Abos - Hand, Wrist, And Forearm: Flexor And Extensor Tendon Anatomy, Injury, And Repair

Front 1

Flexor tendon blood supply is via vincula entering (dorsally or volarly?)

Back 1

Dorsally

Front 2

By what methods are tendons nourished?

Back 2

Synovial nutrition
Longitudinal intertendinous vessels
Vessel branches in vincula

Front 3

This process of synovial nutrition is also known as what?

Back 3

lmbibition

Front 4

The two terminal slips of FDS join at what location?

Back 4

Camper’s chiasm

Front 5

What structure passes over this point?

Back 5

FDP

Front 6

What is the relationship of the FDP to the FDS at all locations except at Camper’s chiasm?

Back 6

FDP deep to FDS in the palm and digits except at Campers chiasm

Front 7

What pulleys are considered critical to normal finger function? Why?

Back 7

A2
A4
These are the most critical for
preventirrg flexor tender bow-stringing

Front 8

What pulleys are located over the joints of the digits?

Back 8

A1
A3
A5

Front 9

When exposing the PIP volar plate, what pulleys can be sacrificed safely?

Back 9

Distal part of C1
Entire A3
Proximal part of C2

Front 10

What are the zones of flexor tendon injury?

Back 10

I: distal to FDS insertion (PDP only)
II: from A1 pulley (both FDP and FDS,
no-man’s land") to FDS insertion
lll: proximal to A1 pulley distal to carpal tunnel
IV: within carpal tunnel
V: wrist/forearm

Front 11

What is the treatment for flexor tendon injury involving <25% tendon diameter?

Back 11

Trim torn fragment

Front 12

What is the treatment for injury involving 25 to 50% of tendon diameter?

Back 12

Epitenon repair

Front 13

What is the treatment for injury involving over 50% of tendon diameter?

Back 13

Core and epitenon repair

Front 14

Clinically obvious bow—stringing suggests what associated injuries?

Back 14

Flexor tendon sheath disruption likely involving A2 and A4 pulleys

Front 15

What are the three flexor tendon healing phases, and characteristics of each?

Back 15

Inflammatory (days, 0 to 5): minimal strength, suture imparts tendon repair strength
Fibroblastic (day 5 to 3-6 weeks): increasing strength, fibroblasts proliferate
Remodeling (>day 28): collagen cross-linking

Front 16

At which time point is the repair weakest?

Back 16

Days 6 to 12 (end of inflammatory phase)

Front 17

The majority of the repaired tendon strength returns by what time?

Back 17

28 days (end of fibroblastic phase)

Front 18

When is the maximum strength of the repair achieved?

Back 18

6 months (end of remodeling phase)

Front 19

What is the most important factor in determining strength of repair?

Back 19

Number of crossing core suture strands

Front 20

The addition of epitendinous suture increases repair strength by how much?

Back 20

50%

Front 21

Is there a reported advantage to pulley release at the time of flexor tendon repair?

Back 21

Increased tendon excursion

Front 22

Rehabilitation protocols emphasize what type of motion?

Back 22

Patient—controlled passive motion

Front 23

If an active motion rehabilitation program is planned, how many crossing suture strands are necessary?

Back 23

At least six strands

Front 24

What are the two general types of rehabilitation protocols?

Back 24

Duran (active extension, patient flexes passively)
Kleinert (active extension, dynamic T splint flexes passively)

Front 25

What is the classic position for hand and wrist splinting after flexor tendon repair?

Back 25

Wrist flexed 30 degrees
Metaphalangeals (MCPs) flexed 70 degrees

Front 26

What is the advantage of a continuous passive motion (CPM) device postoperatively?

Back 26

Decreased rate of adhesions
Maintains joint motion

Front 27

What is the frequency of symptomatic flexor tendon adhesions at 3 months after repair?

Back 27

50% of patients require tenolysis at 3 months

Front 28

What clinical exam findings are suggestive of postoperative tendon adhesions?

Back 28

Full passive range of motion (ROM)
Decreased active ROM

Front 29

What is the reported advantage of antiadhesion gel application?

Back 29

Improved active PIP motion

Front 30

Has polyvinyl alcohol been shown to be effective against adhesions?

Back 30

No, increases risk of rupture

Front 31

Repairs rupture most commonly at what location?

Back 31

Knot

Front 32

Rupture is most often secondary to what?

Back 32

Gap formation

Front 33

What two pulleys are most important?

Back 33

Oblique
A1

Front 34

Is early motion advocated after flexor pollicis longus (FPL) repairs?

Back 34

No

Front 35

Why not?

Back 35

Because FPL rupture rate is up to 20% (versus 2 to 5% for other digits)

Front 36

What is the most commonly affected finger?

Back 36

Ring finger

Front 37

If the avulsed FDP remains attached to a bony fragment, to what location does
it commonly retract?

Back 37

A4 pulley

Front 38

What is the treatment method of choice for an FDP avulsion with an attached fracture fragment?

Back 38

Open reduction with internal fixation (ORIF) of fragment

Front 39

If no fracture fragment is attached, what is the most important consideration in planning tendon repair and why?

Back 39

Location of the retracted tendon
Dictates the timing of the repair

Front 40

What is the timing for repair of an avulsed FDP retracted all the way to the palm? Why?

Back 40

Repair within 7 to 10 days
Because vascular supply to retracted tendon is poor

Front 41

If FDP retracts only to the PIP joint, what is the recommended timing of repair? Why?

Back 41

Within 3 months (does not need to be as acute)
Because vincula are intact