Tendon injuries

March 2018 | by EMauthor


Assess the functions of individual tendons in injured hands

Always examine wounds over finger and hand under local anaesthesia (after you have assessed the sensory functions) and examine tendon movement looking for partial injury of tendon

Complete division of tendons result in lack of tendon function. Incomplete division present with pain on active use (especially against resistance), but often only revealed on wound exploration

In testing for tendon damage keep these points in mind

oThe flexor superficialis tendon acts on the PIP joints. To eliminate profundus activity at the PIP joint, hold the other fingers in extension while testing. Superficialis damage will appear as failure of PIP joint flexion

oThe long finger extensors are the only extensors of the MCP joints

oFlexor Pollicis Longus function is tested at the thumb IP joint

oDivision of central slip of the extensor tendon (usually result from hyperextension injury, or following dislocation at PIP joint) can be missed initially and can result in Boutonniere deformity. To test it hold the PIP joint flexed at 90 degrees over table edge, attempts at extension against resistance will result in hyperextension of DIP joint


Management


Extensor tendon, complete division or division of more than 30% will require repair, refer to orthopaedics

Single flexor tendon, refer to orthopaedics

Multiple flexor tendons injury, refer to plastics

Tendon injuries in children, refer to plastics



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