In the case of an open injury to the hand, first aid should be administered right away to stop bleeding and clean the wound. The initial evaluation of hand injuries needs a strong dose of paranoia to suspect and spot flexor tendon injuries. It covers all aspects, including assessment, treatment and rehabilitation. Severe multiple tissue injuries to fingers, palm gross wound contamination significant skin loss over the flexor system ideal repair easy placement of sutures in the tendon secure suture knots smooth junction of tendon ends minimal gapping at the repair site minimal interference with tendon vascularity.
An overview of the management of flexor tendon injuries. This article outlines some key principles about tendon injuries with a particular focus on diagnosis and management. Injuries to flexor tendons may occur from cuts, crush injuries, sprains, or in rare cases, without apparent injury. Flexor tendon injuries brandon orthopedic associates. Complications are discussed and secondary reconstructive options explained. Full, normal function of the finger is rarely obtained after a flexor tendon injury, but close aher nc tob il. Flexor tendon might be injured with a blunt, sharp tool or by being quashed or ruptured with avulsion polatkan, 2007. Tamura n, nukada t, kato t, kuroda t, kotoyori y, fukuda k, kasashima y. Flexor tendon injuries hand orthopedics library demo. Flexor tendon reconstructions and salvage procedures randall w. In all cases, a doctor will explain the operation to. Historical perspectives are provided as well as practical tips on modern operative techniques. The flexor tendons are the long tendons that run from the midforearm to the fingertip. It takes 10 to 12 weeks for the tendons to regain most of their strength.
These flexor tendons slide in and out of the finger as we make a fist and then straighten our fingers. Pdf on jul 25, 2018, justin yousef and others published flexor tendon injuries find, read and cite all the research you need on researchgate. Our goal is to restore mobility and function of the fingers as soon as possible with minimal impact on the patients quality of life. Common flexor tendon injuries include lacerations, ruptures. Excess sheath effusion and lameness are the most typical signs. The repair of flexor tendon injuries is a challenge that hand surgeons commonly face, and one that can have an important impact on patients quality of life and hand function. Injury can occur secondary to acute trauma ie, laceration, avulsion or secondary to chronic degeneration, and clinical presentation. Postoperative instructions for flexor tendon repair. Diagnosis is made primarily on history and examination with imaging prescribed for unusual or. The vinculum brevis superficialis vbs and the vinculum brevis profundus vbp consist of small.
Even with no visible signs of injury, there can be extensive internal damage to the flexor tendon if it has been cut or torn. The patient had suffered a laceration at the level of the distal interphalangeal joint with severance of the fdp. These long structures are connected to the flexor muscles in the forearm. Although flexor tendon injuries account for less than 1% of all hand injuries, functional results are so important that they cannot be ignored by both the patient and society ciloglu et al.
The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries. This chapter will comprise flexor tendon anatomy, types of flexor tendon injury, modes of healing, molecular updates, repair techniques and postoperative rehabilitation. The flexor tendons muscles are responsible for flexing bending your fingers. To quickly treat the pain brought on by a flexor tendon injury, first aid can be applied in the form of ice. Large section of tendon has been damaged in zone 2 injury 4. We would like to show you a description here but the site wont allow us. In some cases, an additional surgery to remove scar tissue around the tendon is required to improve motion to the affected fingers. Flexor tendon injuries a deep cut on the palm side of your fingers, hand, wrist, or forearm can damage your flexor tendons, which are the tissues that help control movement in your hand. Superficial digital flexor tendon sdft injuries are particularly common in eventers and racehorses, but can occur in any horse through field injury or overexertion. The most common cause of a flexor tendon injury is a deep cut to the palm or the fingers.
Flexor tendons are required to glide large distances to allow the digits full composite flexion and extension, running within a tight pulley system to maximize their efficiency fig. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. An injury to one of these tendons can cause pain and inability to flex the finger or thumb and grasp with the hand. Flexor tendon reconstructions and salvage procedures.
How to approach flexor tendor injuries explorehealth. The university of michigan hand surgery team is fellowship trained and specializes in the treatment of flexor tendon injuries, from simple to complex. The flexor tendons of the hand are responsible for flexion of the fingers and thumb toward the palm. A jersey finger happens when a finger is caught on another players jersey or clothes and the tendon is pulled off from the tip of the bone. Postoperative instructions for flexor tendon repair purpose of surgery the goal of the operation is to repair or reattach lacerated or detached flexor tendons.
They are attached to your fingers by long cables called flexor tendons. As a result, new and stronger tendon repair techniques have evolved, permitting the application of early passive and even light active forces. Injuries relating to the flexor tendon are relatively common. Anatomy your hand is composed of many bones that provide structure for your wrist and fingers. Once severed, it is unlikely that a tendon can heal without surgical repair. Splinting and hand therapy rehabilitation usually follow surgical treatment.
Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair. To understand a flexor tendon injury, you first must understand a bit about how the hand works. If a tendon is partially cut, the finger may still bend a little. Flexor tendon injuries can cause loss of movement, pain, and swelling. Few clinicians would miss a completely lacerated flexor tendon, assuming that tendon function was adequately evaluated, but a major partial tendon injury, often initially clandestine in the depths of a swollen, bloody, and tender laceration, can mislead even a hand surgeon on the. Compressions should also be implemented to the inflicted area so the flow of blood will slow to the damaged area on the finger. Tendonitis varies in severity, but horses with even the most.
