day ten: flexor tendon injuries

Question 1

what two arteries supply the hand?

Answer 1

ulnar and radial

Question 2

what two arches do you have?

Answer 2

superficial and deep palmer arch

Question 3

what confirms the blood supply integrity

Answer 3

allens test

Question 4

what would you use the allens test on?

Answer 4

to confirm the blood supply integrity

Question 5

what do neurovascular bundles contain?

Answer 5

digital arteries vein and nerves

Question 6

how many neurovascular bundles are there

Answer 6

two

• one radial and
• one ulnar

Question 7

where does tendon nutrition come from?

Answer 7

1. intrinsic : vascular perfusion

2. extrinsic: diffusion from synovial fluid

Question 8

where does intrinsic nutrition come from?

Answer 8

vascular perfusion

Question 9

where does extrinsic nutrition come from

Answer 9

diffusion from synovial fluid

Question 10

vinculi branch

Answer 10

off the common digital artery

Question 11

two types of vinculi

Answer 11

short and long

Question 12

what does the vinculi supply?

Answer 12

FDS and FDP

Question 13

vascular supply mainly comes form where?

Answer 13

the dorsal side of the hand

Question 14

why is movement important for tendon healing?

Answer 14

synovial fluid bathes tendon = lubrication for glide

diffusion occurs as the synovial fluid gets umped into the tendon fibers during flexion and extension of the fingers

Question 15

how many pulleys do you have?

Answer 15

five

Question 16

what do pulleys do?

Answer 16

hold tendons close to the bone

Question 17

pulleys improve

Answer 17

the biomechanical efficiency of the flexor tendon system

Question 18

key pulley are

Answer 18

A-2 and A-4

Question 19

pulley damage causes:

Answer 19

bowstringing

Question 20

how does bowstringing present?

Answer 20

flexion of all dip pip mcps

Question 21

how many pulleys does the thumb have?

Answer 21

three pulleys

Question 22

what is the camper’s chiasm?

Answer 22

the space between the FDS and FDP tendons

Question 23

injury at zone 1 is

Answer 23

jersey finger

Question 24

jersy finger means

Answer 24

the FDP is involved so you can’t bend the tip of the finger

Question 25

zone 1 does

Answer 25

extends from the fingertip to the midportion of the middle phalanx

Question 26

zone 2 :

Answer 26

extends from the midportion of the middle phalanx FDS insertion to the distal palmar crease

Question 27

injury at zone 2 is

Answer 27

no man's land

Question 28

where is the most common area for flexor tenodn laceration ?

Answer 28

zone 2

Question 29

zone three does

Answer 29

extends from the distal palmar crease to the distal portion of the transverse carpal ligament - not as much scarring in this area

Question 30

zone four does:

Answer 30

overlies the transverse carpal ligament

Question 31

zone five

Answer 31

extends from the wrist crease to the level of the muscultendinous junction of the flexor tendon

Question 32

injury to zone five is

Answer 32

a spaghetti wrist

Question 33

surgical tendon repairs are called

Answer 33

incisions: z plasty

Question 34

a primary repair is when

Answer 34

within the first two weeks of tendon laceration you fix tendon

Question 35

a secondary repair is when

Answer 35

they were repaired after two weeks

Question 36

you would prefer a _______ repair

Answer 36

primary

Question 37

in a secondary repair what happens to the tendons?

Answer 37

the teonds and tendon sheaths become scarred | the musculotendinous units retract

Question 38

non bulky

Answer 38

old school 2 strand repair

Question 39

bulky

Answer 39

6 strand core: Strickland method

Question 40

pro cons of non bulky

Answer 40

pro passes under pulleys secondary less bulk | con; gaps and is weak

Question 41

bulky pros cons

Answer 41

con: doesn't pass through pulleys pro: you can just vent the pulley

Question 42

epitendinous suture

Answer 42

core suture followed by an epiteninous suture to complete the tendon reapire

Question 43

when you repair the sheath it

Answer 43

helps prevent adhesion formation | helps prevent triggering

Question 44

tendon repair is at its weakest day

Answer 44

10-12

Question 45

estimated core suture tensile strength decreases by _________ by end of the week one

Answer 45

50%

Question 46

list four therapy goals

Answer 46

prevent tendon rupture patient education promote tendon healing encourage tendon gliding

Question 47

three main therapy approaches to tendon management

Answer 47

controlled mobilization early active mobilization immolbization

Question 48

duran protocol entails

Answer 48

dorsal blocking splint which positions the wrist 20* flex MCP 60* flex ip neutrals

Question 49

in controlled mobilization the splint must allow

Answer 49

full IP extension

Question 50

controlled mobilization 4 weeks:

Answer 50

passive PIP and DIP movement

Question 51

controlled mobilization after 4 weeks

Answer 51

dorsal splint may be removed and gentle composite ROM

Question 52

controlled mobilization 6 weeks

Answer 52

completely remove splint

Question 53

controlled mobilization after 8 weeks

Answer 53

light strengthening

Question 54

controlled mobilization after 10 weeks

Answer 54

moderate strengthening exercises are begun

Question 55

controlled mobilization 12 weeks

Answer 55

pt resumes normal activities

Question 56

when is early active mobilization used?

Answer 56

4 strand repairs and greater

Question 57

what do you do with early active mobilization?

Answer 57

tendon gliding is elicted by active contraction of the injured muscle using tenodesis

Question 58

when you would use immobilization method?

Answer 58

young patient cognitive deficits non compliant patients

Question 59

what would you do with the immobilization method?

Answer 59

completely immobilize the patient for 4 weeks following tendon repair

Question 60

what is the most common complication

Answer 60

adhesion formation

Question 61

what does adhesion formation cause

Answer 61

stiff joints - limits ROM

Question 62

factors that promote adhesions are:

Answer 62

trauma to the tendon and sheath tendon ischemia digital immobilization prolonged edema

Question 63

factors that suppress adhesion formation are:

Answer 63

good surgical technique tendon mobilization early motion between the tendon and its sheath

Question 64

list four reasons for a tendon rupture:

Answer 64

non compliance accidental injury or fall place and hold exercises blocking exercises

Question 65

list five complications:

Answer 65

``` injury to neurovascular structures hypersensitivity complex regional pain syndrome bowstringing of the tendon infection ```

Question 66

tendon gapping:

Answer 66

separation of the two ends that creates a space and causes the tendon to have gap form end to end

Question 67

why is tendon gapping bad?

Answer 67

makes the tendon longer therefore it can not pull as effectively

Question 68

what is a WALANT method?

Answer 68

``` Wide Awake Lidocaine Anesthesia No Tourniquet ```