Flexor and Extensor Tendon Injuries Quiz and Flashcards

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Questions and Answers

What are the three phases of healing that decision-making should align with after repair of tendons?

Inflammatory, fibroplasia, remodelling (correct)

Inflammation, fibrosis, restructuring

Infection, fibroplasia, renovation

Inflammatory, fibrosis, remodeling

What is classified as 'early' motion following flexor injury?

0–5 days

4–5 days (correct)

5–10 days

1–2 weeks

Which tendon excursion issue is likely to increase after repair or re-insertion in zone I of the flexor digitorum profundus tendon?

Joint instability

Muscle atrophy

Adhesion formation (correct)

Ligament laxity

What type of regimen is considered unsuitable for a vulnerable repair in zone I of the flexor digitorum profundus tendon?

Kleinert type regimen Signup and view all the answers

What undesirable consequence can occur after injury and surgery at zone I of the flexor digitorum profundus tendon?

Tendon tethering Signup and view all the answers

Which factor influences decision-making after tendon repair based on an individual's response to injury and the severity of soft tissue and bone involvement?

Biological response to injury Signup and view all the answers

What is a crucial factor in determining the fate of flexor and extensor tendon systems?

Early motion introduction Signup and view all the answers

Which of the following complications may arise due to inadequate intervention in tendon injuries?

Joint contractures Signup and view all the answers

What is emphasized as being as crucial as the repair technique in tendon injuries?

Surgeon-therapist communication Signup and view all the answers

What has recent advances improved in the surgical and rehabilitation treatment of acute tendon injuries?

Complications reduction Signup and view all the answers

What plays a significant role in enhancing final outcomes following tendon repair?

Active motion introduction Signup and view all the answers

What is vital to determine safe splint position and motion progression during early phases of tendon healing?

Intra-operative information Signup and view all the answers

What is the recommended splint position for Zone 1 flexor tendon injuries?

Wrist at 10°–30° extension and MCP joints at 30° flexion Signup and view all the answers

What is the primary objective of current rehabilitation regimens at Zone II level for tendon repairs?

Promote differential tendon glide Signup and view all the answers

Why is a passive regimen considered a safer option in vulnerable repairs?

To prevent extension deficits Signup and view all the answers

What should be avoided in the presence of nerve injury with zones 4 and 5 flexor tendon injuries?

Prolonged splinting Signup and view all the answers

What should patients be discouraged from doing when there are injuries to the pulley system?

Using maximal effort to flex the DIP joints Signup and view all the answers

'Confining motion to the PIP joint only will encourage cross adherence' implies that this approach may lead to:

Encouraging adhesions between tendons Signup and view all the answers

'The strength of the repair decreases as the angle of tension increases' suggests that high tension can:

Impede active motion Signup and view all the answers

'One of the primary objectives of current rehabilitation regimens at this level is the preservation of differential tendon glide' implies that this preservation aims to:

Maintain healthy tendon movement Signup and view all the answers

'Passive flexion must be restored before active digital flexion exercises are initiated' indicates that active motion should not start until:

'Place and hold until full active tendon glide assured' Signup and view all the answers

'Emphasise active DIP joint flexion to ensure tendon glide' highlights that focusing on DIP joint flexion helps prevent:

'Increased risk of DIP joint fixed flexion deformities' Signup and view all the answers

What amount of motion is needed to retain extensor tendon excursion after repair in zones 5–7 and T4–5 of the thumb?

5 mm Signup and view all the answers

In which zones is immobilization crucial after extensor tendon repair?

F1–3 and T1–2 Signup and view all the answers

What is the focus of the Safe Controlled Motion (SCM) program in the first three postoperative weeks?

Preventing adhesions Signup and view all the answers

Which zones may result in significant extension lag even with minimal tendon attenuation?

F1–2 Signup and view all the answers

What is the purpose of active hold (place and hold) during rehabilitation after extensor tendon repair?

