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Ortho Eval > Week 13 - Flexor Tendon Injuries > Flashcards

Week 13 - Flexor Tendon Injuries Flashcards

1
Q

name 2 examples of closed flexor tendon injuries

A
  • punctures

- forced extension during finger flexion

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2
Q

name an example of a closed flexor tendon injury.

A

“jersey injury” FDP rupture from distal insertion while grabbing players jersey

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3
Q

usually associated with other neurovascular deficits

A

open flexor tendon injuries

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4
Q

name the 4 superficial flexor tendons of forearm.

A
  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • flexor carpi ulnaris
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5
Q

name the intermediate flexor tendon of the forearm.

A

flexor digitorum superficialis

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6
Q

name the 2 deep flexor tendons of the forearm.

A
  • flexor digitorum profundus

- flexor pollicis longus

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7
Q

travels through carpal tunnel to base of proximal phalanx

A

FDS

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8
Q

travels through carpal tunnel and through camper’s chiasm becoming more superficial to DIP

A

FDP

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9
Q

name the 2 flexor tendons that travel to the fingers.

A

FDS and FDP

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10
Q

between joints

A

annular pulleys

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11
Q

over joints

A

cruciform pulleys

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12
Q

what is the role of the pulley system?

A

keep tendons close to bone for mechanical advantage (prevent bowstringing)

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13
Q

what is a jersey injury?

A

hyperextension of PIP causing FDP to rupture/pull out

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14
Q
  • pulling up of tendon without pulleys

- can’t make a full fist

A

bowstringing

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15
Q

name the 2 sources of nutrition for tendons.

A
  • perfusion

- diffusion

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16
Q

blood enters tendon

A

perfusion

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17
Q

extrinsic via synovial fluid; degree of difference in concentration (surrounding area)

A

diffusion

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18
Q

what are critical for bringing blood to tendon?

A

vincula

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19
Q

the passages of fluid through the circulatory system (blood stream) or lymphatic system to an organ or tissue, usually referring to the delivery of blood to an area

A

perfusion

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20
Q

the tendency of the molecules of a substance (gas, liquid, or solid) to move from a region of high concentration to one of lower concentration. ex: oxygen and co2

A

diffusion

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21
Q

zone 1 - flexor tendon

A

FDP only

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22
Q
  • “no man’s land”

- insertion of FDS to A1

A

zone II

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23
Q

lumbrical origin in palm

A

zone III

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24
Q

carpal tunnel

A

zone IV

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25
Q

proximal to CT in forearm

A

zone V

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26
Q

zone I

A

FDP only

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27
Q

zone II

A
  • no man’s land

- insertion of FDS to A1

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28
Q

zone III

A

lumbrical origin in palm

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29
Q

zone IV

A

carpal tunnel

30
Q

zone V

A

proximal to CT in forearm

31
Q

what is the optimal time of flexor tendon repair?

A

within 24 hours of injury

32
Q

unrepaired tendons develop which 2 things?

A
  • adhesions

- scar which impedes restoring full function

33
Q

unlike extensor tendons, flexors can what?

A

retract into forearm if not repaired

34
Q

name 3 key outcomes of “wide awake” flexor tendon surgeries.

A
  • decreases rupture rates
  • decreases tenolysis rates
  • facilitates active protected movement after surgery
35
Q

surgery needed to clean tendon scarring

A

tenolysis

36
Q

name 2 aspects of flexor tendon injury post operative care and rehab (OT).

A
  • precautions to safely participate in their ADLs

- educate the pt. on one handed techniques.

37
Q

describe rehab during the first 2 to 4 days post surgery.

A

keep the hand elevated and immobile in an orthosis with the wrist in comfortable extension.

38
Q

describe a flexor tendon orthosis 2 to 4 days post surgery.

A
  • wrist in comfortable extension

- MCP joint flexed to 80-90 and PIP and DIP joints extended

39
Q

describe OT rehab on days 4 to 21 post surgery.

A
  • full active extension of IP joints with MP joints flexed.
  • passively warm up MP, PIP, and DIP joints to decrease friction and work of the tendons before starting active movement.
  • midrange active movement: pts. make half a fist, 45 degrees flexion of each of MP, PIP, and DIP joints active flexion
40
Q

name the general goals of OT rehab in flexor tendon injuries.

