wrist and hand tendon laceration Flashcards
finger flexor zone 1
insertion of FDP on distal phalanx to insertion of FDS on middle phalanx
finger flexor zone 2
distal insertion of FDS to distal palmar crease
finger flexor zone 3
palmar aspect
neck of metacarpals to distal border of carpal tunnel
finger flexor zone 4
carpal tunnel
finger flexor zone 5
proximal border of carpal ligament to extrinsic flexors in distal FA
thumb flexor zone 1
distal insertion of FPL on distal phalanx to neck of proximal phalanx
thumb flexor zone 2
proximal phalanx across MP jt to neck of 1st metacarpal
thumb flexor zone 3
1st metacarpal to proximal margin of carpal ligament
finger extensor zone 1
DIP jt
finger extensor zone 2
middle phalanx
finger extensor zone 3
PIP jt
finger extensor zone 4
proximal phalanx
finger extensor zone 5
apex of MP jt
finger extensor zone 6
dorsum of hand
finger extensor zone 7
midcarpal jt or wrist region
finger extensor zone 8 and 9
distal and middle forearm
thumb extensor zone 1
IP joint
thumb extensor zone 2
proximal phalanx
thumb extensor zone 3
MCP joint
thumb extensor zone 4
metacarpal
thumb extensor zone 5
carpometacarpal joint
discuss the anatomical and morphological differences between flexor and extensor tendon laceration
flexor - return to full activity by 12 weeks
extensor - more common since superficial
discuss the condition of tendon after rupture between flexor and extensor tendon laceration
flexor - tendons retract and usually require surgery
extensor - less likely to retract d/t numerous soft tissue attachment but also more prone to adhesions
discuss the most difficult zones to treat between flexor and extensor tendon laceration
flexor - zone 2; no mans land d/t limited vascularity
extensor - zone 3 and 4
discuss jersey finger
rupture or avulsion of the flexor digitorum profundus; zone I is affected
discuss mallet finger
zone I injury to the extensor tendon mechanism at or near the DIP joint
discuss direct repair
end-to-end repair in which the tendon ends are re-opposed and sutured together
discuss tendon grafta
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
discuss timing of repair
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
what is the significance of timing of repair
if the repair is immediate, we wouldn’t be as concerned with atrophy, tightness than late staged reconstructions
discuss delayed motion phase
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
position of immob if flexor zones 1,2,3 is affected
10-45° wrist and 40-70° MCP flexion with PIP & DIP extension
position of immob if flexor zones 2 or 4 is affected
70° MCP flexion, neutral wrist
position of immob if extensor zones 3 or 4 is affected
PIP & DIP extension
position of immob if extensor zones 5 or 6 is affected
30° wrist extension and 30-45° MCP flexion
discuss early controlled motion phase
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
discus maximum protection phase
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
discus moderate protection phase
cont place and hold - graduallly inc tension
active flexion of IP in dynamic splint
tendon gliding and blocking
discuss minimum protection phase
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
