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Ortho Eval > Week 12 - Extensor Tendon Injuries > Flashcards

Week 12 - Extensor Tendon Injuries Flashcards

1
Q

why are extensor tendons vulnerable to injury?

A

little subcutaneous tissue on dorsal hand

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2
Q

name 3 common post injury complications of extensor tendon injuries.

A
  • tendon adhesions
  • extensor lag
  • significant stiffness
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3
Q

what do extensor tendons have instead of a synovial sheath?

A

paratenon

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4
Q

name 4 characteristics of extensor tendon anatomy.

A
  • numerous soft tissue attachments and interconnections
  • no synovial sheath but a paratenon
  • extra-synovial course facilitates repair
  • thinner and tend to become adherent to underlying bone
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5
Q

the anatomical characteristics of extensor tendon prevent what?

A

retraction of divided tendon

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6
Q

what do the characteristics of extensor tendons allow for?

A

conservative management

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7
Q

describe extensor lag.

A
  • good PIP passive extension but extensor tendon can’t fully extend actively
  • don’t have full active extension ROM
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8
Q

affects AROM but could still have good PROM

A

tendon adhesions

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9
Q
  • circulates around tendon and provides synovial fluid

- thinner than a sheath

A

paratenon

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10
Q

name the extensor tendons of the first dorsal compartment.

A
  • abductor pollicis longus

- extensor pollicis brevis

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11
Q

name the extensor tendons of the second dorsal compartment.

A
  • extensor carpi radialis longus

- extensor carpi radialis brevis

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12
Q

name the extensor tendon of the 3rd dorsal compartment.

A

extensor pollicis longus

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13
Q

name the extensor tendons of the 4th dorsal compartment.

A
  • extensor digitorum communis

- extensor indicis proprius

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14
Q

name the extensor tendon of the 5th dorsal compartment.

A

extensor digiti minimi

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15
Q

name the extensor tendon of the 6th dorsal compartment.

A

extensor carpi ulnaris

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16
Q

where is juncturae tendini located?*

A

proximal to MCP joint

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17
Q

what does juncturae tendini bind to?*

A

extensor digitorum communis

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18
Q
  • proximal to MCP joint

- binds EDC

A

juncturae tendini

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19
Q

broad fibrous band with fibers from sagittal bands

A

dorsal hood - MCP joint

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20
Q

what is the purpose of the dorsal hood?

A

to center EDC

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21
Q

innervation of EDC?

A

radial nerve

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22
Q

name the three parts of EDC (each digit)

A
  • central slip

- 2 lateral slips

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23
Q
  • proximal to lateral bands

- unite distally to form terminal tendon

A

lateral slips

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24
Q

name the functions of the volar and dorsal interossei.

A
  • flexion of MCP

- contribute to PIP extension when MCP is flexed

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25
Q

which tendon do the lumbricals rise from?

A

FDP

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26
Q

where do the lumbricals insert?

A

into extensor tendon - radial lateral band of each finger

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27
Q

where are the central and lateral slips located (in general)?

A

on outside of joint to keep everything in

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28
Q

critical for positioning and holding in the right place and observing for deformities

A

retinacular ligaments

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29
Q

stabilizes extensor tendon over PIP joint

A

transverse retinacular ligament

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30
Q

name the 3 retinacular ligaments.

A
  • transverse
  • oblique
  • triangular
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31
Q

helps to center tendon on dorsal surface

A

oblique retinacular ligament

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32
Q

where is the oblique retinacular ligament located?

A

volar to axis of PIP joint and dorsal to DIP joint

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33
Q

prevents volar subluxation of lateral bands

A

triangular ligament

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34
Q

what are odd # zones of injury for extensor tendons?

A

over joints

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35
Q

what are even # zones of injury in extensor tendons?

A

-phalanxes, metacarpals, forearm

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36
Q

injury is distal to the DIP joint

A

zone I

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37
Q

injury is overlying the middle phalanx

A

zone II

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38
Q

injury is over the PIP joint

A

zone III

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39
Q

injury is overlying the proximal phalanx

A

zone IV

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40
Q

injury is over the MCP joint

A

zone V

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41
Q

injury is over the metacarpal

A

zone VI

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42
Q

what is the most common zone of extensor tendon injury?

