Tendon flexor injury

FDS (flexor digitorum superfisialis)• origin (2 muscle belly)– Epicondilus Medial – Radial shaft

FDP(flexor digitorum profundus)

• Origin: ulna & membran interosseous • FDP: Common muscle origin for several tendons

FDP

• FDS• FDP• FPL• Lumbricals

origin from radial side of FDP

CAMPER’s CHIASMA

• FDS divides and passes around the FDP tendon, the two portions of the FDS reunite at “Camper’s Chiasma”

Preserve A2 and A4 pulley to prevent bowstringing. NOTE: There is a mistake in this Preserve A2 and A4 pulley to prevent bowstringing. NOTE: There is a mistake in this diagram: The C1 pulley is DISTAL to the A2 pulley!diagram: The C1 pulley is DISTAL to the A2 pulley!

PULLEYS

BLOOD SUPPLY

• Segmental branches of digital arteries which enter the tendon through: – vincula– osseous insertions

• Synovial fluid diffusion

FDS: Clinical Exam

FDS: Clinical Exam

FDP: Clinical Exam

ZONES

COMPLICATIONS

• Stiffness• Re-rupture• Tenolysis may be required in an estimated

18% to 25% of patients – No earlier than 3 months after repair– If no ROM improvement for 1-2 months

TENDON HEALING

PHASES OF TENDON HEALING

1.Inflamasi (0-5 ) : 2.Fibroblastic (5-28 ) : collagen-producing

phase3.Remodelling (28 hari - 4 bulan)

SUTURE TECHNIQUES

Kessler

Modified Kessler(1 suture)

• Advantage: Only one node inside the repair site. Easier to use a monofilament suture like a 4.0 Proline to re-approximate tendon edges.

Kessler-Tajima(2 sutures)

SUTURE MATERIAL

• Non-absorbable• Most authors prefer a synthetic braided 3.0 or

4.0 suture, usually of polyester material (Mersilene, Tycron, Tevdek)

• However, monofilament sutures like nylon and wire are also used (e.g. Proline)

• Additional running, circumferential 5-0 or 6-0 nylon is used often

POST-OP PROTOCOLS

1. Kleinert: Active extension, passive flexion by rubber bands

2. Duran: Controlled Passive Motion Methods3. Strickland: Early active ROM

GOAL: FULL ACTIVE ROM @ 10-12 weeks

Kleinert Protocol

COMPLICATIONS

• Joint contracture• Adhesions • Rupture • Bowstringing • Infection