What Are Different Types of Flexor Tendon Injury?

Hand tendon injuries are mostly open, with many cutting injuries, often accompanied by neurovascular injury or bone and joint injury, and closed lacerations can also occur. After a tendon rupture, the corresponding joint loses its function. Since the internal hand muscles are still intact, the metacarpophalangeal joint flexion is not affected. Different parts of the extensor tendon are broken, and their corresponding joints cannot be extended, and deformities can occur.

Basic Information

Visiting department

orthopedics

Common causes

Cutting injuries, chainsaw injuries, crush injuries, etc.

Common symptoms

Interphalangeal joints cannot flex

Contagious

no

Causes of flexor tendon injury

Hand tendon injuries are mostly open, with traumatic factors such as cutting injuries, as well as chainsaw injuries, crush injuries, etc., mostly due to tendon rupture and corresponding symptoms. The contusion surrounding the crush injury is severe, often accompanied by nerve, blood vessel, bone and joint damage. Attention should be paid during treatment.

Clinical manifestations of flexor tendon injury

The disease is mainly manifested as impaired mobility in the corresponding area of the damaged flexor tendon:

1. Superficial flexor tendon rupture

The corresponding interphalangeal joint cannot flex.

2. Finger rupture of deep flexor tendon

The distal interphalangeal joint cannot be flexed.

3. Both the deep and shallow flexor tendons are broken

The distal and proximal interphalangeal joints cannot be flexed. Since the internal hand muscles are still intact, the metacarpophalangeal joint flexion is not affected.

Examination of flexor tendon injury

The clinical diagnosis of flexor tendon injury is not difficult. According to the history of trauma and the functional performance of the affected area, the diagnosis can generally be made. For some patients with incompletely ruptured tendons, joint activity may appear normal. At this time, a resistance test may be performed, which manifests as weakness and pain in the fingers, so that a diagnosis can be made and a corresponding treatment method can be made.

Diagnosis of flexor tendon injury

The disease is mainly caused by traumatic factors, which can be diagnosed based on the patient's traumatic history, clinical and examination.

Complications of flexor tendon injury

This disease is often associated with neurovascular injuries or bone and joint injuries, and closed lacerations can also occur. These complications are more likely to occur in patients with crush injuries. After a tendon rupture, the corresponding joints will lose their mobility. In addition, the disease is also prone to tendon adhesions. Tendon nutrition, tendon healing, and tendon adhesions are a causal relationship. The more severe the tendon nutrition, the slower the tendon healing, and the more severe tendon adhesions. Collapse and atrophy of the tendon sheath can even occur.

Flexor tendon injury treatment

The treatment of this disease has different treatment methods depending on the area of injury:

1. Deep tendon abutment zone (zone )

From the middle phalanx to the point of deep tendon resistance. In this area, only the deep flexor tendon is referred to. Early repair is required after rupture, and the stump is sutured directly. If it breaks within 1 cm of the abutment point, the tendon end can be moved forward, that is, the distal segment is cut off, and the proximal end is reattached to the rest point.

2. Tendon sheath area (II area)

From the start of the tendon sheath to the attachment of the superficial flexor muscle (the middle part of the phalanx), the deep and superficial flexor tendon is confined within the narrow tendon sheath. It is easy to stick after injury, difficult to handle, and the effect is poor, so Also called "no man's land". At present, it is generally suggested that if the superficial flexor tendon is pulled and broken, it may not be anastomosis to avoid adhesion. The deep tendon and the superficial tendon are broken at the same time. Only the deep tendon is anastomosed and the superficial tendon is removed at the same time. There are also claims to repair both shallow and deep flexor tendons.

3. Palm area (III area)

Transverse wrist transverse ligament to the area before the tendon enters the tendon sheath. Vermiform muscles are attached to the radial side of the deep tendon in the palm, limiting the proximal tendon retraction after rupture. In the vermiform muscle region, the deep and shallow tendons are broken at the same time, and anastomosis can be performed at the same time. The deep tendons are wrapped with vermiform muscles to prevent adhesion to the superficial tendons. Vermiform muscle to the tendon sheath segment, only anastomosing the deep tendon, and removing the superficial tendon.

4. Carpal tunnel area (zone )

Nine tendons and median nerves are squeezed in the carpal tunnel, and the space is small. The median nerves are superficial and often injured simultaneously with the tendons. During treatment, the transverse carpal ligament should be incised, and only the deep tendon and long flexor hallucis tendon are sutured, and the superficial tendon is removed to increase the gap. The anastomosis should not be on the same plane. The median nerve must be anastomotic at the same time.

5. Forearm area (zone )

From the start of the tendon to the proximal end of the carpal tunnel, which is 1/3 below the forearm. In this area, the flexor tendon is protected by the peri-tendon tissue and surrounding soft tissues, and there is less chance of adhesion. Flexor tendons are injured in this area, and all should be sutured in the first stage. The effect is usually better. However, when multiple tendons of the deep and shallow flexor tendons are broken, the anastomosis should be on the same plane to reduce adhesions.

Rupture of the hallucis longus tendon should also be repaired in the first stage. At the level of the metacarpophalangeal joint, the tendon is sandwiched between two sesamoid bones, which can easily cause adhesions. The fracture of this plane does not directly suture the tendon, but cuts off the distal end, and stretches the tendon at the abdomen junction of the upper tendon of the wrist. Metastasis of the hallucis longus flexor tendon. Rupture within 1 cm of the dead point, usually using the tendon forward method, but does not extend the tendon.