FLEXOR TENDON INJURIES


Flexor tendons refer to the tendons that bend the fingers and the thumb. Flexor tendons run on the palm side of the hand. Each finger has two tendons (flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP)) and the thumb has one tendon called flexor pollicus longus (FPL).

Injuries to these structures are devastating and there is no quick fix. The injury could be closed, as in a jersey finger where the attachment of the tendon is pulled off the bone. This injury is commonly found in rugby players hooking their finger in the opponent’s rugby jersey. This usually involves the ring finger.

Open injuries are usually caused by lacerations of the forearm, palm or fingers. Tendon injuries are complex injuries and should be managed by a dedicated hand surgeon and dedicated hand rehabilitation team. It must be dealt with as soon as possible as the tendons retract towards arm and make surgery later more complex.

Cutting tendons in fingers is even more complex, as this area has a very intricate fibrous tunnel with multiple pulleys keeping the tendons close to the bone to increase the flexion arc of the finger. Repairing tendons in this zone (called the no-mans land) is very complex due to this pulley system, as well as the complex anatomy of the deep and superficial tendons attachment.

A good surgical repair is protected by a forearm based splint on the back of the hand that prevents the fingers from straightening, which could, potentially, undo or rupture the repair. These injuries require a minimum of six weeks of full time splinting and approximately a further six weeks of hand therapy to ensure optimal results.

It takes a lot of hard work to ensure the hand reaches its optimal strength, function and range of movement of the fingers.


Flexor Tendon Rehabilitation

Following a flexor tendon repair, is it important to start early protected mobilisation of the affected fingers around 3-5 days post surgery. This is to ensure that the repaired tendon starts gliding, thereby preventing scar adhesions that stick or trap the tendons and prevent the fingers from moving. The movement, however, needs to be done in a careful, protected way, so that the repaired tendon does not snap or rupture.

At 5 days post surgery, the post surgery cast will be removed and the bulky dressing removed. The base layer of dressings should remain in place.

A thermoplastic splint is fabricated. This fits on the back of the forearm and prevents the wrist and fingers from straightening. This splint is worn full time until 4 weeks post surgery. Thereafter it is worn when sleeping and for protection for a further 2 weeks.

The hand therapist will teach specific active and passive exercises to promote the movement of the fingers, without jeopardising the repaired tendon/s. The hand therapist will also assist with scar and swelling management, strengthening and give advice around the safe use of your hand.

Compliance with rehabilitation and home exercises is strongly recommended to achieve the best possible outcome.

FLEXOR TENDON INJURIES


Flexor tendons refer to the tendons that bend the fingers and the thumb. Flexor tendons run on the palm side of the hand. Each finger has two tendons (flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP)) and the thumb has one tendon called flexor pollicus longus (FPL).

Injuries to these structures are devastating and there is no quick fix. The injury could be closed, as in a jersey finger where the attachment of the tendon is pulled off the bone. This injury is commonly found in rugby players hooking their finger in the opponent’s rugby jersey. This usually involves the ring finger.

Open injuries are usually caused by lacerations of the forearm, palm or fingers. Tendon injuries are complex injuries and should be managed by a dedicated hand surgeon and dedicated hand rehabilitation team. It must be dealt with as soon as possible as the tendons retract towards arm and make surgery later more complex.

Cutting tendons in fingers is even more complex, as this area has a very intricate fibrous tunnel with multiple pulleys keeping the tendons close to the bone to increase the flexion arc of the finger. Repairing tendons in this zone (called the no-mans land) is very complex due to this pulley system, as well as the complex anatomy of the deep and superficial tendons attachment.

A good surgical repair is protected by a forearm based splint on the back of the hand that prevents the fingers from straightening, which could, potentially, undo or rupture the repair. These injuries require a minimum of six weeks of full time splinting and approximately a further six weeks of hand therapy to ensure optimal results.

It takes a lot of hard work to ensure the hand reaches its optimal strength, function and range of movement of the fingers.

Flexor Tendon Rehabilitation

Following a flexor tendon repair, is it important to start early protected mobilisation of the affected fingers around 3-5 days post surgery. This is to ensure that the repaired tendon starts gliding, thereby preventing scar adhesions that stick or trap the tendons and prevent the fingers from moving. The movement, however, needs to be done in a careful, protected way, so that the repaired tendon does not snap or rupture.

At 5 days post surgery, the post surgery cast will be removed and the bulky dressing removed. The base layer of dressings should remain in place.

A thermoplastic splint is fabricated. This fits on the back of the forearm and prevents the wrist and fingers from straightening. This splint is worn full time until 4 weeks post surgery. Thereafter it is worn when sleeping and for protection for a further 2 weeks.

The hand therapist will teach specific active and passive exercises to promote the movement of the fingers, without jeopardising the repaired tendon/s. The hand therapist will also assist with scar and swelling management, strengthening and give advice around the safe use of your hand.

Compliance with rehabilitation and home exercises is strongly recommended to achieve the best possible outcome.

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