Flexor hallucis longus anatomy origin posterior tibia and fibula passes deep to flexor retinaculum runs in fibroosseous tunnel along posterior talus between medial and lateral tubercles under sustentaculum tali deep to fdl at knot of henry. Help us write another book on this subject and reach those readers. 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. 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. This occurs as a result of gradual wear and tear of the tendon from overuse or aging. Klein, in fundamentals of hand therapy second edition, 2014. Flexor tendons run from the flexor muscles in the forearm to the finger bones along the palm side of the hand. Flexor tendon injury occurs to the muscle tendon flexor system of the hand. Closed flexor tendon ruptures due to trauma without an external wound are rare. Flexor tendon reconstructions and salvage procedures randall w. Management of flexor tendon injuries in hand intechopen.
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%. However the long tendons of the limbs are vulnerable to damage during exercise or as a result of trauma. The most common cause of a flexor tendon injury is a deep cut to the palm or the fingers. The flexor tendons are the most important structures of. A dorsal blocking splint obs is fitted to be worn at all times except during the active place and hold exercises. Athletes with iliopsoas tendonitis often complain of clicking in the hip and. Tendonitis of the hand causes severe pain with movement of the hand. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion. Anatomy tendons are tissues that connect muscles to bone. Hip flexor strain can occur when the hip flexor muscles are pulled, strained, torn or injured. Since the first flexor tendon repair was described by kirchmayr in 1917, several approaches to flexor tendon injury have enabled. During the last 20 years there have been significant innovations in injury repair and aftercare for patients who sustain zone 2 flexor tendon injuries. We would like to show you a description here but the site wont allow us.
Their job is to allow the body to move and to transfer weight. Flexor tendon injuries are caused by either overstrain of the tendon or direct trauma. Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. The initial evaluation of hand injuries needs a strong dose of paranoia to suspect and spot flexor tendon injuries. Tendon injuries tendons are the straplike elastic structures that attach muscles to the bones of which they act on.
Flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Tendons are made up of tough bundle of fibrous tissue, which connects muscles and bones. Exercises to strengthen hand flexor tendons healthy living. Most tendons are relatively short and rarely damaged. It is by no means intended to be a substitute for ones. There are two different types of tendons in the hand. Zone is unique in that fdp and fds in same tendon sheath both can be injured within the flexor retinaculum. To provide local rest for the flexor tendon and its sheath by limiting tendon excursion, in order to decrease inflammation, pain and associated triggering 5,16,17. Flexor tendon injuries in the hand and forearm adams plastic.
Review article avulsion injuries of the flexor digitorum. Refers to an avulsion injury of fdp from insertion at base of distal phalanx. Important considerations include fractures of the metacarpals or phalanges that may entrap the flexor tendon, limiting its motion. Flexor tendon reconstructions and salvage procedures. 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. Flexor tendon injury an overview sciencedirect topics. Tendons of the hand are thin, flat and white in color. Each of the flexor tendons passes through a tunnel in the palm and fingers that allows it to glide smoothly as the finger bends and straightens. The flexor tendons are responsible for allowing your fingers to bend. Early active motion protocol following triple kessler. While most people find grasping an object with their fingers to be trivially automatic, anyone who has suffered a hand flexor. Tendons and ligament injuries scott dunns equine clinic. Majority of the cases of flexor tenosynovitis are infectious in nature. Pdf flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient.
Flexor tendon injuries can occur in your hand and finger, causing pain and interfering with your normal range of motion. When the muscles contract, tendons bend the fingers. When the muscles contract, the flexor tendons allow the fingers to bend. If poor flexor tendon glide is evident and patient is compliant, splint is discontinued at 5 weeks postop. Sports injuries are also common causes of hand flexor tendon ruptures, usually in football, wrestling or rugby. A range of activities may cause the condition with the chief symptom being sharp pain. Moore md, in essentials of physical medicine and rehabilitation fourth edition, 2020. Justin mirza, orthopedic physicians at mirza orthopedics, outline some common symptoms of flexor tendon injuries.
While in the dbs the modified duran exercise program is performed. There are two flexor tendons for each finger and for the thumb. Each finger has two flexor tendons one bends the middle joint, the other bends both the middle and fingertip joints. An overview of the management of flexor tendon injuries. Although various repair techniques have been described, none has emerged as superior to others. Advice and exercises following your flexor tendon repair patient information clinical and diagnostic services centre hand therapy your flexor tendons bend your fingers. Flexor tendons are quite prone to injury due to their location below the skin and lack of flesh in the hand. This tendon can get irritated from overuse, muscle weakness and muscle tightness, causing tenderness and pain. Flexor tendon repair therapy protocol sideline orthopedics. A flexor tendon injury can make it impossible to bend your fingers or thumb. These flexor muscles move the fingers through cord like extensions called tendons, which connect the muscles to bone.
