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MSK III P3 Fall > Flexor Tendon Repair > Flashcards

Flexor Tendon Repair Flashcards

1
Q

Origin of FDS

A

Medial epicondyle
Coronado process
Proximal radius

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2
Q

Insertion of FDS

A

Bifurcates around FDS
Meets up at Casper’s chiasm
Middle phalanx

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3
Q

Action fo FDS

A

PIP flex

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4
Q

Action of FDP

A

DIP flex

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5
Q

Origin of FDP

A

Volar and medial ulna surface
Interosseous membrane
Maybe proximal radius

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6
Q

Insertion of FDP

A

Palmar base of distal phalanx

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7
Q

Innervation of FDS

A

Median nerve

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8
Q

Lumrbical action

A

Flex MCP

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9
Q

Origin of lumbricals

A

FDP

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10
Q

Insertion of lumbricals

A

Extensor expansion

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11
Q

Strong, broad

Provides mechanical stability

A

Annual pulley

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12
Q

Provides flex

A

Cruciate pulley

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13
Q

Need to keep intact during surgery

A

A2 and A4

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14
Q

Bowstringing, which pulley

A

A2

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15
Q

Most common way of injuring flexor tendon

A

Sharp transection through glass or knife

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16
Q

Zone 1

A

FDS to distal

- FDP avulsion or laceration

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17
Q

Zone 2

A

A1 pulley to FDS insertion

  • no man’s land
  • chiasm of campers
  • within tendon sheath
  • neurovascular injury
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18
Q

Zone 3

A

End of carpal tunnel to A1 pulley

  • no Flexor sheath except 5th
  • intrinsic injury (lumbrical)
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19
Q

Zone 4

A

Within carpal tunnel

20
Q

Zone 5

A

Proximal to carpal tunnel

21
Q

FDS injured

A

No PIP flex

22
Q

FDP injured

A

No DIP flex

23
Q

How do you know index finger is intact for FDS?

A

It can do PIP flex and DIP extension

24
Q

If fingers were extended during injury

A

Skin and tendons cut at Same level

25
Q

If fingers were flexed during injury

A

Tendon injury is distal to cut

26
Q

Which suture are needed for 25-50% laceration

A

Epitenon suture

27
Q

Which 2 core sutures most common

A

Modified Kessler

4 strand cruciate

28
Q

Which technique most common for epitenon

A

Cross-stitch

29
Q

Optimal surgical technique

A

4-6 core and epitendon sutures

30
Q

Tendon gliding force

Passive mvmt

A

2-4 N

31
Q

Tendon gliding force AAROM

A

Up to 10 N

32
Q

Tendon gliding force AROM (strong grasp)

A

More than 70 N

33
Q

4 strand suture force allows for

A

40-45 N

34
Q

Goal of surgical mgmt

A

Strong repair site that wont allow more than 3 mm length with gentle AROM therapy designed to prevent adhesions

35
Q

Weakest time for post surgical healing

A

First 10 days

Minimal strength at day 5

36
Q

Early controlled ROM and why

A

Promote 3-5 mm of tendon gliding to prevent adhesions and contractures

37
Q

Contraindications for 0-5 days

Inflammatory phase

A

Active tendons contraction

Passive tendon length into extension

38
Q

Contraindications for fibroplastic phase

5-21 days

A

Active grasping

Full passive tendon length into extension

39
Q

Normal glide, responsive tendon

A

Less than 5 deg between AROM and PROM
No adhesions
Continue with protocol

40
Q

Decreased glide, but tendon is responsive

A

More than 10 deg between AROM and PROM: lag present
More than 10% resolution of active lag between sessions
Plan: dont increase force until next visit

41
Q

Decreased glide, NON-responsive tension

A

More than 10 deg between AROM and PROM: lag present
Less than 10% resolved b/w sessions
Plan: increase force

42
Q

Zone 1 rehab concerns

How much DIP flex needed?

A

Stiffness and less FDP glide

40 DIP flex needed for function

43
Q

Zone 2 rehab concerns

A

Hardest to repair - no mans land
Camper chiasm where FDP and FDS meet
FDP and FDS strong adhesion impairs gliding
Early active protocol is more effective

44
Q

Zone 3 rehab concerns

A

Intrinsic contracture and tight

Better results b/c no tendon sheath

45
Q

Zone 4 rehab concerns

A

Adhesions b/w tendon and median nerve b/c of carpal tunnel

46
Q

Zone 5 rehab concerns

A

Risk for neurovascular injury

Quicker healing, less adhesions, more mobile tissue

MSK III P3 Fall (19 decks)

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