Flexor Tendon Injuries

Front 1

What annular pulleys are the most crucial for normal digital function

Back 1

A2 and A4

Front 2

HOw many annular and Cruciform pulleys are there

Back 2

4 annular
3 cruciform

Front 3

What promotes healing with the healing of a tendon

Back 3

the intrinsic vascular supply

Front 4

The vincula

Back 4

Vascular and nutritional supply to the tendons

Front 5

How do you test the FDS

Back 5

With adjacent fingers
in full extension, prohibiting
FDP motion, efforts at finger flexion produce in normal
hand isolated FDS function.

Front 6

FDP testing

Back 6

Testing of FDP function.
Isolated DIP flexion can only
be accomplished with intact
FDP musculature.

Front 7

Flexor zone 5

Back 7

Extends proximally from the proximal edge of the carpal ligament to the musculotendinous junction of the long flexor tendons.

Front 8

Flexor injuries in zone 5 are usually accompanied by

Back 8

major nerve injruies and possible arterial invovlement

Front 9

Therapeutic goal for zone 5 injury

Back 9

challenge:To restore differential gliding of the tendons as injuries at this level can easily adhere to skin and surrounding structures.

Front 10

Zone 4

Back 10

the tendons pass through the narrow carpal canal, which underlies the transverse carpal ligament. The proximal limit on the skin would correspond to the volar wrist crease.

Front 11

Injuries to Zone 4

Back 11

Involve both flexor tendons or can be just the superficialis. Can involve median and ulnar nerves.

Front 12

Therapeutic goal of zone 4 injury

Back 12

to restore tendon glide

Front 13

Zone 3

Back 13

Located in the palm
Proceeds proximally from the metacarpal neck to the distal end of the transverse carpal ligament
Delineated by the boundaries of the flexor retinaculum

Front 14

Zone 3 injuries

Back 14

level:Involve both flexor tendons or just the superficialis.

Front 15

How do zone 3 injuries heal

Back 15

typically quickly

Front 16

therapeutic goal for zone 3

Back 16

Intrinsic muscle contracture can result from adhesions and protective positioning during the first few weeks of healing especially if the therapist does not concentrate on tendon gliding exercises and MP ROM.

Front 17

Zone 2 is titled...

Back 17

"no Man's land"
Sheath area that is hard to get to by surgeons

Front 18

Zone 2 is delineated by

Back 18

the boundaries of the flexor reticulum which extends fromt he mid portion of the middle phalanx proximally to the neck of the metacarpal

Front 19

Injuries at zone 2

Back 19

Can affect one or both of the flexor tendons

Front 20

Therapeutic challenge of zone 2

Back 20

to restore maximal tendon glide

Front 21

Zone 1

Back 21

Compromises the base of the distal phalanx to the middle of the middle phalanx. This zone is distal to the insertion of the flexor digitorum superficialis.

Front 22

Most common zone to experience injury..that we will see in practice

Back 22

Zone2

Front 23

Primary surgical option for tendon repair

Back 23

within 24 hours

Front 24

Delayed primary surgery option for tendon repair

Back 24

Performed 24 hours to 3 weeks post injruy

Front 25

secondary repair surgery option for tendon reapir

Back 25

more than 3 weeks after the injury
most at risk for scarring

Front 26

Inflammatory phase

Back 26

48 -72 hours after
little collagen is laid donw

Front 27

During inflammatory phase, tendon repairs are held together by

Back 27

the strength of the suture material

Front 28

when does strenght begin to come back after injury

Back 28

does not strengthen until 21 days

Front 29

Fibroplasia phase

Back 29

rapid scar formation
new scar is very weak
repair can be easily disrupted by excessive force

Front 30

time frame for fibroplasia phase

Back 30

5 days to 4 weeks

Front 31

Maturation phase

Back 31

Increased repair strength allows therapists to apply greater and greater stresses to the tendon, thus influencing scar remodeling

Front 32

complications after injury

Back 32

Rupture and Adhesions

Front 33

Implications for therapy after repair

Back 33

early controlled mobs

Front 34

when should mobilizations start

Back 34

during the inflammatory and fibroplasia stages

Front 35

When does AROM begin after surgery

Back 35

3 weeks or earlier

Front 36

At 3 weeks, how strong is the tendon?

Back 36

only at 20% of its tensile strength

Front 37

Factors affecting adhesions

Back 37

Age
Health
Nutritional Status
Means of Injury-initial trauma
Surgical Technique
Hx of smoking or alcohol consumption
Systemic disease
Gapping at repair site
tendon immobilization
Tendon Ischemia

Front 38

Adhesions cause

Back 38

limited flexion due to scar tissue

Front 39

All protocols are based on

Back 39

the date of the repair

Front 40

How long does rehab typically last

Back 40

12-16 weeks

Front 41

Intervention priorities to consider

Back 41

Education
Protection - splinting
Wound management
Edema
Mobilize joitns and tendon
Prevent contractures

Front 42

intervention approaches types

Back 42

immobilization
early Passive mobs
Early active mobs

Front 43

What is the most recent approach used for flexion protocol?

Back 43

Early active mobilization
based on minimizing work of flexors. wrist is positioned in neutral or slight ext. w\

Front 44

Common Protocols for Early passive mobs

Back 44

Kleinart
Duran
Houser

Front 45

Modified Duran is typically used for what zones?

Back 45

2 or 3

Front 46

Modified Duran proticol

Back 46

After tendon repair, a dorsal cast or splint is applied maintaining the wrist in 20to 30 of flexion, the MP in 50to 70 of flexion and the IPs in neutral.

Front 47

Kleinert was developed specifically for..

Back 47

Repairs in zone 2

Front 48

Kleinert uses...to facilitate

Back 48

Rubber band traction

Front 49

when do you start strengthening

Back 49

6-8 weeks

Front 50

when will a pt with a tendon repair be able to return to work

Back 50

10-12 weeks
with proper rehab

Front 51

Precautions with Exercise

Back 51

Do not forecfully extend
Passive motion should be done in a slack and protected position
Watch for contractures