Even though flexor tendon injury is common, much remains to be elucidated about the best way to facilitate the intrinsic healing process and to minimise scarring. All flexor tendon injuries need supervised rehabilitation with the therapists for at least 6 weeks and often longer. Ultrasonography can identify tendon injuries, but tears of the. The muscles that bend your fingers are located in your forearm. Since the first flexor tendon repair was described by kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 7090%. Primary or delayed flexor tendon repairs in the hand have become standard practice over the past 30 years.
The damaged ends of the tendon are brought together with sutures to achieve a secure repair. Diagnosis of straininduced tendon injuries of the equine distal limb are based on history usually a. Flexor tendon injuries are relatively common in horses. Flexor tendon injuries florida bone and joint specialists. Few clinicians would miss a completely lacerated extensor or flexor tendon, assuming that tendon unction was adequately evaluated. Hand flexor tendon injuries, microsurgery, traditional singlestrand modified kessler suture, efficacy introduction the incidence of hand injuries is fairly high, accounting for about 30% of all limb injuries 1. The tendons of the hand run from the flexor muscles in the elbow and forearm to the bones of the fingers. Partial laceration partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. Results flexor tendon surgery is one of the most difficult injuries to recover from. In all cases, a doctor will explain the operation to you and answer any questions you may have. The flexor tendon repair is usually an outpatient procedure and can be performed under local or general anesthesia. Neglected 3 to 6 weeks with tendon degeneration and scar within the tendon sheath. Tendon injuries are common, generally degenerative in nature, and can cause significant morbidity if not appropriately managed.
Secondary repair of flexor tendon injuries request pdf. Bunnell named this region of the hand, no mans land. Klein, in fundamentals of hand therapy second edition, 2014. Management of flexor tendon injuries following surgical repair. Hand therapy and rehabilitation for flexor tendon injuries. They are thick cordlike connective tissues that attach the finger bones to muscles in the forearm and allow the fingers to bend. Flexor tendon injuries are caused by either overstrain of the tendon or direct trauma. Patient information flexor tendon repair amazon s3. When flexor tendons are completely cut, the finger cannot be bent. Rehabilitation schedule for common tendonligament injuries.
The flexor tendons are located on the palm side of the hand. After surgery, the area of the injured tendon must be protected from movement. Rehabilitation schedule for common tendon ligament injuries. Digital flexor tendon injury tendonitis primarily involving the superficial digital flexor tendon sdft is a substantial cause of economic loss in the thoroughbred industry. Pediatric flexor tendon injuries remain rare and usually involve the dominant hand holding or manipulating an object glass or knife. Injuries to flexor tendons may severely affect function of the hand due to disruption of the muscle tendon units. You will need to wear a splint typically for 6 weeks, complete frequent speci. Flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Because the tendon has severed or torn, it will not grow back unless the torn ends are touching.
Prior to the 1970s, repair of intrasynovial flexor tendon injuries yielded consistently poor results. Place hold for isolated fds glide of involved digits. This chapter provides a comprehensive narrative on the subject of flexor tendon injury. You will have a firm splint covering your forearm and the back of your. Flexor tendon injury an overview sciencedirect topics. Simple or complex tendon injuries are the most common 2. The segmental vascular supply to the flexor tendons is by means of long and short vincular connections. This cast or splint is usually worn until 6 weeks after surgery. The surgeon makes an incision on the skin over the injured tendon. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and rep. In our cohort, an excellent outcome was found in 95. Their actions are complex, and injuries to them are devastating. Flexor tendon injuries and treatment results of 67 patients.
Pdf epidemiology of flexor tendon injuries of the hand in a. The muscles that connect to these tendons originate in the forearm even though their action is in the hand. Nov 30, 20 partial laceration partially severed tendon should not be repaired if at least 40% of the tendon remains intact j hand surg 2000. Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. These injuries can result from such things as deep cuts or tears. The primary defect is a central rupture of tendon fibres resulting in bleeding and swelling. Once seen by a doctor, a flexor tendon injury may be treated with a splint. When flexor tendons are completely cut, the finger cannot bend. The hand may be placed in a protective splint until surgical repair is performed. Injuries can also occur in sports or due to arthritic conditions. Diagnosis of a flexor tendon injury will include a physical exam of the injured region, an assessment of the functioning of the affected area, and often an xray.
Delayed presentation of fdp avulsion injuries associated with significant tendon retraction. Flexor tendon injuries, however, can be very challenging to treat. Proper management is essential to ensure optimal outcomes. When this happens it becomes impossible to bend your fingers. For this reason, this series of presentations will focus on these injuries. The objective of the study was to determine if there was evidence to support 1 type of exercise regimen. When a tendon has been cut, it is common for there to be no outward signs at all.
When cut, the tendon acts like a rubber band, and the end pulls away from one another. Delayed presentation of fdp avulsion injuries associated with. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion. A flexor tendon injury can make it impossible to bend your fingers or thumb. Flexor tendon injuries usually occur as a result of a cut to the palm side of the hand.
Exercise protocol following first examination 0 to 60 days. Flexor tendons are quite prone to injury due to their location below the skin and lack of flesh in the hand. Placehold for hook, full and straight fist with wrist extended. Diagnosis of tendon injury the most frequently injured tendons and ligaments in the horse are those on the palmar or plantar aspect of the distal limb. Physical therapy zones 25 flexor tendon repair protocol timelinesplint therapeutic exercise precautionsother week 3 may initiate serial static pip extension splints at night if needed. Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries. However, most flexor tendon injuries will require surgery. Pdf epidemiology of flexor tendon injuries of the hand. Treatment of these injuries requires surgical repair. Original article a comparison of microscopic surgeries and.