Flexor Tendon Injuries

2018 ◽  
Author(s):  
Chao Long ◽  
Lisa C Moody ◽  
Paige M Fox ◽  
James Chang
Keyword(s):  
Flexor Tendon ◽  
Hand Function ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Tendon Injuries ◽  
Pulley System ◽  
Rehabilitation Protocols ◽  
Flexor Tendon Injuries

Flexor tendon injuries are common hand injuries that can significantly affect hand function. Treatment of these injuries requires a thorough understanding of the intricate anatomy and biomechanics of flexor tendons. The goals of reconstruction include restoration of tendon continuity, preservation and reconstruction of the pulley system, maximizing tendon gliding, and minimizing adhesion formation. Surgical treatment, in conjunction with postoperative hand therapy, provides enhanced function. This review provides the surgeon with the relevant anatomy, pearls of clinical evaluation, necessary investigative studies, management algorithms, surgical techniques, rehabilitation protocols, and approaches to common complications. It ends with a discussion of basic and translational research currently being undertaken to address the challenges posed by flexor tendon injuries and how this research can potentially advance patient care.   This review contains 16 figures, 5 tables and 55 references Key words: flexor tendon, flexor tendon injuries, flexor tendon reconstruction, flexor tendon repair, hand, hand surgery, injury, surgical technique, tendons

scholarly journals An Overview of the Management of Flexor Tendon Injuries

2012 ◽  
Vol 6 (1) ◽  
pp. 28-35 ◽  
Author(s):  
M Griffin ◽  
S Hindocha ◽  
D Jordan ◽  
M Saleh ◽  
W Khan
Keyword(s):  
Flexor Tendon ◽  
Current Knowledge ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injury ◽  
Post Surgery ◽  
Flexor Tendon Injuries

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines.

ROLE OF THE HYALURONAN-PRODUCING TENOSYNOVIUM IN PREVENTING ADHESION FORMATION DURING HEALING OF FLEXOR TENDON INJURIES

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 13-17 ◽  
Author(s):  
Masaharu Yagi ◽  
Yasuhiro Mitsui ◽  
Masafumi Gotoh ◽  
Naoto Sato ◽  
Kenji Yoshida ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Immunohistochemical Analysis ◽  
Tendon Injuries ◽  
White Leghorn ◽  
Group I ◽  
Flexor Tendon Injuries ◽  
The Right ◽  
Hematoxylin Eosin

Flexor tendons of white Leghorn chickens (n = 25) were used for this study. One chicken was used as a normal control (no surgery), and the remaining 24 were used for experiments. After partial tendon-severing in both legs of 24 chickens, the right and the left leg were treated differently, thereby creating two groups: Group I, in which the tenosynovium was preserved, and Group II, in which the tenosynovium was removed. Hematoxylin-eosin staining was performed to observe adhesions; immunohistochemical analysis was used to localize HA. HA production was noted in granulation tissue invading between the tendon stumps in both groups; however, HA expression in the tenosynovium was observed only in Group I where adhesion formation was minimal. The HA-producing tenosynovium plays a crucial role in preventing adhesion formation in this model of flexor tendon injuries.

Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

1989 ◽  
Vol 14 (4) ◽  
pp. 392-395
Author(s):  
K. W. CULLEN ◽  
PAMELA TOLHURST ◽  
D. LANG ◽  
R. E. PAGE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Adult Patients ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

scholarly journals Wide awake surgery for flexor tendon primary repair: A literature review

2020 ◽  
Author(s):  
Camillo Fulchignoni ◽  
Mario Alessandri Bonetti ◽  
Giuseppe Rovere ◽  
Antonio Ziranu ◽  
Giulio Maccauro ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Awake Surgery ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Flexor Tendon Injuries ◽  
Wide Awake

Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

Flexor tendon injuries in the child

2013 ◽  
Vol 39 (1) ◽  
pp. 46-53 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Skin Closure ◽  
Two Stage ◽  
Flexor Tendon Repair ◽  
Technical Aspects ◽  
Tendon Reconstruction ◽  
Flexor Tendons ◽  
Flexor Tendon Injuries

This review aims to highlight the differences in the management of flexor tendon injuries between children and adults. These include differences in epidemiology, anatomy, classification, diagnosis, incisions and skin closure, the size of the flexor tendons, technical aspects of zones I and II repairs, core suture purchase length, rehabilitation, results, and complications of primary flexor tendon repair. Finally, one- versus two-stage flexor tendon reconstruction in children is reviewed.

scholarly journals A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

2015 ◽  
Vol 7 (4) ◽  
Author(s):  
Rohit Singh ◽  
Ben Rymer ◽  
Peter Theobald ◽  
Peter B.M. Thomas
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Functional Anatomy ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries ◽  
No Man's Land ◽  
American Society

Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

scholarly journals Post-operative management of flexor tendon injuries at zone II and flexor Pollicis Longus – a survey of Irish practice

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michelle Spirtos ◽  
Mary Naughton ◽  
Emma Carr ◽  
Tadhg Stapleton ◽  
Michelle O'Donnell
Keyword(s):  
Flexor Tendon ◽  
Surgical Techniques ◽  
Operative Management ◽  
Tendon Injuries ◽  
Influential Factor ◽  
Exercise Session ◽  
Flexor Pollicis Longus ◽  
Content Type ◽  
Flexor Tendon Injuries ◽  
Zone Ii

Purpose The post-operative management of flexor tendon injuries has been the focus of considerable exploration and there continues to be variation in approaches and methods of mobilisation. The purpose of this paper is to explore therapy management following repair to flexor tendons at zone II and flexor pollicis longus (FPL) (all zones) in Ireland. Design/methodology/approach A descriptive survey questionnaire design through an online format was used. Therapists were recruited through the Irish Association of Hand Therapists, the national bodies for occupational therapy and physiotherapy and therapy managers in acute hospitals, with 29 therapists participating in the study. Descriptive statistics were used to analyse the survey data. Findings Patients were generally seen three to five days following surgery. Early active mobilisation approaches were favoured by all but one therapist, with 62% using the Belfast protocol and 34% the Manchester Short Splint (MSS) protocol. Each early active protocol exercise session commences with passive motion followed by graded active flexion. Tenodesis is incorporated by the majority of respondents within the first four weeks. Therapy programme and splints are modified based on patient presentation. Resistance exercises are commenced from week seven. Patient compliance was identified as the most influential factor in the post-operative intervention approach taken. Originality/value This study provides the first Irish profile of current practice in the post-operative management of flexor tendon repairs at zone II and FPL which has not previously been reported. Further research should explore the reasoning behind the interventions chosen and also the implications for practice of changes to surgical techniques.

Flexor Tendon Injuries in Children

1994 ◽  
Vol 19 (6) ◽  
pp. 696-698 ◽  
Author(s):  
A. O. GROBBELAAR ◽  
D. A. HUDSON
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendons ◽  
Ulnar Nerve Palsy ◽  
Flexor Tendon Injuries ◽  
Rapid Healing ◽  
Tendon Ruptures ◽  
Better Than

Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister’s criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.

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