Flexor Tendon

Question 1

blood supply to flexor tendons

Answer 1

from the vinculae supplied by the digital arteries

Question 2

healing of flexor tendons comes from

Answer 2

the blood supply and the synovial fluid

Question 3

when is the flexor tendon weakest?

Answer 3

inflammatory phase (0-2 weeks)

Question 4

tensile strength

Answer 4

the amount of force the tendon will tolerate before rupture

Question 5

most important flexor tendon pulleys

Answer 5

A2 and A4 (prevent bowstringing)

Question 6

FTR sutures

Answer 6

2, 4, or 6 strands*need to know number of strands used to select the appropriate protocol

Question 7

FTR rehab approaches (3)

Answer 7

1. immobilization2. immediate passive motion in the direction of the repair3. immediate active motion in the direction of the repair

Question 8

FTR immobilization use

Answer 8

rarely usedmay be used for children, limited cognition, or severe fractures

Question 9

FTR immobilization complications

Answer 9

adhesions and joint stiffness

Question 10

FTR immobilization orthosis

Answer 10

dorsal blocking orthosis wrist 20-30 deg flexionMP 50-60 deg flexionIP full extension

Question 11

FTR immediate passive flexion orthosis

Answer 11

dorsal blocking orthosiswith static IP positioning or elastic traction*may use elastic traction during day and strap in extension at night

Question 12

FTR immediate active flexion use

Answer 12

be selective on which patients you do this onpreferably at least 4 strand repairconsider edemamultiple protocols

Question 13

FTR immediate active flexion orthosis

Answer 13

protective dorsal blocking orthosis

Question 14

FTR wrist positioning

Answer 14

least tension in flexor tendons during flexion is with the wrist in slight extension

Question 15

FTR early immediate active flexion goal

Answer 15

light fist with DIP flexion NOT FORCEFUL

Question 16

FTR Pyramid of Progressive Force Application (9)

Answer 16

1. passive protected extension2. place and hold3. active composite fist4. hook and straight fist5. isolated joint motion6. discontinuation of protective splint7. resistive composite fist8. resistive hook with straight fist9. resistive isolated joint motion*first 4 wrist protected, last 5 wrist unprotected

Question 17

quadriga effect

Answer 17

limited active DIP flexion of adjacent digits in FTR because of common muscle belly of FDP

Question 18

FTR lumbrical plus finger

Answer 18

FDP is lacerated or too long distal to the lumbrical origin and the only/first available connection to finger movement is via the intact lumbricalonly resolved through surgical interventionnot to be confused with lumbrical tightness caused by adaptive shortening