The damaged ends of the tendon are brought together with sutures to achieve a secure repair. To quickly treat the pain brought on by a flexor tendon injury, first aid can be applied in the form of ice. Flexor tendons run from the flexor muscles in the forearm to the finger bones along the palm side of the hand. Therapy for flexor tendon injuries is provided on site at the university of michigans hand program by our team of occupational and. 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. From the department of surgery, university of louisville school of medicine, louisville, kentucky 1001 doctors office building, louisville, kentucky 40202 trauma. This injury occurs most often in athletes involved in contact sports, such as american football or rugby. In all cases, a doctor will explain the operation to you and answer any questions you may have. Restoration and salvage flexor tendon injuries harold e. Compressions should also be implemented to the inflicted area so the flow of blood will slow to the damaged area on the finger. Flexor tendon injuries musculoskeletal system human. Flexor tendon injuries are caused by either overstrain of the tendon or direct trauma. Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient.
These findings suggest that tendonbone healing does not follow the same time course as the healing of intrasynovial flexor tendon repairs. An overview of the management of flexor tendon injuries. When flexor tendons are completely cut, the finger cannot be bent. Prolong phase iii until 1012 weeks postoperatively responsive flexor lag. When cut, the tendon acts like a rubber band, and the end pulls away from one another. Therapeutic manipulation for flexor tendon injuries youtube.
Once seen by a doctor, a flexor tendon injury may be treated with a splint. Therapeutic exercises for flexor tendon injuries duration. 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%. Pain may be more pronounced when the finger is bent. The incidence of acute traumatic tendon injuries in the. Progress to phase iv by week 8 unresponsive flexor lag. The surgeon makes an incision on the skin over the injured tendon.
Your doctor will advise you on how soon surgery is needed after a flexor tendon is cut. Hand rehabilitation after flexor tendon injury repair. In some cases, an additional surgery to remove scar tissue around the tendon is required to improve motion to the affected fingers. Early postoperative mobilization of flexor tendon injuries using a modification of the kleinert technique. How to care for your flexor tendon injury duration. All flexor tendon and all complex extensor tendon injuries should be splinted and seen by plastics in. 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. Tamura n, nukada t, kato t, kuroda t, kotoyori y, fukuda k, kasashima y. Flexor tendon injuries, however, can be very challenging to treat. Nearby nerves and blood vessels may need to be repaired as well. Patient information flexor tendon repair amazon s3.
Flexor tendon injuries are not common in most sporting venues. Tenderness, bruising, or swelling may be present on the palm side of the hand along the affected digit. Flexor tendon injuries account for 1% of total crush hand. The impacts of tendon injuries and treatment options. This blog tracks the recovery of a flexor tendon laceration in zone v.
Flexor tendon graft for late management of isolated rupture of the profundus tendon. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Flexor tendon injuries usually occur as a result of a cut to the palm side of the hand. The injury is often overlooked by players and trainers and misdiagnosed as a jammed or sprained finger, but requires more urgent management than these. 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. However, depending on the mechanism and extent of injury, other injuries may also be present. Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair. Because the tendon has severed or torn, it will not grow back unless the torn ends are touching. Injuries can also occur in sports or due to arthritic conditions. Progress to phase iv by week 6 postoperative phase iv 816 weeks. Flexor tendon injury musculoskeletal medicine for medical. The flexor tendon repair is usually an outpatient procedure and can be performed under local or general anesthesia.
Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries. Partial laceration partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. The damaged ends of the tendon are brought together with sutures to achieve a secure. 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. 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.
Open injuries demand immediate wound care and evaluation as to the integrity of the flexor apparatus. Of the two flexor tendons, the superficial digital flexor tendon sdft is more commonly injured than the deep digital flexor tendon ddft. When this happens it becomes impossible to bend your fingers. Deardorff, md, an orthopaedic surgeon with carondelet orthopaedic surgeons, a division of signature medical group, discusses flexor tendon. 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. Flexor tendon repair therapy protocol 5 of 5 education for light activityuse of newly splintfree hand criteria for advancement absent flexor lag.
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. 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. 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. Use a single horizontal mattress suture and splint the hand. In all cases, a doctor will explain the operation to. Fds flexor digitorum superficialis, superficial tendon flexes the pip joint fdp flexor digitorum profundus deep tendon flexors all joints in the finger.
