Flexor Tendons

Question 1

Which flexor tendons are found in the hand/wrist?

Answer 1

-flexor digitorum superficialis (FDS) -flexor digitorum profundus (FDP)

Question 2

How are tendons different in the hand as compared to other areas of the body?

Answer 2

-tendons are long and thin in the hand -tendons glide and run under a tight pulley system

Question 3

Pulleys are found on the flexor side to prevent bowstringing and consist of ___, ___, ___, and ___ and ___, ___, ___, and ___.

Answer 3

-A1, A2, A3 and A4 -C1, C2, C3, and C4

Question 4

Nerve supply is innervated by the ___, ___, and ___ branches of the hand.

Answer 4

-medial -radial -ulnar

Question 5

What are the flexor tendon zones?

Answer 5

-Zone I: extends from the fingertip to the center portion of the middle phalanx -Zone II: extends from the center portion of the middle phalanx to the distal palmar crease (known as “no man’s land” due to difficulty of tendon gliding without scarring to surrounding tissues) -Zone III: extends from the distal palmar crease to the transverse carpal ligament -Zone IV: overlies the transverse carpal ligament -Zone V: extends beyond the level of the wrist

Question 6

What are potential complications?

Answer 6

-nerve involvement (usually laceration) is common due to mechanisms by which tendons are injured -edema must be therapeutically controlled to maintain motion and reduce pain and joint stiffness -pain is common at the site of injury (an ADL checklist should be used to assess ADL dysfunction) -muscle actions are affected by impairment in flexion and deviation of the wrists and digits

Question 7

What is the Duran protocol for flexor tendon injuries?

Answer 7

-an early passive ROM program

Question 8

What is the Kleinert protocol for flexor tendon injuries?

Answer 8

-involves active extension of digits with passive flexion via traction, typically a rubber band

Question 9

What is the early active motion protocol for flexor tendon injuries?

Answer 9

-begins within days of surgery to prevent adhesions and promote tendon gliding and excursion

Question 10

What is an immobilization protocol for flexor tendon injuries?

Answer 10

-advisable only for those patients unable to care for themselves or who do not have the cognitive capacity to ensure safety post-op -this protocol is sometimes used with children as well in order to prevent rupture of the repair

Question 11

Because a repaired tendon is at its weakest 10-12 days post-surgery, ___ is used to prevent rupture.

Answer 11

-splinting

Question 12

As an intervention, exercises promote ___ and prevent ___.

Answer 12

• promote tendon excursion
• prevent adhesions

Question 13

Use of modalities in intervention begins once cleared by the prescribing physician. The modality of ___ gradually prepares the tissue for motion while the modality of ___ promotes tendon excursion and activation.

Answer 13

• head gradually prepares the tissue for motion
• NMES (neuromuscular electrical stimulation) promotes tendon excursion and activation

Question 14

Tendon glides are an intervention used to promote ___ and prevent ___.

Answer 14

• promote excursion
• prevent adhesions

Question 15

What are tendon glides? What is the sequence of movements?

Answer 15

• a sequence of movements used to promote full tendon excursion and full AROM and prevent adhesions
• the sequence of movements is fingers straight, MCP flexion, hook fist, then flat fist

Question 16

When is strengthening initiated after surgical repair of a flexor tendon injury?

Answer 16

-usually not until the late phase of the repair, around 8-12 weeks after surgery

Question 17

What intervention is typically used if a client cannot cognitively follow a protocol?

Answer 17

-the extremity is cast in a protected position for 6 weeks

Question 18

Other interventions after surgical repair of a flexor tendon injury include ___ and ___.

Answer 18

• a home exercise program
• ROM