Flexor Tendon

Question 1

the distal tendon insertions determine the
level offlexion

Answer 1

T

Question 2

The FDS and FDP tendons within the flexor tendon sheath receive
nutritional supply and eliminate wastes by two ways: vascular perfusion
and synovial diffusion.

Question 3

well-developed vincular system, which takes off the
common digital arteries and continues to the dorsal aspectofthe tendon

Answer 3

T

Question 4

The palmar aspect ofthe tendon is relatively avascular,
and the paratenon promotes material exchange by means ofdiffusion

Answer 4

T

Question 5

The A2 and A4 pulleys originate from the periosteum of the proximal and middle phalanx, respectively. They are the most important pulleys in maintaining grip power and preventing bowstringing of the flexor tendons during active finger flexion.

Answer 5

T

Question 6

cruciate (Cl-C3) pulleys

Answer 6

They function to accommodate
full flexion and extension of the joints without significant collapse or
expansion ofthe adjacent annular pulleys during finger motion.

Question 7

Zone I is the area
distal to the insertion of the FDS tendon only involving the FDP
tendon

Answer 7

T

Question 8

Zone 2 describes the area within the flexor tendon sheath
distal to the Al pulley but proximal to the FDS insertion;

Answer 8

T

Question 9

Zone 4 tendon injury
is rather uncommon because the overlying trapezium and hamate
prominence shield the tendons in this zone from laceration

Answer 9

T

Question 10

for smooth gliding and minimize peri tendinous adhesion Sometimes this
requires partial excision of the FDP tendon to decrease the repair
bulk,

Answer 10

F FDS

Question 11

for smooth gliding and minimize peri tendinous adhesion Sometimes this
requires partial release of the adjacent pulleys

Answer 11

T

Question 12

In the setting of vascular compromise to the digit we repair the tendons concomitant with vascular injury

Answer 12

T microvascular repair or reconstruction to restore digital perfusion
are indicated, and the lacerated flexor tendons can be repaired at the
same time.

Question 13

Beyond
6 weeks, the primary repair of flexor tendon is unlikely to succeed why?

Answer 13

because of myostatic contracture of the lacerated tendon and swelling of the tendon ends that do not permit tendons to be retrieved
through the pulleys

Question 14

later experiments demonstrated the alternative intrinsic
tendon healing without adhesion

Answer 14

T

Question 15

increasing the suture caliber can increase the tensile strength at
the repair site.20 Similarly, an increased number of core strands also
increases repair strength

Answer 15

T

Question 16

core strand number is more important than suture caliber in terms
of increasing repair site strength.

Answer 16

T

Question 17

locking
core suture loops are stronger than grasping loops

Answer 17

T

Question 18

the location
of the core suture knot, inside or outside of the repair site, has not
been shown to affect the repair site strength

Answer 18

T

Question 19

Deeply
placed epitendinous sutures provide better repair strength compared to those placed superficially

Answer 19

T

Question 20

Epitendinous sutures placed
further from the cut edges also improve the tensile strength at the
repair site

Answer 20

T

Question 21

epitendinous sutures for Zone 2 are recommended in addition to the core sutures

Answer 21

T

Question 22

Epitendinoud repair placed at 2 mm from the cut edges and
2 mm deep

Answer 22

T

Question 23

a gap less than 3 mm is the critical gap to facilitate
adequate healing of the tendon and increased repair strength with
time

Answer 23

T

Question 24

Shortening of the FDP tendon by more than 1 cm is undesirable because of the quadriga effec

Answer 24

T

Question 25

When nonunion is present in the absence of scaphoid flexion, screw fixation and autogenous distal radius cancellous bone grafting can be performed via a dorsal or volar approach

Answer 25

T

Question 26

In type II avulsion, the FDP tendon retracts to the level of the PIP joint, and can be repaired within 6 weeks from the time of injury

Answer 26

T

Question 27

type III injuries usually do not retract proximal to the A4 pulley

Answer 27

T

Question 28

if the distal stump is Jess than I cm in length may require tendon-tobone repair

Answer 28

T

Question 29

In delayed presentation of Zone 1 injuries outside of the time window for repaire What is the treatment

Answer 29

DIP arthrodesis

Question 30

If the proximal FPL tendon cannot be retrieved readily, we prefer to make an incision at the wrist, radial to the FCR tendon

Answer 30

t

Question 31

epi tendinous sutures may not be necessary in zone 3.4.5 because there is more room in these zones for tendon excursion, which decreases the intensity of the adhesions

Answer 31

T multiple structures are cut in these zones, which require expedient repairs to keep the tourniquet time within 2 hours

Question 32

Repairs in Zones 3, 4, and 5 have less adhesion formation and better prognosis.

