Scribd
Upload
107 views44 pages

Flexor Tendon Injuries: - Applied Anatomy & Examination - Tendon Healing - Management

The document discusses flexor tendon injuries, including their anatomy, structure, vascular supply, biomechanics within the digital sheath and pulley system, and management. Key points are that flexor tendons are composed of collagen fibrils within a proteoglycan matrix; they receive nutrients via perfusion and diffusion within the synovial sheath; preservation of the A2 and A4 pulleys is important for function; and surgical repair aims to leave the sheath intact while avoiding blind passage of instruments.

Uploaded by

ayelhuseny
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
107 views44 pages

Flexor Tendon Injuries: - Applied Anatomy & Examination - Tendon Healing - Management

The document discusses flexor tendon injuries, including their anatomy, structure, vascular supply, biomechanics within the digital sheath and pulley system, and management. Key points are that flexor tendons are composed of collagen fibrils within a proteoglycan matrix; they receive nutrients via perfusion and diffusion within the synovial sheath; preservation of the A2 and A4 pulleys is important for function; and surgical repair aims to leave the sheath intact while avoiding blind passage of instruments.

Uploaded by

ayelhuseny
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 44

Flexor Tendon Injuries

• Applied Anatomy & Examination

• Tendon Healing

• Management
Flexor Tendon Injuries
Applied Anatomy
Anatomy
• Musculotendinous units
• Synovial sheaths & Fibrosseous canals
• Pulleys
• Vascular supply
• Zones
Tendon Structure
• Composite material consisting of collagen
fibrils embedded in a matrix of proteoglycans
– Type I collagen (95%)
– Type III and IV collagen (5%)
• Tenocytes are arranged in parallel rows
between bundles
Tendon Structure
Tendon Structure

• Endotenon circumscribes each fascicle


– Permits fascicular gliding

• Epitenon surrounds the tendon


– Contains capillary blood supply
Tendon Structure

Epitenon

Paratenon
Endotenon
Tendon Structure
• Paratenon is the adventitia that covers
the flexor tendon in the palm
– Consists of visceral & parietal layer
– Continuous with synovial mesotenon
– Supplies tendon nutrients
– Allows tendon gliding
Applied Anatomy
• FDS
• FDP
• FPL
• N&V
FDS
FDP
FPL
FDP
Verdan Zones
Zone 5
Zone 5/4
Zone 4
Zone 3
Zone 1/2
Zone 2 – Campers Chiasma
Tendon Nutrition
Nutrient Supply
• Dual Source via Perfusion and Diffusion
A. Perfusion from blood supplied by longitudinal
vessels as well as the vincula system.
B. Diffusion within the sheath is via synovial
fluid.
• Diffusion is more important within the
digital sheath. (Lundborg 1978, 1980)
Vascular Supply
Synovial Sheaths
Digital Sheaths

• Analogous to paratenon
– Visceral layer surrounds
tendons
– Parietal layer contains
thickenings that
comprise the flexor
sheath and pulley system
– Contains synovial fluid
Pulleys
Pulleys- A2 & A4
Biomechanics
• Moment arm-pulleys
– Loss of pulleys increase
excursion necessary for
desired flexion
Strickland OCNA 1983
Biomechanics
• Forces generated during tendon function
– Passive flexion 2-4 N
– Active with mild resistance 10N
– Active with moderate resistance 17N
– Strong grasp 70N
– Tip pinch 120N
– Power grip 200N

– (FDS 30% < FDP, loads increased by edema/scar)

Schiund et al JHS 1992


Biomechanics
• 9 cm of tendon excursion is required for
composite wrist & digital flexion
– 2.5 cm for full digital flexion with wrist
stabilized

• Tendon excursion and joint rotation are


controlled by pulley system
Summary
• Intrasynovial flexor tendon repair- leave
sheath intact

• Preservation of A2 & A4 pulleys

• Digital arterial ladder branch is identified


and preserved
Summary
• Thick skin flaps retracted with sutures

• Create windows in the membranous portion of the


flexor tendon sheath

• Blind passage of instruments into the tendon


sheath should be avoided
Management of Flexor tendon
Lacerations
• History
• Physical Examination
• Surgical Repair
• Rehabilitation
Examination
• Colour, Capillary Refill, Temperature

• Compare to non-injured hand


Circulation
Nerves - Sensory
Diagnosis of Flexor Injury

• Posture of Hand/ Normal cascade


• Passive tenodesis test
• Forearm compression test
• Independent testing of FDS & FDP
• Partial damage
Normal Flexion Cascade
Flexor Tendon Testing
FPL

You might also like