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FlexorTendonInjuriesoftheHandMargaretFOKAssociateConsultantHonoraryClinicalAssistantProfessorQueenMaryHospital
AnatomyOfFlexorTendonFDSdecussatesintotwotendonslipsPassaroundtheFDPneartheMCPJSubsequentlyinsertasachiasmaonthepalmarsurfaceoftheMP (Camper’sChiasma)FDPpassesthroughthedecussationandinsertatthedistalphalanx(ZoneI).
FlexorTendonSheathSynovialsheathprovideslow-frictionglidingprovidessynovialnutritionFibrousretinacularsheath:“pulley”systemAnnularpulleysCruciatepulleys
ExaminationInFlexorTendonInjuryPostureSqueezetestTenodesiseffectActivemotiontest
ExaminationinFlexorTendonInjuryTendodesiseffectActiveflexion test
Zoneofflexortendoninjury
FlexorTendonInjuryPrimaryordelayedsurgicalrepairWoundextendingincisionsAtraumatictechnique:decreasedamagetoepitenonanddecreaseadhesionCoresutureandcircumferentialsutureSheathrepair:controversialImprovetendonglidingandnutritionDelayedpresentationesp3weeks-2stage
ZoneIAlwayspreserveA4pulleyDirectrepairifresidualstumpgoodenoughtoacceptcoresuturejustrunvolarepitendinoussutureposterior-wall-firstcircumferentialepitendinoussuture(Strickland)Advancementwithpull-outwireifresidualstumptooshortforcoresuture:(rare)
ZoneIIBoth(FDS,FDP)tendonsrepaired?pros:vincularbloodsupplytoFDPpreserved,independentFDSmotion,morestrengthcons:difficultsurgeryesp.aroundchiasma,bulkinessofrepairrestrictedmotionesp.underA2pulleySheathclosure?pros:preventtriggeringcons:restrictedmotion
ZoneII:ARationalApproachCleancutrepaireverythingintra-op.motiontestexciseportionofsheath(cruciatepulley)ifnecessaryCrush/Raggedinjuriestryrepairbothtendonsexciseportionofsheath(cruciatepulley)ifnecessaryintra-op.testforimpedenceofFDPthroughchiasmaexciseFD
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