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Flexor Tendon Injury

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 32-year-old chef presents 4 hours after sustaining a laceration to the volar aspect of his right ring finger while preparing food. The wound is over the proximal phalanx. On examination, the finger rests in relative extension compared to adjacent fingers. He is unable to flex the DIP joint when the PIP is held. He also cannot flex the PIP when adjacent fingers are held extended. Sensation is intact to both digital nerves. There is no active bleeding.
Clinical photograph demonstrating examination of flexor tendon function. The ring finger is held in extension at rest (cascade disrupted). Testing FDP: holding middle phalanx, patient cannot flex DIP. Testing FDS: holding adjacent fingers extended, patient cannot flex PIP. This demonstrates complete laceration of both FDP and FDS tendons in Zone II (no man's land). Urgent surgical repair is required.
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Clinical photograph demonstrating examination of flexor tendon function. The ring finger is held in extension at rest (cascade disrupted). Testing FDP: holding middle phalanx, patient cannot flex DIP. Testing FDS: holding adjacent fingers extended, patient cannot flex PIP. This demonstrates complete laceration of both FDP and FDS tendons in Zone II (no man's land). Urgent surgical repair is required.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the anatomy of the flexor tendon system including zones and pulleys.

Question 2 (5 marks)

How do you examine flexor tendon function and what are the findings?

Question 3 (6 marks)

Describe the surgical technique for Zone II flexor tendon repair.

Question 4 (5 marks)

What are the rehabilitation protocols after flexor tendon repair?

Question 5 (4 marks)

What are the complications and how do you manage them?

Question 6 (4 marks)

What are special considerations for thumb flexor tendon injuries?

Exam Day Cheat Sheet

Must Mention

  • •Zone II = "No Man's Land" (A1 to FDS insertion)
  • •Critical pulleys: A2 and A4
  • •FDP test: hold PIP, flex DIP
  • •FDS test: hold adjacent fingers extended
  • •4-6 strand core + epitendinous repair
  • •Early active motion prevents adhesions

Common Pitfalls

  • •Wrong zone definition
  • •Missing critical pulleys
  • •Wrong testing technique
  • •Missing suture strength
  • •No rehabilitation mention
  • •Missing complications