Hand and finger tendon injuries: Difference between revisions

No edit summary
No edit summary
Line 1: Line 1:
==Flexor==
==Flexor==
===Management===
*Primary repair should occur w/in 12hr; secondary repair can occur up to 4wk after injury
*Hand surgeon should repair all flexor tendon lacerations
*If hand surgeon is not immediately available:
**Irrigate open wounds and close with 5-0 nylon
**Most advocate antibiotics
**Splint hand with:
***Wrist in 30 deg of flexion
***MCP joints in 70 deg of flexion
***IP joint flexed 10-15 deg of flexion
==Extensor==
===Background===
===Background===
*Hand surgeon should repair all flexor tendon lacerations
*Most common site of tendon injuries b/c of superfical location on dorsum of hand
*Primary repair should occur w/in 12hr; secondary repair can occur up to 4wk after injury
*If tendon lac suspected but unable to be located it's ok to refer to specialist w/in 3d
**Delayed repair up to 7-10d usually has equal outcome to immediate repair
*See [[Extensor Tendon Repair]]
===Zones===
===Zones===
#Zone I
#Zone I
##Extends from insertion of flexor digitorum profundus to superficialis
##Area over distal phalanx and DIP joint
##Loss of flexion at DIP joint
##Complete laceration at this level will result in DIP joint flexed 40 degrees
##Retrieval of proximal tendon is often difficult
##"Mallet finger" refers to closed disruption of the distal extensor apparatus
###Occurs due to sudden forceful flexion of extended finger (finger gets "jammed")
###Most common tendon injury in athletes
##Immobilize DIP joint only in continuous slight hyperextension for 6-8wks
#Zone II
#Zone II
##Portion of digital canal occupied by both flexor digitorum super. and profundus tendons
##Area over middle phalanx
##Close proximity of these tendons makes exact repair essential
##Treatment is similar to zone I injuries
##Partial lacerations are more common in this zone than complete injuries
#Zone III
#Zone III
##Extends from distal edge of the carpal tunnel to the proximal edge of the flexor sheath
##Area over the PIP joint
##Outcomes are generally favorable
##Central tendon is most commonly injured structure
##Controversial whether conservative or operative management is best
###Closed injuries are initially treated w/ PIP joint immobilized in extension for 5-6wks
###Must be followed closely by hand specialist
#Zone IV
#Zone IV
##Involves the carpal tunnel and related structures
##Involves area over proximal phalanx
##Area must be explored carefully as many vital structures traverse this region
##Clinical findings are similar to zone III injuries
##Isolated injuries are the exception
#Zone V
#Zone V
##Proximal to the carpal tunnel
##Area over MCP joint
##Injuries tend to be severe and often involve multiple tendons/median and ulnar nerves
##Open injuries to this area should be considered human bites until proven otherwise
==Extensor==
###If it is human bite performed delayed repair following course of abx
===Background===
#Zone VI
*Most common site of tendon injuries b/c of superfical location on dorsum of hand
##Area over dorsum of hand
===Zones===
##Tendons in this area are superficial; even minor-appearing lacs are a/w tendon injuries
#
##Treatment typically requires operative fixation w/ K wires
#Zone VII
##Area over the wrist
##Repair can be difficult because of presence of extensor retinaculum
#Zone VIII
##Area of the distal forearm
##Tendons frequently retract into the forearm and must be retrieved and repaired
##Lac <25%: does not require repair
##Lac 25-50% requires simple suture repair
##Lac >50% requires specialized repair
 
==See Also==
[[Extensor Tendon Repair]]
 


==Images==
==Images==
Line 33: Line 64:
*Extensor Zones
*Extensor Zones
[[File:Extensor_Zones.jpg]]
[[File:Extensor_Zones.jpg]]
==Source==
*Tintinalli
*Rosen's
[[Category:Ortho]]

Revision as of 02:10, 27 September 2011

Flexor

Management

  • Primary repair should occur w/in 12hr; secondary repair can occur up to 4wk after injury
  • Hand surgeon should repair all flexor tendon lacerations
  • If hand surgeon is not immediately available:
    • Irrigate open wounds and close with 5-0 nylon
    • Most advocate antibiotics
    • Splint hand with:
      • Wrist in 30 deg of flexion
      • MCP joints in 70 deg of flexion
      • IP joint flexed 10-15 deg of flexion

Extensor

Background

  • Most common site of tendon injuries b/c of superfical location on dorsum of hand
  • If tendon lac suspected but unable to be located it's ok to refer to specialist w/in 3d
    • Delayed repair up to 7-10d usually has equal outcome to immediate repair
  • See Extensor Tendon Repair

Zones

  1. Zone I
    1. Area over distal phalanx and DIP joint
    2. Complete laceration at this level will result in DIP joint flexed 40 degrees
    3. "Mallet finger" refers to closed disruption of the distal extensor apparatus
      1. Occurs due to sudden forceful flexion of extended finger (finger gets "jammed")
      2. Most common tendon injury in athletes
    4. Immobilize DIP joint only in continuous slight hyperextension for 6-8wks
  2. Zone II
    1. Area over middle phalanx
    2. Treatment is similar to zone I injuries
  3. Zone III
    1. Area over the PIP joint
    2. Central tendon is most commonly injured structure
    3. Controversial whether conservative or operative management is best
      1. Closed injuries are initially treated w/ PIP joint immobilized in extension for 5-6wks
      2. Must be followed closely by hand specialist
  4. Zone IV
    1. Involves area over proximal phalanx
    2. Clinical findings are similar to zone III injuries
  5. Zone V
    1. Area over MCP joint
    2. Open injuries to this area should be considered human bites until proven otherwise
      1. If it is human bite performed delayed repair following course of abx
  6. Zone VI
    1. Area over dorsum of hand
    2. Tendons in this area are superficial; even minor-appearing lacs are a/w tendon injuries
    3. Treatment typically requires operative fixation w/ K wires
  7. Zone VII
    1. Area over the wrist
    2. Repair can be difficult because of presence of extensor retinaculum
  8. Zone VIII
    1. Area of the distal forearm
    2. Tendons frequently retract into the forearm and must be retrieved and repaired
    3. Lac <25%: does not require repair
    4. Lac 25-50% requires simple suture repair
    5. Lac >50% requires specialized repair

See Also

Extensor Tendon Repair


Images

  • Flexor Zones

Flexor Zones.jpg

  • Extensor Zones

Extensor Zones.jpg

Source

  • Tintinalli
  • Rosen's
Retrieved from "https://www.wikem.org/w/index.php?title=Hand_and_finger_tendon_injuries&oldid=5867"