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musculoskeletal exam two > day ten: flexor tendon injuries > Flashcards

day ten: flexor tendon injuries Flashcards

1
Q

what two arteries supply the hand?

A

ulnar and radial

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2
Q

what two arches do you have?

A

superficial and deep palmer arch

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3
Q

what confirms the blood supply integrity

A

allens test

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4
Q

what would you use the allens test on?

A

to confirm the blood supply integrity

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5
Q

what do neurovascular bundles contain?

A

digital arteries vein and nerves

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6
Q

how many neurovascular bundles are there

A

two

  • one radial and
  • one ulnar
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7
Q

where does tendon nutrition come from?

A
  1. intrinsic : vascular perfusion

2. extrinsic: diffusion from synovial fluid

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8
Q

where does intrinsic nutrition come from?

A

vascular perfusion

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9
Q

where does extrinsic nutrition come from

A

diffusion from synovial fluid

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10
Q

vinculi branch

A

off the common digital artery

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11
Q

two types of vinculi

A

short and long

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12
Q

what does the vinculi supply?

A

FDS and FDP

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13
Q

vascular supply mainly comes form where?

A

the dorsal side of the hand

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14
Q

why is movement important for tendon healing?

A

synovial fluid bathes tendon = lubrication for glide

diffusion occurs as the synovial fluid gets umped into the tendon fibers during flexion and extension of the fingers

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15
Q

how many pulleys do you have?

A

five

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16
Q

what do pulleys do?

A

hold tendons close to the bone

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17
Q

pulleys improve

A

the biomechanical efficiency of the flexor tendon system

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18
Q

key pulley are

A

A-2 and A-4

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19
Q

pulley damage causes:

A

bowstringing

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20
Q

how does bowstringing present?

A

flexion of all dip pip mcps

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21
Q

how many pulleys does the thumb have?

A

three pulleys

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22
Q

what is the camper’s chiasm?

A

the space between the FDS and FDP tendons

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23
Q

injury at zone 1 is

A

jersey finger

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24
Q

jersy finger means

A

the FDP is involved so you can’t bend the tip of the finger

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25
Q

zone 1 does

A

extends from the fingertip to the midportion of the middle phalanx

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26
Q

zone 2 :

A

extends from the midportion of the middle phalanx FDS insertion to the distal palmar crease

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27
Q

injury at zone 2 is

A

no man’s land

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28
Q

where is the most common area for flexor tenodn laceration ?

A

zone 2

29
Q

zone three does

A

extends from the distal palmar crease to the distal portion of the transverse carpal ligament
- not as much scarring in this area

30
Q

zone four does:

A

overlies the transverse carpal ligament

31
Q

zone five

A

extends from the wrist crease to the level of the muscultendinous junction of the flexor tendon

32
Q

injury to zone five is

A

a spaghetti wrist

33
Q

surgical tendon repairs are called

A

incisions: z plasty

34
Q

a primary repair is when

A

within the first two weeks of tendon laceration you fix tendon

35
Q

a secondary repair is when

A

they were repaired after two weeks

36
Q

you would prefer a _______ repair

A

primary

37
Q

in a secondary repair what happens to the tendons?

A

the teonds and tendon sheaths become scarred

the musculotendinous units retract

38
Q

non bulky

A

old school 2 strand repair

39
Q

bulky

A

6 strand core: Strickland method

40
Q

pro cons of non bulky

A

pro passes under pulleys secondary less bulk

con; gaps and is weak

41
Q

bulky pros cons

A

con: doesn’t pass through pulleys
pro: you can just vent the pulley

42
Q

epitendinous suture

A

core suture followed by an epiteninous suture to complete the tendon reapire

43
Q

when you repair the sheath it

A

helps prevent adhesion formation

helps prevent triggering

44
Q

tendon repair is at its weakest day

A

10-12

45
Q

estimated core suture tensile strength decreases by _________
by end of the week one

A

50%

46
Q

list four therapy goals

A

prevent tendon rupture
patient education
promote tendon healing
encourage tendon gliding

47
Q

three main therapy approaches to tendon management

A

controlled mobilization
early active mobilization
immolbization

48
Q

duran protocol entails

A

dorsal blocking splint which positions the wrist 20* flex
MCP 60* flex
ip neutrals

49
Q

in controlled mobilization the splint must allow

A

full IP extension

50
Q

controlled mobilization 4 weeks:

A

passive PIP and DIP movement

51
Q

controlled mobilization after 4 weeks

A

dorsal splint may be removed and gentle composite ROM

52
Q

controlled mobilization 6 weeks

A

completely remove splint

53
Q

controlled mobilization after 8 weeks

A

light strengthening

54
Q

controlled mobilization after 10 weeks

A

moderate strengthening exercises are begun

55
Q

controlled mobilization 12 weeks

A

pt resumes normal activities

56
Q

when is early active mobilization used?

A

4 strand repairs and greater

57
Q

what do you do with early active mobilization?

A

tendon gliding is elicted by active contraction of the injured muscle using tenodesis

58
Q

when you would use immobilization method?

A

young patient
cognitive deficits
non compliant patients

59
Q

what would you do with the immobilization method?

A

completely immobilize the patient for 4 weeks following tendon repair

60
Q

what is the most common complication

A

adhesion formation

61
Q

what does adhesion formation cause

A

stiff joints - limits ROM

62
Q

factors that promote adhesions are:

A

trauma to the tendon and sheath
tendon ischemia
digital immobilization
prolonged edema

63
Q

factors that suppress adhesion formation are:

A

good surgical technique
tendon mobilization early
motion between the tendon and its sheath

64
Q

list four reasons for a tendon rupture:

A

non compliance
accidental injury or fall
place and hold exercises
blocking exercises

65
Q

list five complications:

A 
injury to neurovascular structures 
hypersensitivity 
complex regional pain syndrome 
bowstringing of the tendon 
infection
66
Q

tendon gapping:

A

separation of the two ends that creates a space and causes the tendon to have gap form end to end

67
Q

why is tendon gapping bad?

A

makes the tendon longer therefore it can not pull as effectively

68
Q

what is a WALANT method?

A 
Wide 
Awake 
Lidocaine 
Anesthesia 
No 
Tourniquet

musculoskeletal exam two (6 decks)

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