A

zone VI

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43
Q

injury to the tendon and retinaculum over the wrist joint

A

zone VII

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44
Q

injury to the muscle belly in the distal forearm

A

zone VIII

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45
Q

injury is distal to the IP joint of the thumb

A

zone TI

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46
Q

injury is overlying the proximal phalanx of the thumb

A

zone TII

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47
Q

injury is over the MCP joint of the thumb

A

zone TIII

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48
Q

injury is over the CMC joint of the thumb

A

zone TIV

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49
Q

zone I - ET

A

DIP joint

50
Q

zone II - ET

A

middle phalanx

51
Q

zone III - ET

A

PIP joint

52
Q

zone IV - ET

A

proximal phalanx

53
Q

zone V - ET

A

MCP joint

54
Q

zone VI - ET

A

metacarpals

55
Q

zone VII - ET

A

carpals

56
Q

zone VIII - ET

A

proximal wrist

57
Q

which zone is mallet finger in?

A

zone I

58
Q

describe an orthosis for a mallet finger.

A
  • must be able to flex and extend PIPs
  • maintains 10-15 degrees of DIP hyperextension
  • allows PIP movement
59
Q

name the 3 rehab approaches for extensor tendon injuries.

A
  • immobilization (no movement)
  • early but controlled mobilization (some movement) - short arc of motion
  • early and active mobilization (full movement)
60
Q

disruption of the terminal extensor tendon secondary to laceration, rupture, avulsion

A

mallet finger

61
Q

what is the mechanism of mallet finger injury?

A

hyper flexion of DIP joint

62
Q

what is the resulting deformity of mallet finger?

A

inability to extend DIP joint

63
Q

how many weeks of immobilization does mallet finger require?

A

6-8 weeks

64
Q

what can a mallet finger orthosis not allow?

A

cannot allow even slight flexion at DIP

65
Q

for a mallet finger (closed injury) pt. must support finger tip at all times during splint ___ & ___.

A

removal and replacement

66
Q

what type of exercise should begin during weeks 1-6 or 8 for a mallet finger (closed) injury?

A

active PIP flexion/extension in orthosis

67
Q

n/a

A

n/a

68
Q

what zone(s) is involved in a boutonniere injury?

A

zones III and IV

69
Q

what is the resultant deformity of boutonniere injury?

A

PIP flexion with DIP extension

70
Q
  • results from either an open or closed zone III extensor tendon injury.
  • resultant deformity is PIP flexion with DIP extension
A

boutonniere injury

71
Q

name 4 causes of boutonniere injury.

A
  • lacerating, rupture of central extensor tendon
  • proximal phalanx head button holes through tendon
  • volar migration of the lateral bands
  • hyper-extension of DIP joint
72
Q

describe the mechanism of injury of boutonniere deformity.

A

disruption of central slip and triangular ligament

73
Q

name 6 causes of injury of boutonniere deformity.

A
  • rupture
  • avulsion
  • burns
  • laceration
  • RA
  • PIP joint dislocations
74
Q

in order to be classified as boutonniere deformity - which 2 deformities must be present?

A

PIP flexion AND DIP extension

75
Q

name the 3 components of boutonniere deformity injury.

A
  1. central slip rupture
  2. triangular ligament attenuation
  3. lateral band volar migration
76
Q
  • very complex injuries involving soft tissue, PIP joint and/or DIP joints
  • adhesion of either central slip and/or lateral bands causes limitation in BOTH flexion and extension
  • if untreated, deformity becomes fixed
A

boutonniere injury

77
Q

describe orthotic treatment for boutonniere deformity.

A
  • static orthotic treatment

- PIP in full extension, DIP is free

78
Q

how long is a splint for boutonniere deformity worn for?

A

6 weeks

79
Q

describe splinting for boutonniere deformity during weeks 6-9.

A
  • may need dynamic extension but allow active flexion

- continue night time static splinting

80
Q

describe exercise during weeks 1-3 for boutonniere deformity.

A

DIP blocking - 10 reps, 5 times/day

81
Q

describe exercise during weeks 3-6 for boutonniere deformity.

A
  • flexion - GENTLE flexion to 30 degrees
  • extension - active PIP extension with MCP in neutral
  • continue night time static splinting
82
Q

describe exercise during week 7 for boutonniere deformity.

A

begin PROM, watch for extensor lag

83
Q

describe exercise during weeks 10-12 for boutonniere deformity.

A

start gentle strengthening

84
Q

develops from either loss of extension mechanism at the distal phalanx or tightening or overpull of the extensor mechanism on the proximal phalanx.

A

swan neck deformity

85
Q

name 3 causes of injury to the terminal tendon that leads to swan neck deformity.

A
  • laceration
  • closed avulsion from direct blow on the distal phalanx of an extended digit
  • attrition by weakening from chronic inflammation of the DIP joint along with tendon subluxation due to RA or other inflammatory process.
86
Q

hyperextension of the PIP joint can be due to the tightness of the intrinsic muscles and increased pull at the central slip. could be secondary to RA, spasticity from TBI, or stroke and intrinsic tightness alone

A

swan neck deformity

87
Q

laxity of what is also a cause of swan neck deformity and the hyperextension seen at the PIP joint?