The surgeon approximated the ends of the cut tendon together and placed special designated. Flexor tendon injuries have constituted a large portion of the literature in hand surgery over many years. To decrease mechanical friction of the flexor tendon at the a1 pulley by blocking mcp flexion during movement 4,14. Placehold for hook, full and straight fist with wrist extended. Tenolysis is a wellestablished salvage procedure, which can be applied when nongliding adhesions form along the surface of a tendon after injury or repair and prevent gliding of the tendon in. Why is the equine superficial digital flexor tendon most at risk. Most often, the flexor tendons are damaged by a cut, which may also damage adjacent nerves. Flexor tendon injuries can be challenging, especially in zone ii. Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries. Pdf an overview of the management of flexor tendon. Diagnosis of straininduced tendon injuries of the equine distal limb are based on history usually a. The flexor tendons are located on the palm side of the hand. Any repetitive actions are more likely to damage a tendon.
Other injuries to the digital flexor tendons are result of tiny tears to the tendon that happen over time. Flexor tendon anatomy flexor tendon repair flexor tendon rehabilitation. Zone 1, fdp flexor tendon repair protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a flexor tendon repair. Pdf an overview of the management of 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 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. Early active mobilisation eam protocols are commonly used. Klein flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Flexor tendon injuries faq 1 what is a flexor tendon injury.
What is flexor tenosynovitis, know its causes, symptoms. Flexor tendon injuries are common and may have debilitating sequalae, with reoperation rates as high as 11%, culminating in poor patientreported outcomes. 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. Flexor tendon repair therapy protocol 2 of 5 o active digital extension with wrist flexed o fds blocking to uninvolved digits and tendons o fdp blocking to uninvolved digits, if fdp is not involved o 10 times, each, every 2 hours scar management. The athlete may feel a sensation of crepitus in the tendon and triggering of the first toe depending on the severity of the tendon injury 6. Hand injuries account for up to 20% of all presentations to emergency departments and cost the national health service nhs over. Flexor tendon injuries, however, can be very challenging to treat. Flexor tendon repair protocol zone i passive motion. The patient had suffered a laceration at the level of the distal interphalangeal joint with severance of the fdp. Triggering may also involve an inability to relax the toe after full plantar flexion of the ankle when pointing the foot, resulting in a feeling of.
For this reason, this series of presentations will focus on these injuries. Flexor tendon injury, repair and rehabilitation orthopedic clinics. The evidencebase for the management of flexor tendon. Materials and methods between 2009 and 2011, 25 men and one woman 36 fingers aged 22 to 56 mean, 33 years underwent 6strand triple kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. A direct flexor tendon injury must be suspected in all patients who present with an inability to flex one or more digits. Tendons are tough, stretchy tissues that join muscles to bone. Complications after flexor tendon injuries request pdf. Flexor tendon repair protocol zones iiii early active. Place hold for isolated fds glide of involved digits.
The human hand is a highly complex system that requires 29 bones, 29 joints, 123 ligaments, 34 muscles and three major nerves to act in concert. Hand tendon lacerations are notoriously difficult to treat with over 25% of patients achieving an unsatisfactory clinical outcome as assessed by the clinician, and 7. Flexor tendon repair, flexor laceration, post operative mobilisation, hand injuries, tendon injuries. Flexor tendons are prone to laceration and rupture with injuries commonly occurring in association with manual labor, athletics, and in the setting of degenerative tendon rupture. Doctors perform tendon repair surgery to fix a tendon injury. Disruption of the flexor digitorum profundus tendon, also known as jersey finger figure 4, commonly occurs when an athletes finger catches on another players cloth. Inflammation of the tendon sheath results in trigger finger. Avulsion injuries of the flexor digitorum profundus tendon abstract avulsions of the. Over 30,000 people suffer tendon injury in the uk per annum and over two thirds of these are hand tendon injuries1. The flexor tendons are long cordlike structures that attach the muscles of the forearm to the bones of the fingers. When this happens, the flexor tendon catches and the patient is unable to extend or flex the finger.
Yet many controversies remain and the techniques of surgery and therapy are still evolving. Even though flexor tendon injury is common, much remains to be elucidated about the best way to facilitate the intrinsic healing process and to. Flexor tenosynovitis is a condition where there is inflammation around the flexor tendons of the finger. However, depending on the mechanism and extent of injury, other injuries may also be present. Many injuries to the flexor tendons involve lacerations that cut into the tendon.