuries. Fds flexor digitorum superficialis, superficial tendon flexes the pip joint fdp flexor digitorum profundus deep tendon flexors all joints in the finger the tendons run up the front of the finger in a tunnel flexor sheath which is lined by synovium, a lubricating tissue which allows the tendon to glide without resistance. Treatment of these injuries requires surgical repair. Important considerations include fractures of the metacarpals or phalanges that may entrap the flexor tendon, limiting its motion. Mr imaging of ligament and tendon injuries of the fingers. A jersey finger happens when a finger is caught on another players jersey or clothes and the tendon is pulled. There are two different types of tendons in the hand. Flexor tendon injuries are not as simple as they appear to be and patients should be well prepared that they may never recover some of the functions in their fingers. Many times, an injury that looks simple on the outside, like a cut, can be very complicated on the inside. Flexor tendon injuries can occur in your hand and finger, causing pain and interfering with your normal range of motion. Despite the frequency, few studies have examined the true incidence of acute traumatic tendon injuries in the hand and wrist or compared the incidences of both extensor and flexor tendon injuries. Feb 26, 2011 these findings suggest that tendon bone healing does not follow the same time course as the healing of intrasynovial flexor tendon repairs.
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