gps flexor-tendon-talk
TRANSCRIPT
Flexor Tendons - Zones
• Extensor Tendons Zones
Diagnosis of Flexor Injury
• Normal cascade• Independent testing of FDS & FDP• Passive tenodesis test• Forearm compression test
Flexor Tendon Testing
Normal Flexion Cascade
TenosynovitisAnatomy
• Flexor sheaths are closed spaces• Extend from the mid-palmar crease
to the DIPJ (Prox edge of A1 pulley to distal edge of A5 pulley)
• Flexor sheath of small finger is continuous proximally with the Ulnar Bursa, while the sheath of the thumb is continuous with the Radial Bursa
• Radial & Ulnar bursae extend proximal to the TCL and connect with the Parona space(Potential space between FDP & PQ muscle)
TenosynovitisGeneral
• Flexor sheath infections most often as a result of penetrating trauma– More likely at joint flexion creases– Sheaths are separated from skin by only a small amount of
subcutaneous tissue here
• Also, Felons can rupture into the distal flexor sheath• Usual causative agent: S. Aureus• most commonly affected digits:
– Ring, long & index fingers
TenosynovitisGeneral
• Purulence within the sheath destroys the gliding mechanism, rapidly creating adhesions that lead to loss of function
• destroys the blood supply producing tendon necrosis
TenosynovitisClinical
• Kanavel’s 4 cardinal signs:
– Tenderness over & limited to the flexor sheath– Symmetrical enlargement of the digit (“fusiform”)– Severe pain on passive extension of the finger (> proximally)– Flexed posture of the involved digit
• Not all four signs may be present early on• Most reliable sign: pain w. passive extension• Cellulitis of the hand may appear similar, but swelling &
tenderness is not usually isolated to a single digit
TenosynovitisTreatment
• Early infection < 48 hrs (& usually lacking all 4 signs) may initially be treated with IV Abx, splinting & elevation– Failure to respond within 24 hrs. should necessitate drainage
• Established pyogenic tenosynovitis is a surgical emergency– Requires prompt surgical drainage– Delays may result in tendon
&/or skin necrosis