wrist and hand tendon laceration

Question 1

finger flexor zone 1

Answer 1

insertion of FDP on distal phalanx to insertion of FDS on middle phalanx

Question 2

finger flexor zone 2

Answer 2

distal insertion of FDS to distal palmar crease

Question 3

finger flexor zone 3

Answer 3

palmar aspect

neck of metacarpals to distal border of carpal tunnel

Question 4

finger flexor zone 4

Answer 4

carpal tunnel

Question 5

finger flexor zone 5

Answer 5

proximal border of carpal ligament to extrinsic flexors in distal FA

Question 6

thumb flexor zone 1

Answer 6

distal insertion of FPL on distal phalanx to neck of proximal phalanx

Question 7

thumb flexor zone 2

Answer 7

proximal phalanx across MP jt to neck of 1st metacarpal

Question 8

thumb flexor zone 3

Answer 8

1st metacarpal to proximal margin of carpal ligament

Question 9

finger extensor zone 1

Answer 9

DIP jt

Question 10

finger extensor zone 2

Answer 10

middle phalanx

Question 11

finger extensor zone 3

Answer 11

PIP jt

Question 12

finger extensor zone 4

Answer 12

proximal phalanx

Question 13

finger extensor zone 5

Answer 13

apex of MP jt

Question 14

finger extensor zone 6

Answer 14

dorsum of hand

Question 15

finger extensor zone 7

Answer 15

midcarpal jt or wrist region

Question 16

finger extensor zone 8 and 9

Answer 16

distal and middle forearm

Question 17

thumb extensor zone 1

Answer 17

IP joint

Question 18

thumb extensor zone 2

Answer 18

proximal phalanx

Question 19

thumb extensor zone 3

Answer 19

MCP joint

Question 20

thumb extensor zone 4

Answer 20

metacarpal

Question 21

thumb extensor zone 5

Answer 21

carpometacarpal joint

Question 22

discuss the anatomical and morphological differences between flexor and extensor tendon laceration

Answer 22

flexor - return to full activity by 12 weeks

extensor - more common since superficial

Question 23

discuss the condition of tendon after rupture between flexor and extensor tendon laceration

Answer 23

flexor - tendons retract and usually require surgery

extensor - less likely to retract d/t numerous soft tissue attachment but also more prone to adhesions

Question 24

discuss the most difficult zones to treat between flexor and extensor tendon laceration

Answer 24

flexor - zone 2; no mans land d/t limited vascularity

extensor - zone 3 and 4

Question 25

discuss jersey finger

Answer 25

rupture or avulsion of the flexor digitorum profundus; zone I is affected

Question 26

discuss mallet finger

Answer 26

zone I injury to the extensor tendon mechanism at or near the DIP joint

Question 27

discuss direct repair

Answer 27

end-to-end repair in which the tendon ends are re-opposed and sutured together

Question 28

discuss tendon grafta

Answer 28

autogenous donor tendon (autograft - palmaris longus is sutured to replace damaged tendon necessary when the ends of the severed tendon(s) cannot be brought together without undue tension

Question 29

discuss timing of repair

Answer 29

immediate primary - w/in 24 hrs after injury delayed primary - up to 10 days post secondary - 10 days to 3 wks late reconstruction - beyond 3 to 4 wks staged - multiple surgeries over weeks to months; extensively damaged or scarred tendon

Question 30

what is the significance of timing of repair

Answer 30

if the repair is immediate, we wouldn’t be as concerned with atrophy, tightness than late staged reconstructions

Question 31

discuss delayed motion phase

Answer 31

when controlled immob extends for 3-4 wks pt is: - 7 to 10 yo - impaired cognitive capacity - unlikely to adhere to program - staged reconstruction compensate is primary since hands cant be used restore is secondary

Question 32

position of immob if flexor zones 1,2,3 is affected

Answer 32

10-45° wrist and 40-70° MCP flexion with PIP & DIP extension

Question 33

position of immob if flexor zones 2 or 4 is affected

Answer 33

70° MCP flexion, neutral wrist

Question 34

position of immob if extensor zones 3 or 4 is affected

Answer 34

PIP & DIP extension

Question 35

position of immob if extensor zones 5 or 6 is affected

Answer 35

30° wrist extension and 30-45° MCP flexion

Question 36

discuss early controlled motion phase

Answer 36

24-48 hrs after repair and no later than 5 days post op dec dema maintain tendon gliding - dec adhesions inc synovial diffusion better collagen alignment dec gap formation early active motion approach - use of MAT; isoms w/in allowed range

Question 37

discus maximum protection phase

Answer 37

after a short period of immobilization of only 1-3 days passive motion w/in allowed range differential gliding of FDS and FDP place and hold exercises

Question 38

discus moderate protection phase

Answer 38

cont place and hold - graduallly inc tension active flexion of IP in dynamic splint tendon gliding and blocking

Question 39

discuss minimum protection phase

Answer 39

no more splint, healed surgery na dexterity ex - buttoning, typing, writing low-load resistive ex - manual, light resistance, spider web sustained grasp ex - holding cup half filled muna then full functional use - simulate movements gradually progressed resistance exercises to improve strength and endurance, dexterity