To enhance tendon excursion Signup and view all the answers

Which factor equates with loss of active extension after extensor tendon gapping?

Excessive flexion Signup and view all the answers

What is a common concern for patients with injuries involving zones F1–2?

Thumb dexterity loss Signup and view all the answers

When does Safe Splint Position (SSP) need to be established for all zones?

Immediately at repair Signup and view all the answers

How should the MP joints be positioned to facilitate digital flexion and inhibit the development of claw deformity in injuries involving finger tendons and nerve injuries?

60°–70° of flexion Signup and view all the answers

Which position is generally considered the best compromise in splinting the wrist post-injury to prevent tension on nerve repair?

Wrist neutral position Signup and view all the answers

What is the primary concern with wrist extension post-injury in relation to tendon prolapse?

Risk of tendon rupture Signup and view all the answers

In zone IV injuries, what type of lacerations are not common?

Tendon lacerations within carpal tunnel Signup and view all the answers

What is the main purpose of positioning the MP joints in 60°–70° of flexion post-injury?

To facilitate digital flexion and prevent claw deformity Signup and view all the answers

Why should adhesions between tendons be prevented after surgery?

To optimize tendon glide Signup and view all the answers

What is a potential consequence of significant intrinsic muscle involvement in injuries?

Claw deformity and scarring Signup and view all the answers

What is crucial in preventing claw deformity and achieving a greater range of IP joint flexion post-injury?

Positioning MP joints in 60°–70° of flexion Signup and view all the answers

What approach is recommended if there is doubt about the ability of a repair to withstand active motion post-surgery?

Passive techniques like the Kleinert regimen Signup and view all the answers

What should be included in the rehabilitation regimen for zone V injuries involving neurovascular structures?

Exercises focusing on differential glide Signup and view all the answers

What splint position is recommended for zone F7 injuries according to the provided text?

Wrist positioned in neutral Signup and view all the answers

What is essential for the surgeon to avoid in relation to tendon excursion after resecting part of the retinaculum?

Bunching of retinacular tendons Signup and view all the answers

Which injuries should be treated using the relative motion extension yoke splint?

T5 EPL injuries with wrist extension Signup and view all the answers

What is emphasized as having the greatest impact on the final outcome after tendon repair according to the text?

Early motion decisions Signup and view all the answers

What is advised as the standard rehabilitation program for most repaired tendon injuries?

Early motion Signup and view all the answers

For extensor tendon repairs, what method is suggested due to the lack of standard protocols according to the text?

Communicate with the surgeon and gather information Signup and view all the answers

What is the purpose of combining DIP extension with 20° of PIP flexion in a splint?

To relax the lateral bands Signup and view all the answers

Which type of injury often requires immobilization for 6–12 weeks, regardless of repair?

F1–2 injuries Signup and view all the answers

What deformity results from failure to repair or position the PIP joint properly after injuries in zones F3 and T3–4?

Boutonnière deformity Signup and view all the answers

What happens when there is a loss of central tendon integrity in zone 3 injuries?

Loss of finger PIP and thumb MP extension Signup and view all the answers

In zone T3–4 injuries, what contributes to the development of a boutonnière deformity?

Intrinsic thumb muscle hyperextension Signup and view all the answers

What is encouraged in the first 0–5 days postoperative period for zone F3 central tendon division?

Immobilization in neutral extension Signup and view all the answers

What is essential to limit tendon excursion in zones 4–7 after repair?

Immediate SCM Signup and view all the answers

What is the primary function of the relative motion extension yoke splint?

Encourage controlled active motion post-repair Signup and view all the answers

Why is the relative motion extension yoke splint unsuitable when all EDC, EIP, and EDM have been repaired?

It does not shield all repaired tendons from excess tension. Signup and view all the answers

What happens during immediate splint controlled motion (ICAM) using the relative motion extension yoke splint?

