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msk2 > wrist and hand tendon laceration > Flashcards

wrist and hand tendon laceration Flashcards

1
Q

finger flexor zone 1

A

insertion of FDP on distal phalanx to insertion of FDS on middle phalanx

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2
Q

finger flexor zone 2

A

distal insertion of FDS to distal palmar crease

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3
Q

finger flexor zone 3

A

palmar aspect

neck of metacarpals to distal border of carpal tunnel

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4
Q

finger flexor zone 4

A

carpal tunnel

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5
Q

finger flexor zone 5

A

proximal border of carpal ligament to extrinsic flexors in distal FA

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6
Q

thumb flexor zone 1

A

distal insertion of FPL on distal phalanx to neck of proximal phalanx

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7
Q

thumb flexor zone 2

A

proximal phalanx across MP jt to neck of 1st metacarpal

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8
Q

thumb flexor zone 3

A

1st metacarpal to proximal margin of carpal ligament

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9
Q

finger extensor zone 1

A

DIP jt

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10
Q

finger extensor zone 2

A

middle phalanx

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11
Q

finger extensor zone 3

A

PIP jt

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12
Q

finger extensor zone 4

A

proximal phalanx

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13
Q

finger extensor zone 5

A

apex of MP jt

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14
Q

finger extensor zone 6

A

dorsum of hand

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15
Q

finger extensor zone 7

A

midcarpal jt or wrist region

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16
Q

finger extensor zone 8 and 9

A

distal and middle forearm

17
Q

thumb extensor zone 1

A

IP joint

18
Q

thumb extensor zone 2

A

proximal phalanx

19
Q

thumb extensor zone 3

A

MCP joint

20
Q

thumb extensor zone 4

A

metacarpal

21
Q

thumb extensor zone 5

A

carpometacarpal joint

22
Q

discuss the anatomical and morphological differences between flexor and extensor tendon laceration

A

flexor - return to full activity by 12 weeks

extensor - more common since superficial

23
Q

discuss the condition of tendon after rupture between flexor and extensor tendon laceration

A

flexor - tendons retract and usually require surgery

extensor - less likely to retract d/t numerous soft tissue attachment but also more prone to adhesions

24
Q

discuss the most difficult zones to treat between flexor and extensor tendon laceration

A

flexor - zone 2; no mans land d/t limited vascularity

extensor - zone 3 and 4

25
Q

discuss jersey finger

A

rupture or avulsion of the flexor digitorum profundus; zone I is affected

26
Q

discuss mallet finger

A

zone I injury to the extensor tendon mechanism at or near the DIP joint

27
Q

discuss direct repair

A

end-to-end repair in which the tendon ends are re-opposed and sutured together

28
Q

discuss tendon grafta

A

autogenous donor tendon (autograft - palmaris longus is sutured to replace damaged tendon

necessary when the ends of the severed tendon(s) cannot be brought together without undue tension

29
Q

discuss timing of repair

A

immediate primary - w/in 24 hrs after injury

delayed primary - up to 10 days post

secondary - 10 days to 3 wks

late reconstruction - beyond 3 to 4 wks

staged - multiple surgeries over weeks to months; extensively damaged or scarred tendon

30
Q

what is the significance of timing of repair

A

if the repair is immediate, we wouldn’t be as concerned with atrophy, tightness than late staged reconstructions

31
Q

discuss delayed motion phase

A

when controlled immob extends for 3-4 wks

pt is:
- 7 to 10 yo
- impaired cognitive capacity
- unlikely to adhere to program
- staged reconstruction

compensate is primary since hands cant be used

restore is secondary

32
Q

position of immob if flexor zones 1,2,3 is affected

A

10-45° wrist and 40-70° MCP flexion with PIP & DIP extension

33
Q

position of immob if flexor zones 2 or 4 is affected

A

70° MCP flexion, neutral wrist

34
Q

position of immob if extensor zones 3 or 4 is affected

A

PIP & DIP extension

35
Q

position of immob if extensor zones 5 or 6 is affected

A

30° wrist extension and 30-45° MCP flexion

36
Q

discuss early controlled motion phase

A

24-48 hrs after repair and no later than 5 days post op

dec dema
maintain tendon gliding - dec adhesions
inc synovial diffusion
better collagen alignment
dec gap formation

early active motion approach - use of MAT; isoms w/in allowed range

37
Q

discus maximum protection phase

A

after a short period of immobilization of only 1-3 days

passive motion w/in allowed range
differential gliding of FDS and FDP
place and hold exercises

38
Q

discus moderate protection phase

A

cont place and hold - graduallly inc tension
active flexion of IP in dynamic splint
tendon gliding and blocking

39
Q

discuss minimum protection phase

A

no more splint, healed surgery na

dexterity ex - buttoning, typing, writing
low-load resistive ex - manual, light resistance, spider web
sustained grasp ex - holding cup half filled muna then full
functional use - simulate movements

gradually progressed resistance exercises to improve strength and endurance, dexterity

msk2 (42 decks)

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