Extensor Tendon Repairs

Question 1

Primary extensor of fingers

Answer 1

EDC

Question 2

What else helps with PIP extension?

Answer 2

Dorsal Interossei and lumbricals

Question 3

What is the small slip of EDC attached to base of dorsal aspect of the proximal phalanx ?

Answer 3

Dorsal hood?

Question 4

EXTENSOR TENDONS Originate?

Answer 4

Originate off lateral elbow

Go through 6 dorsal compartments, then fan out to digits

Question 5

CHARACTERISTICS OF EXTENSOR TENDONS

Answer 5

Weaker than the flexors
Thinner and more broad than the flexors
Superficial in comparison to the flexors

Question 6

FUNCTIONAL COMPLICATIONS

Answer 6

Loss of flexion – due to scarring of the extensors
Extensor lag
Decrease grip

Question 7

EXTENSOR ZONES

Answer 7

(8 zones)
1 – dip distal (mallet finger)
2 – middle phalanx
3 – over the PIP
4 – proximal phalanx
5 - MCP
6 - dorsum of hand/metacarpals
7 - over the extensor retinaculum/carpals
8 - proximal wrist
**Note: Zones of thumb are a little different**

Question 8

ZONE 1 AND 2 INJURIES

Answer 8

Mallet finger

Question 9

ZONE 1 AND 2 INJURIES Conservative Tx

Answer 9

Conservative treatment – orthosis to immobilize the DIP. Timeline is approx. 6 weeks then wean. May have them wear at night another 6 weeks
Splint – hyperextension of DIP to approximate tendon ends
Surgery – pinning

Question 10

ZONE 3 AND 4 INJURIES

Answer 10

Boutonniere deformity

Central slip injury so lateral bands slip down

Question 11

ZONE 3 AND 4 INJURIES Immobilization Protocol

Answer 11

Immobilization protocol – PIP and DIP in full extension, worn for 3-4 weeks post op
Immediate passive extension protocol – extension outrigger orthosis (supports MP and provides passive extension of the PIP joint) allowed to flexion 30 degrees. Some allow more flexion during the 3-4 weeks of wearing
Immediate active extension protocol – SAM (short arc motion) protocol

Question 12

ZONE 5, 6, AND 7 INJURIES Immobilization Protocol

Answer 12

Immobilization protocol – full length orthosisIf repair is proximal the juncturae tendinum, the tendons on either side of the injured tendons must be supported in extension along with the injured tendon. If It is repaired distal, the injured finger with the repaired tendon may be held in full extension with the adjacent fingers place in 30 degrees MP flexion or allowed to flex to tolerance

Question 13

Zone 5, 6, 7, IMMEDIATE PASSIVE EXTENSION PROTOCOL

Answer 13

Initiate within the first 3 days
Orthosis – full time for first 3 weeks, might need night extension orthosis – exercise, flex to the block, relax for the passive extension. After 3 weeks, remove the block and wear another 2-3 weeks
Passive wrist tenodesis

Question 14

Zone 5, 6, 7, IMMEDIATE ACTIVE EXTENSION PROTOCOL

Answer 14

Recommended for complex injuries
Immediate controlled active motion program – same orthosis as the immediate active approach, IN therapy exercises
Relative motion orthotic positioning immediate controlled active motion (ICAM)

Question 15

REHAB FOR ZONE 5, 6, 7

Answer 15

Decrease use of protective orthosis to work and risky activities at 4 weeks
At 4 weeks gradually increase active flexion for individual joints, modalities as needed
5-6 weeks, begin composite flexion of fingers
6-7 weeks, composite flexion of wrist/fingers

Question 16

Extensor Tendon Clinical Reasoning

Answer 16

Table top extension exercises

EDC extension exercises

Question 17

CONCEPTS TO REMEMBER WHEN TREATING EXTENSOR TENDONS

Answer 17

Two ways a tendon will rupture – from a stretch or from a muscle contraction
3 types of protocols except for zones 1 and 2 (only option is immobilization)