A
  • assist development of strong tendon
  • assist freely gliding tendon
  • be careful to maintain joint mobility
  • STRIKE BALANCE - between protection and application of controlled stress
41
Q

name the 5 methods of flexor tendon rehab.

A
  • immobilization
  • immediate passive flexion
  • delayed mobilization
  • early active flexion
  • immediate active flexion
42
Q

*what is the splint called that is used for flexor tendon injuries?

A

dorsal blocking splint

43
Q

describe the positioning of a dorsal blocking splint.

A
  • wrist: 20-30 degrees flexion
  • MCP: 50-70 degrees flexion
  • PIPs/DIPs: extension
44
Q

which populations should be immobilized during flexor tendon injuries?

A
  • children under 12 years old
  • adults with cog./psych issues
  • other injuries (fractures, burns, skin grafts)
45
Q

how long should a flexor tendon splint/cast be in place (immobilized)?

A

3-5 weeks

46
Q

how should an OT exercise the pt. when immobilized in splint post flexor tendon injury?

A
  • passive if possible in splint to maintain joint mobility

- edema control

47
Q

name 2 purposes of the dorsal blocking splint.

A
  • shortens flexors a little

- prevents pts. from over pulling tendons

48
Q

no matter which protocol you follow you will likely make which type of splint?

A

dorsal blocking splint

49
Q

what is the immediate passive protocol also known as?

A

modified duran

50
Q

name a protocol that does “immediate active”?

A

indiana protocol

51
Q

describe the indiana protocol.

A
  • 1st - passively flex fingers into palm
  • actively hold fingers down
  • PLACE/HOLD
  • 2nd - active fist and straighten fingers within splint
52
Q

how many splints are required in the indiana protocol?

A

2

53
Q

describe the indiana protocol (2nd - hinged splint).

A
  • passively extend wrist while simultaneously holding fingers in flexion
  • after 5 seconds, relax the muscle contraction and allow wrist to drop into flexion - automatically allows fingers to gently straighten.
54
Q

name 3 main exercises of the indiana protocol.

A
  • place/hold, then flex wrist
  • actively make a fist (composite and hook) followed by active extension
  • blocking exercises
55
Q

describe general time frame of PROM and AROM.

A

passive flexion active extension right away

56
Q

what is place/hold also known as?

A

tenodesis

57
Q
  • begins in all protocols eventually

- requires 1 tendon to do all the work

A

blocking

58
Q

eventually needs to be done in all flexor tendon injuries.

A

tendon gliding

59
Q

used to hold the space of a tendon

A

hunter rod

60
Q

what type of motion is used when hunter rod is in?

A

must be PROM

61
Q

name 4 OT goals used for hunter rod patients.

A
  • control edema
  • manage scar
  • improve/maintain joint mobility especially PIP joint
  • begin tendon rehab after tendon graft
62
Q

name 4 treatments used for adhesions restricting tendon glide.

A
  • blocking
  • NMES
  • scar massage/release techniques
  • ultrasound (8th week)
63
Q

name 2 treatment methods for decreased tendon length restricting extension at 2 or more joints.

A
  • ultrasound (8th week)

- dynamic or static progressive extension splinting

64
Q

name 3 treatment methods for flexion contractures of PIP or DIP joints.

A
  • heat with stretch in direction of limitation
  • dynamic or static progressive splint
  • joint mobilization techniques
65
Q

name 5 treatment methods for skin to tendon adherence.

A
  • ultrasound for scar softening
  • stretch scar adhesion
  • myofascial release
  • friction massage
  • NMES to involved finger (move skin in opposite direction)
66
Q

describe the duran protocol.

A
  • passive digital flexion and extension within a protective orthosis
  • gentle active motion begins with medical clearance about 4 weeks after surgery.
67
Q

when does AROM (flexion) of digits usually begin for flexor tendon injuries?

A

4 to 6 weeks from initial repair and increases in frequency and intensity until full function (12 weeks after repair)

68
Q

name 2 typical early techniques following the discontinuation of the dorsal protective orthosis.

A
  • tendon gliding exercises

- place and hold exercises

69
Q

in general, describe the duran protocol.

A

passive flexion and extension of fingers

70
Q

when does strengthening begin?

A

week 8

71
Q

when is the splint not used anymore?

A

6 weeks

Ortho Eval (24 decks)

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