Flexor Tendon Flashcards
blood supply to flexor tendons
from the vinculae supplied by the digital arteries
healing of flexor tendons comes from
the blood supply and the synovial fluid
when is the flexor tendon weakest?
inflammatory phase (0-2 weeks)
tensile strength
the amount of force the tendon will tolerate before rupture
most important flexor tendon pulleys
A2 and A4 (prevent bowstringing)
FTR sutures
2, 4, or 6 strands
*need to know number of strands used to select the appropriate protocol
FTR rehab approaches (3)
- immobilization
- immediate passive motion in the direction of the repair
- immediate active motion in the direction of the repair
FTR immobilization use
rarely used
may be used for children, limited cognition, or severe fractures
FTR immobilization complications
adhesions and joint stiffness
FTR immobilization orthosis
dorsal blocking orthosis
wrist 20-30 deg flexion
MP 50-60 deg flexion
IP full extension
FTR immediate passive flexion orthosis
dorsal blocking orthosis
with static IP positioning or elastic traction
*may use elastic traction during day and strap in extension at night
FTR immediate active flexion use
be selective on which patients you do this on
preferably at least 4 strand repair
consider edema
multiple protocols
FTR immediate active flexion orthosis
protective dorsal blocking orthosis
FTR wrist positioning
least tension in flexor tendons during flexion is with the wrist in slight extension
FTR early immediate active flexion goal
light fist with DIP flexion
NOT FORCEFUL
FTR Pyramid of Progressive Force Application (9)
- passive protected extension
- place and hold
- active composite fist
- hook and straight fist
- isolated joint motion
- discontinuation of protective splint
- resistive composite fist
- resistive hook with straight fist
- resistive isolated joint motion
* first 4 wrist protected, last 5 wrist unprotected
quadriga effect
limited active DIP flexion of adjacent digits in FTR because of common muscle belly of FDP
FTR lumbrical plus finger
FDP is lacerated or too long distal to the lumbrical origin and the only/first available connection to finger movement is via the intact lumbrical
- only resolved through surgical intervention
- not to be confused with lumbrical tightness caused by adaptive shortening
2 Flexor Tendons Commonly Injured
FDS & FDP
Where do flexor tendons get blood supply?
Vincula
FLEXOR TENDON ZONES
ZONE 1 Just profundus is affected FDP pulled loose from bone (sometimes with a piece of bone) = jersey finger ZONE 2- “NO MAN’S LAND” ZONE 3 ZONE 4, 5 – “Spaghetti wrist”
Quadriga Effect
limited active DIP flexion of the adjacent digit because of the common muscle belly of the FDP.
Are PIP flexion contractures common?
YES!
PRECAUTIONS
Too much force can overpower the adhesions and repair and cause a rupture of the tendon
If the treatment seems to be going better than expected, not much scarring…be careful!
