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Flexor Tendon Injuries Applied Anatomy & Examination
Tendon Healing
Management
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Flexor Tendon Injuries
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Applied Anatomy
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Anatomy Musculotendinous units
Synovial sheaths & Fibrosseous canals
Pulleys
Vascular supply
Zones
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Tendon Structure
Composite material consisting of collagenfibrils embedded in a matrix of proteoglycans
Type I collagen (95%)
Type III and IV collagen (5%) Tenocytes are arranged in parallel rows
between bundles
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Tendon Structure
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Tendon Structure
Endotenon circumscribes each fascicle
Permits fascicular gliding
Epitenon surrounds the tendon
Contains capillary blood supply
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Tendon Structure
Epitenon
Endotenon
Paratenon
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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
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Applied Anatomy FDS
FDP
FPL
N & V
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FDS
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FDP
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FPL
FDP
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Verdan Zones
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Zone 5
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Zone 5/4
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Zone 3
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Zone 1/2
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Tendon Nutrition
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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 thedigital sheath. (Lundborg 1978, 1980)
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Vascular Supply
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Synovial Sheaths
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Pulleys
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Pulleys- A2 & A4
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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
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Summary Intrasynovial flexor tendon repair- leave
sheath intact
Preservation of A2 & A4 pulleys
Digital arterial ladder branch is identified
and preserved
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Summary Thick skin flaps retracted with sutures
Create windows in the membranous portion of theflexor tendon sheath
Blind passage of instruments into the tendon
sheath shouldbe avoided
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Management of Flexor tendonLacerations
History
Physical Examination
Surgical Repair
Rehabilitation
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Examination Colour, Capillary Refill, Temperature
Compare to non-injured hand
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Circulation
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Nerves - Sensory
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Diagnosis of Flexor Injury
Posture of Hand/ Normal cascade
Passive tenodesis test
Forearm compression test
Independent testing of FDS & FDP
Partial damage
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Normal Flexion Cascade
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Flexor Tendon Testing
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FPL
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