Active controlled motion is encouraged to prevent adhesions. Signup and view all the answers

Study Notes

Flexor Tendon Rehabilitation

Surgeon's assessment of repair quality, motion in adjacent joints, and individual's biological response influence decision-making for splint design and early motion.
Decision-making should align with phases of healing: inflammatory (0-5 days), fibroplasia (3-21 days), and remodelling (21 days-3 months).

Zone I Flexor Tendon Rehabilitation

Open lacerations of FDP tendon in zone I are subdivided into three levels: under A4 pulley, just distal to A4 pulley, and at or close to the insertion.
Exercises focus on achieving passive, followed by active, distal interphalangeal joint (DIP) motion.
Undesirable consequences of injury and surgery at this level include tendon tethering and DIP joint flexion deformity.

Zone II Flexor Tendon Rehabilitation

Immobilization for 6-12 weeks is common for F1-2 injuries.
The safe splint position (SSP) in the 0-5 days period immobilizes the IP in hyperextension, with MP motion unloading the EPL repair during motion through the intrinsic muscle insertions into the extensor apparatus.

Zone III and IV Flexor Tendon Rehabilitation

A boutonnière deformity results from failure to repair or properly position the PIP joint after injuries in zones F3 and T3-4.
The SSP in the 0-5 days period for the zone F3 central tendon (CT) division, with or without lateral band (LB) involvement, is with the PIP and DIP immobilized in neutral extension.

Zone IV Flexor Tendon Rehabilitation

Tendon excursion in zones 4-7 is greatest, necessitating controlled motion after repair to discourage adhesions.
The relative motion, or immediate controlled active motion (ICAM), splint is effective in limiting excursion of the tendon repaired in zones 4-7.

Extensor Tendon Rehabilitation

Normal tendon excursion in proximal digit zones is greater than in distal zones.
The estimated amount of motion needed to retain extensor tendon excursion after repair is 5 mm in zones 5-7 and T4-5 of the thumb and 4 mm in zones F3-4.
Adhesions become obstacles to tendon excursion in some zones, with immediate to early motion essential to regain normal excursion.

Safe Splint Position (SSP) and Splint Controlled Motion (SCM)

SSP shields the repair from gapping forces and must be established at the time of repair or within 5 days for all zones.
SCM commences during the first three postoperative weeks in all zones, with out-of-splint controlled motion exercises starting after 3 weeks for most zones.
The purpose of SCM is safe tendon excursion, distally and proximally, and active motion is preferable as it produces greater tendon excursion and is more effective in preventing adhesions and preserving motion.### Zone F4–6 and F7 Extensor Tendon Decision Algorithm
The algorithm ensures safe splint position and controlled motion progression during the first 3 postoperative weeks.
The wrist retinaculum can limit tendon excursion in all extensor compartments, and surgeons must resect part of the retinaculum to avoid this problem.

Wrist Retinaculum and Tendon Repairs

Positioning the wrist in neutral or up to 20° extension prevents bunching of retinacular tendons during proximal excursion.
The relative motion extension yoke splint is recommended for zone F7 injuries with the wrist in neutral, and for T5 EPL injuries with the wrist neutral and the thumb column in radial extension.

Decision-Making for Splint Controlled Motion (SCM)

Decisions made within the first 3 weeks after tendon repair have the greatest impact on final outcome.
Early motion requires clinicians to be informed, observant, and guided by goniometric measurement.
Algorithms like Fig. 2, Fig. 3, and Fig. 4 can aid decision-making.

Rehabilitation and Tendon Repairs

Immediate to early motion is the standard rehabilitation program for most repaired tendon injuries.
Active motion regimens are ideal for flexor tendons in all zones, but not always suitable for extensor tendon repairs.
There are no standard protocols for extensor tendon repairs, and therapists must communicate with surgeons and consider individual patient needs.
Optimal tendon glide must not compromise safety.

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Explore the critical decisions made by clinicians, surgical and rehabilitation treatments, and potential complications of acute flexor and extensor tendon injuries. Understand the importance of timely interventions to prevent deformity, loss of motion, and other functional limitations.

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