Our experts suggest ed physicians may repair extensor tendons cut 50% if ends are easily visible and easily opposed. Therapy is an important prerequisite in these injuries aided by the mental strength of the patients themselves. Klein flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Clinical professor of surgery, university of louisville clinical professor of surgery, university of. Anatomy and pathology of the achilles tendon tracy macnair 1 anatomy and pathology of the achilles tendon tracy macnair 2 achilles. When tendons are cut completely through, the finger joints cannot bend on their own see figure 2. Rupture of the flexor digitorum profundus fdp tendon from its distal attachment is commonly known as jersey finger. Why i want to do all my flexor tendon repairs wide awake feat. 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. If a tendon is partially cut, the finger may still bend a little. 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.
Hand therapy and rehabilitation for flexor tendon injuries. 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. There are many ways to repair a cut tendon, and certain types of cuts need a specific type of repair. The flexor tendons are smooth, flexible, thick strings which bend your fingers they look a bit like clothesline rope. Flexor tendon repair therapy protocol sideline orthopedics. Pdf epidemiology of flexor tendon injuries of the 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. Therefore, an injury to this tendon has a greater impact on hand function. 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. 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. Gupta after 25 year long experience, flexor tendon injuries are not very threatening even though they are considered to be serious injuries. Flexor tendons run from the forearm to the ends of the fingers across the palm side of the hand. Many times, an injury that looks simple on the outside, like a cut, can be very complicated on the inside.
A direct flexor tendon injury must be suspected in all patients who present with an inability to flex one or more digits. Flexor tendon injuries can occur in your hand and finger, causing pain and interfering with your normal range of motion. Treatment of these injuries requires surgical repair. The incidence of acute traumatic tendon injuries in the hand. It covers occupational therapy techniques and instruction on what these patients need. Therapeutic manipulation for flexor tendon injuries soohan kim. Therapy for flexor tendon injuries is provided on site at the university of michigans hand program by our team of occupational and physical. Secondary repair of flexor tendon injuries request pdf.
Flexor tendons are quite prone to injury due to their location below the skin and lack of flesh in the hand. A jersey finger happens when a finger is caught on another players jersey or clothes and the tendon is pulled. Because the cut ends of a tendon usually separate after an injury, a cut tendon can not heal without surgery. The flexor tendons are responsible for allowing your fingers to bend.
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. Justin mirza, orthopedic physicians at mirza orthopedics, outline some common symptoms of. Flexor tendon injuries brandon orthopedic associates. The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries. After surgery, the area of the injured tendon must be protected from movement. Pdf epidemiology of flexor tendon injuries of the hand in a. The most profound symptom of flexor tendon injuries is the inability to bend one or more of the joints of a finger. 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.
Flexor tendons general there are 2 tendons acting on each finger to bend or flex the finger. Mr imaging of ligament and tendon injuries of the fingers. 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. The tendons of the hand run from the flexor muscles in the elbow and forearm to the bones of the fingers. Flexor tendon injury is one of the common as an increased incidence of industrial injuries due to rapid industrialization of our country. They work like a bicycle brake cable to bend your fingers, sliding in and out of the finger as it straightens and bends. 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. Anatomy and pathology of the achilles tendon tracy macnair. 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. Flexor tendon injuries are complicated lesions which more often than not are accompanied by nerve injuries as well. Jersey finger, fdp avulsion flexor tendon repair, 2 months old lesion.
Small lacerations or puncture wounds can partially or. Important considerations include fractures of the metacarpals or phalanges that may entrap the flexor tendon, limiting its motion. Justin mirza, orthopedic physicians at mirza orthopedics, outline some common symptoms of flexor tendon injuries. 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. A doublearmed straight needles 30 suture is placed in the proximal tendon stump and passed through the bone hole. Flexor tendon injuries free download as powerpoint presentation. There are two different types of tendons in the hand. Partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. They control the ability to bend fingers down to the palm for example to make a fist, grip, or pinch objects.
A severe cut that injures the tendons will mean that flexing fingers will be not possible. 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. 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. If the tendon injury is severe, a graft may be required. 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.516 822 656 413 888 274 33 29 1046 464 1438 358 58 534 223 577 1221 607 132 1414 194 22 5 1265 950 825 541 1077 915 1034 1462 489 458 524 1290 303 1047 1122 1467 1219 911 975