Answer 32

T

Question 33

Therapy should begin within a week of the surgery under the guidance ofan experienced hand therapist

Answer 33

T

Question 34

Early motion rehabilitation protocol in the appropriate patients helps to decrease intrasynovial adhesion formation and prevent digital stiffness

Answer 34

T

Question 35

It has been well accepted that 3 to 5 mm of tendon excursion sufficiently prevents adhesion formation in Zone 2 repairs

Answer 35

T

Question 36

increasing the level ofapplied force during rehabilitation does not affect the ultimate strength ofthe repaired tendon

Answer 36

T

Question 37

active place-and-hold therapy improved finger active range ofmotion, compared to passive motion therapy, although functional outcome scores were similar in both groups

Answer 37

T

Question 38

More rigorous active finger range of motion starts at 3 to 4 weeks postoperatively

Answer 38

T

Question 39

The protectivedorsalsplint iseventually discontinued around 6 to 8 weeks postoperatively.

Answer 39

T

Question 40

Individual digit strengthening is gradually introduced at 10 weeks after surgery,

Answer 40

T

Question 41

normal activities at 4 to 6 months after surgery

Answer 41

T

Question 42

In pediatric patients and those who are unable to safely participate in an early motion rehabilitation program, cast immobilization for 4 to 6 weeks is used to protect the repair

Answer 42

T

Question 43

Zone 1 and Zone 2 repairs have good to excellent outcomes

Answer 43

T

Question 44

almost all Zone 3, 4, and 5 repairs have good to excellent outcomes.

Answer 44

T

Question 45

Outcomes of flexor tendon repair

Answer 45

depends on multiple factors, severity ofinitial injury, timing and quality of the repair, patient's underlying medical conditions that may affect tendon healing, and the quality of postoperative rehabilitation

Question 46

The most common complication is finger stiffness, which can be a result ofeither tendon adhesion or IP joint contractures

Answer 46

T

Question 47

total active motion (TAM) =

Answer 47

TAM= (MCP+PIP+DIP)flexion - extensionlag

Question 48

a percentage of the normal TAM of 260°

Answer 48

T

Question 49

Normal TAM?

Answer 49

excellent outcome is the recovery of 100% of the normal TAM; a good outcome is the recovery of more than 75% of the normal TAM but less than 100%. A recovery ofless than 75% but more than 50% is considered fair, and anything less than 50% is considered poor

Question 50

At 4 to 6 months after the flexor tendon repair surgery, if a patient's digit function is no longer improving What you will do ?

Answer 50

If the active motion is an absent and passive motion has been restored need tenolysis

Question 51

Tenolysis recommended only for patients with fair or poor outcomes

Answer 51

T

Question 52

Rupture within the first 3 weeks ofthe initial tendon repair warrants an attempt for repeat repair, which has reasonable success

Answer 52

T

Question 53

Ifthe rupture occurs more than 3 weeks after the primary repair, tendon reconstruction should be considered

Answer 53

T

Question 54

IP joint contractures management

Answer 54

passive stretching exercises and static progressive splinting Beyond 4 to 6 months after the index procedure, joint releases to correct the contractures can be considered

Question 55

TENDON RECONSTRUCTION INDICATIONS

Answer 55

flexor tendon injuries that have significant segmental tendon loss or damage present late and outside ofthe time window for primary > 6 week ruptures that occur after primary repair > 3 week

Question 56

flexor tendon injuries require early intervention

Answer 56

T

Question 57

early protective motion therapy to promote healing and decrease adhesion formation

Answer 57

T

Question 58

In type I avulsion, the FDP tendon retracts into the palm with disruption of the vascular system, and thus needs urgent repair within 2 weeks from the time of injury

Answer 58

T

Question 59

However, tenolysis is a complicated procedure that can result in neurovascular injury, worsening stiffness, and even tendon rupture

Answer 59

T