Flexor Tendon Injuries

Question 1

The median nerve lies immediately ulnar to which of the following structures at the level of the distal radioulnar joint?

Answer 1

FCR

Question 2

Flexor tendons of the fingers within Zone 2 receive their primary nutritional supply from?

Answer 2

Diffusion from synovial sheath

Question 3

What percentage of flexor tendon injury necessitates repair?

Answer 3

> 60%; though if less than 60% and not repaired can lead to triggering or gap formation

Question 4

What variable has the greatest effect on increasing the strength of the tendon repair?

Answer 4

Number of core sutures crossing the repair site

Question 5

What general suture principles provide excellent load to failure and efficient gliding?

Answer 5

Repair with 4-6 strand core suture purchase 10mm from the cut edge. Circumferential simple running epitendinous suture.

Question 6

What are advantages of wide awake flexor tendon repair?

Answer 6

1) Local with epi (less operative risk)
2) Intra-op assessment of gap formation
3) Gliding of tendons (reduced need for tenolysis)
4) Allows partial division of pulleys if needed

Question 7

What are the differences between the early passive ROM protocols for flexor tendon repairs?

Answer 7

Duran: active finger extension with patient-assisted passive finger flexion
Kleinert: active finger extension, dynamic splint-assisted passive finger flexion
Mayo Splint: adds active wrist motion which increases flexor tendon excursion the most

Question 8

What is the most common complication following flexor tendon repair?

Answer 8

Tendon adhesion; wait 3 months prior to tenolysis