tendons

Question 1

carpal tunnel has which tendons?

Answer 1

FDS x4
FDP x4
FPL

Question 2

what prevent bowstringing of the digits?

Answer 2

A1 pulleys

Question 3

flexor tendon zone 1

Answer 3

distal to FDS insertion on midpoint of the middle phalanx
- only FDP injured

Question 4

flexor tendon zone 2

Answer 4

Insertion of the FDS to level of the A1 pulley (distal to palmar crease)

Question 5

flexor tendon zone 3

Answer 5

proximal A1 pulley to origin of lumbricals from FDP tendons (dostal edge of the transverse caprpal ligament)

Question 6

flexor tendon zone 4

Answer 6

carpal tunnel

Question 7

flexor tendon zone 5

Answer 7

proximal aspect of transverse carpal ligament to the musculotendinosis junction

Question 8

zone T1

Answer 8

distal to thumb IP joint

Question 9

zone T2

Answer 9

thumb A1 pulley to IP joint

Question 10

zone T3

Answer 10

thenar eminence

Question 11

flexor tendons are relatively ___ between vinculae

Answer 11

avascular

Question 12

intrinsic healing of tendons occurs from?

Answer 12

direct blood supply or nutrients in the synovial fluid

Question 13

tendons ___ after they are cut or ruptured

Answer 13

retract

Question 14

test FDS by
Test FDP by

Answer 14

flexing PIP
flexing DIP

Question 15

how will the injury look if it occurs when the finger is extended

Answer 15

skin wound and FDP, FDS tendons will be lacerated on the same level

Question 16

how will the injury look if it occurs when the finger is flexed?

Answer 16

tendon injury will be distal to wound, FDP will be lacerated on a different level than the FDS due to different excursion

Question 17

symptoms of a flexor tendon injury

Answer 17

abnormal cascade
passive extension of wrist does not produce finger flexion
loss of normal tension
loss of active flexion

Question 18

early phase of tendon healing

Answer 18

0-2 weeks
inflammatory and proliferative phase
tendon is at its weakest
collagen begins laying down

Question 19

intermediate phase of tendon healing

Answer 19

2-6 weeks
tendon beings to gain tensile stregnth

Question 20

what is tensile strength?

Answer 20

amount of force that is tolerated by the tendon before it ruptures

Question 21

late phase of tendon healing

Answer 21

6+ weeks
continued gain of tensile strength
at 12 weeks enough tensile strength for most functional activities

Question 22

a 3mm gap can cause a repaired tendon to

Answer 22

fail to glide or rupture due to catching on pulley edge

Question 23

3 basic protocols for a flexor tendon repair

Answer 23

immobilization (3-4 weeks)
early passive motion (within 24 hours of repair)
early active motion (within a few days of repair)

Question 24

immobilization protocol for orthosis position

Answer 24

wrist flexed 20-30 degrees
MCPs flexed 50-60 degrees
IPs straight

Question 25

how does the immobilization change for a flexor tendon repair in the intermediate phase of healing?

Answer 25

move wrist to a neutral positon

Question 26

when in the intermediate phase of healing from a tendon flexor repair do you wear the orthosis when doing exercises?

Answer 26

No, remove during exercise

Question 27

for early active motion protocol for a flexor tendon repair what orthosis is worn and for how long

Answer 27

a wrist tenodesis orthosis and wrist dorsal blocking orthosis up to 6 weeks

Question 28

kleinert Protocol

Answer 28

passive flexion with rubber bands and active extension in DBS 0-4 weeks: DBS, passive flexion, active extension 4-6 weeks: wristlet, place and hold excercises, scar management 6-8 weeks: AROM, TGEs, differiental gliding, and light ADLs 8-12 weeks: strengthening, work/leisure activities

Question 29

durant protocol

Answer 29

passive flexion and extension in DBS 0-4.5 weeks: DBS, passive flexion and extension 4.5-6 weeks: active flexion and extension in DBS 6-8 weeks: TGEs, diff gliding, scar management, light ADLs 8-12 weeks: strengthening and work/leisure activites

Question 30

the groths pyramid of progressive force application is a guide for progression when adhesions limit...

Answer 30

active flexion

Question 31

start with exercises that result in __ force to the tendon repair

Answer 31

least

Question 32

when is frequency of exercise using the groths pyrmaid higher?

Answer 32

at base of pyramid, decreases at pt moves up

Question 33

if patient has good early active motion delay what type of exercise?

Answer 33

resistance

Question 34

no grip or pinch strength testing till what week?

Answer 34

week 12

Question 35

what modality can be used to decrease adhesions

Answer 35

ultrasound

Question 36

when should you being NMES

Answer 36

within 1 week of resistance exercise

Question 37

Duran and Houser's passive exersies protocol and what mm to promote optimal excursion to decrease adhesion formation

Answer 37

6-8 reps 2x per day 3-5mm

Question 38

pyramid order

Answer 38

bottom to top: passive protected extension palce and hold active composite fist stright and hook fist isolated jt movements discontinue splint reistive comp fist resitive hook and strgiht fist resistive isloated jt movements

Question 39

extensor tendons are ___ and ___ compared to flexor tendons

Answer 39

broad and thin

Question 40

extensors are __ compared to flexors

Answer 40

weak

Question 41

extensors are more ___ and do not run under a ____ system like the flexors do

Answer 41

superficial; pulley

Question 42

the juncturae tendinum is an ___ tendon/ a narrow band of CT interconnecting the ___ tendons

Answer 42

interconnecting; EDC

Question 43

functions of the JT?

Answer 43

force distribution maintain space for the EDC tendons during digit extension MCP stabilization

Question 44

extensors can funtion at ___ weeks versus 12 weeks like the flexors

Answer 44

6-8 weeks

Question 45

3 basic extensor tendon rehab appraoches based on zones

Answer 45

immobiliztion for zone 1 or 2 early passive or active for zone 3-7

Question 46

zone 1 injury also known as a ___ ___ spint this is slight ___ for how many weeks? and then after these weeks what do you limit?

Answer 46

mallet finger HE 6-8 weeks limit DIP flexion to 20-25 degrees

Question 47

no full ___ after a zone 1 injury until 3 months post

Answer 47

flexion

Question 48

zone 5 and 6 injuries are mainly due to what

Answer 48

laceration or rupture due to RA

Question 49

tenolysis is the surgical release of

Answer 49

non gliding tendon adhesions

Question 50

post op week 1

Answer 50

edema control -elevation/cold packs/coban immediate AROM TGEs Place and hold -slight,mod,max flexion