A

volar plate

88
Q

which zone of injury is swan neck deformity?

A

zone III but cause usually elsewhere (DIP, PIP or MCP joints)

89
Q

describe the deformities of swan neck deformity.

A
  • PIP hyperextension with DIP flexion

- MCP flexion can occur too

90
Q

name 2 causes of swan neck deformity.

A
  • usually at MCP joint (RA)

- untreated mallet finger

91
Q

name the 2 features (deformities) of swan neck deformity.

A

PIP hyperextension and DIP flexion

92
Q

extensor tendon rises above PIP joint

A

swan neck deformity

93
Q

describe the role of the ring splint.

A

prevents full extension of PIP, holds it in slight flexion

94
Q

describe an orthosis for zone IV injury.

A
  • hand based splint, involved finger in extension

- MCP 0-30 flexion, PIP full extension

95
Q

describe the orthotic timeline for zone IV injury.

A
  • splint 4-6 weeks, 24 hours/day

- continue splint for 10 weeks after injury (night time)

96
Q

what does an orthosis for zone IV look like?

A

safe position

97
Q
  • applied for extensor tendons repair management

- pt. can actively flex his digits while the metallic springs retrieve the extension position passively

A

Levame system

98
Q

what does short arc of motion promote?

A

passive extension

99
Q
  • usually uncomplicated rehab if started early
  • responds well due to mobility of dorsal skin
  • not the complicated inter-dependence as seen in fingers
A

zone V & VI (dorsum of hand)

100
Q

describe an immobilization orthosis for zone V and VI injuries.

A
  • use resting hand splint pattern omit thumb

- MCP in 10-20 degrees flexion, IPs full extension

101
Q

describe a dynamic orthosis for zone V & VI injury.

A

dorsal outrigger and flexion block

  • wrist 40-50 degrees extension
  • allow 30 degree of active flexion at MCP joint to volar block splint
  • keep IPs in extension
102
Q

describe a dynamic orthosis at 3-4 weeks for zone V & VI injury.

A
  • flexion block is discontinued

- dynamic extension continues

103
Q

describe a dynamic orthosis at weeks 4-6 for zone V & VI injury.

A

MCP block splint is worn until weeks 7-8

104
Q

describe key aspects of rehab for zones V, VI, VII, and VIII injury.

A
  • wrist extension is key to balanced hand function

- importance of MCP joint extension

105
Q

describe an early orthosis for zones V, VI, VII, and VIII injury.

A

wrist - 30 degrees extension
MCPs - slight flexion
PIPs, DIPs - extension at night, out of splint during day

106
Q

what should you do if you suspect a wound is infected?

A

smell it and call doctor

107
Q

vacuum to lift skin up

A

snake biting kit

108
Q

early controlled mobilization results in what?

A

better range of motion at the end of 6 weeks

109
Q

grip strength comes back faster and stronger with ___ ___ compared with ____.

A

controlled mobilization, immobilization

110
Q

goes over middle and ring fingers and under index and small fingers

A

relative motion orthosis

111
Q

what is a relative motion orthosis used for?

A

used for tendon balance - balances out the finger

112
Q

static progressive splints can’t have what?

A

elastic strings - fishing wire is used instead

113
Q

which zones are involved in mallet finger?

A

I and II

114
Q

which zones are involved in boutonniere deformity?

A

III and IV

115
Q

describe general treatment methods for injury to zone I or II.

A

likely won’t require surgical intervention and will be referred to therapy or the surgeon will simply immobilize the DIP in extension for 6 to 8 weeks.

116
Q

describe general treatment methods for injury to zone III or IV.

A

can be treated conservatively or through surgery depending on the extent of the tendon damage

117
Q

describe general treatment methods for injury to zones V, VI, or VII.

A

will require surgical repair followed by immobilization or controlled early motion protocols.

118
Q

in mallet finger injuries, flexion activities must be balanced with active extension to ensure that there is no recurrence of what?

A

DIP extensor lag

119
Q

describe splinting for boutonniere deformity.

A

-splint PIP in full extension for 6 weeks, and promote DIP active and passive flexion to prevent stiffness of the oblique retinacular ligament.

120
Q

watch closely for __ ___ ___ in boutonniere injury when pt. is medically cleared to begin active exercises.

A

PIP extensor lag

121
Q

injury in zones V and VI are typically treated with which 2 protocols?

A
  • immobilization

- controlled early motion

Ortho Eval (24 decks)

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