Flexor Tendon Repairs Flashcards

1
Q

blood supply to flexor tendons

A

from the vinculae supplied by the digital arteries

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2
Q

healing of flexor tendons comes from

A

the blood supply and the synovial fluid

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3
Q

when is the flexor tendon weakest?

A

inflammatory phase (0-2 weeks)

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4
Q

tensile strength

A

the amount of force the tendon will tolerate before rupture

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5
Q

most important flexor tendon pulleys

A

A2 and A4 (prevent bowstringing)

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6
Q

FTR sutures

A

2, 4, or 6 strands*need to know number of strands used to select the appropriate protocol

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7
Q

FTR rehab approaches (3)

A
  1. immobilization2. immediate passive motion in the direction of the repair3. immediate active motion in the direction of the repair
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8
Q

FTR immobilization use

A

rarely usedmay be used for children, limited cognition, or severe fractures

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9
Q

FTR immobilization complications

A

adhesions and joint stiffness

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10
Q

FTR immobilization orthosis

A

dorsal blocking orthosis wrist 20-30 deg flexionMP 50-60 deg flexionIP full extension

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11
Q

FTR immediate passive flexion orthosis

A

dorsal blocking orthosiswith static IP positioning or elastic traction*may use elastic traction during day and strap in extension at night

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12
Q

FTR immediate active flexion use

A

be selective on which patients you do this onpreferably at least 4 strand repairconsider edemamultiple protocols

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13
Q

FTR immediate active flexion orthosis

A

protective dorsal blocking orthosis

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14
Q

FTR wrist positioning

A

least tension in flexor tendons during flexion is with the wrist in slight extension

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15
Q

FTR early immediate active flexion goal

A

light fist with DIP flexion NOT FORCEFUL

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16
Q

FTR Pyramid of Progressive Force Application (9)

A
  1. passive protected extension2. place and hold3. active composite fist4. hook and straight fist5. isolated joint motion6. discontinuation of protective splint7. resistive composite fist8. resistive hook with straight fist9. resistive isolated joint motion*first 4 wrist protected, last 5 wrist unprotected
17
Q

quadriga effect

A

limited active DIP flexion of adjacent digits in FTR because of common muscle belly of FDP

18
Q

FTR lumbrical plus finger

A

FDP is lacerated or too long distal to the lumbrical origin and the only/first available connection to finger movement is via the intact lumbricalonly resolved through surgical interventionnot to be confused with lumbrical tightness caused by adaptive shortening

19
Q

2 Flexor Tendons Commonly Injured

A

FDS & FDP

20
Q

Where do flexor tendons get blood supply?

A

Vincula

21
Q

FLEXOR TENDON ZONES

A

ZONE 1Just profundus is affectedFDP pulled loose from bone (sometimes with a piece of bone) = jersey fingerZONE 2- “NO MAN’S LAND”ZONE 3ZONE 4, 5 – “Spaghetti wrist”

22
Q

Quadriga Effect

A

limited active DIP flexion of the adjacent digit because of the common muscle belly of the FDP.

23
Q

Are PIP flexion contractures common?

A

YES!

24
Q

PRECAUTIONS

A

Too much force can overpower the adhesions and repair and cause a rupture of the tendonIf the treatment seems to be going better than expected, not much scarring…be careful!