Abstract
Flexor tendon injuries are potentially debilitating injuries with developing strategies for treatment. A solid understanding of flexor tendon and flexor pulley anatomy, discerning examination maneuvers, and operative treatment is important for improving outcomes.
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Describe the flexor tendon “zones” | In the fingers |
Zone 1—distal to FDS insertion | |
Zone 2 (“no man’s land”)—distal to distal palmar crease (A1 pulley), proximal to FDS insertion | |
Zone 3—distal to carpal tunnel, proximal to distal palmar crease (A1 pulley) | |
Zone 4—Within carpal tunnel | |
Zone 5—Wrist and forearm proximal to carpal tunnel | |
In the thumb | |
Zone 1—Distal to interphalangeal joint (IP) | |
Zone 2—Distal to A1 pulley, proximal to IP | |
Zone 3—Thenar eminence | |
Zone 4–5—Same as fingers | |
Describe the flexor pulley system | Five annular pulleys, three cruciate pulleys prevent tendon bowstringing and direct tendon gliding |
Odd numbered pulleys (A1, A3, A5) overlay joints (metacarpophalangeal, proximal IP, distal IP) and arise from volar plate of joints | |
Thumb has A1, Av, oblique, A2 pulleys only | |
Which pulleys are the most important to prevent flexor tendon bowstringing in the fingers? In the thumb? | Fingers—A2 and A4 |
Thumb—Oblique pulley | |
What is the orientation of flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons in the palm and digit and what is the anatomic landmark where the orientation changes? | Palm—FDP deep, FDS superficial |
Finger—FDP superficial, FDS deep | |
FDS tendon splits at “campers chiasm” and dives deep to insert on middle phalanx around FDP which continues distal to insert on distal phalanx | |
What are the specific functions of the FDP and FDS tendons? | FDP—Flexion of distal IP joint |
FDS—Flexion of proximal IP joint | |
What is the predominate way that tendons receive nutrition? | Diffusion through synovial fluid created by the tendon’s synovial sheath |
When can flexor tendon lacerations be treated nonoperatively? | Laceration of <60% tendon width |
What is the most important determinant of flexor tendon laceration suture repair strength? | Number of suture strands crossing repair site |
Besides crossing sutures, what can be done to improve gliding and strength of a repaired tendon? | Simple, running epitendinous suture |
How are chronic flexor tendon injuries typically treated? | Two-stage reconstruction |
Stage 1—Silicone rod placement | |
Stage 2—Tendon graft interposition |
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Sobel, A.D. (2018). Flexor Tendon Injuries. In: Eltorai, A., Eberson, C., Daniels, A. (eds) Essential Orthopedic Review. Springer, Cham. https://doi.org/10.1007/978-3-319-78387-1_51
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DOI: https://doi.org/10.1007/978-3-319-78387-1_51
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Publisher Name: Springer, Cham
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Online ISBN: 978-3-319-78387-1
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