What is it?
Injuries of flexor tendons are among the most frequent and difficult to treat injuries of the hand. Flexor tendons running along the palmar side of the hand can be compared to strings which translate movement from flexor muscles located on the forearm to the place of action, i.e. to the wrist or a finger. Each finger has 2 flexors stacked on top of each other.
Being in constant muscular tone, flexor muscles cause that at the moment of breaking continuity of the tendon both ends move even a few centimetres away from each other. Flexor tendons run in their tunnel-sheaths and are additionally secured - as loops in a belt – which conditions correct bending of a finger.
Damage of these structures or their obliteration cause additional complications of return to health after their injury. There are nerves, arteries, and palmar digital veins situated near the tendons, so injuries are often accompanied by injuries of these structures causing loss of touch sensibility or blood supply to the finger. Small injuries on the surface of the palmar surface of the hand should never be underestimated, because they may result in damaging all the above mentioned structures.
Cause
The most frequent cause are injuries: incised, stab, lacerated wounds. In some cases spontaneous ruptures may happen, e.g. rheumatoid arthritis (RA).
Symptoms
In case of complete flexor tenotomy, the possibility of complete or partial bending of a finger is lost. Remember that the tendons can also be partially cut and the damage can remain unnoticed during a quick examination, which may result in complete breaking of the tendon. If dysaesthesia (tingling, numbness) or disturbance of the blood supply in fingers is revealed, then additionally damage of other structure located in the vicinity of the flexor tendons (nerves, finger blood vessels) is suspected.
Examination and diagnosing of the disease
In case of total damage to a tendon, diagnosis is relatively simple, whereas in case of partial damage it is not. Examination should be performed very carefully. Mobility of the finger, hand, its innervations and blood flow should be checked with the use of various tests. The examination should be carried out by an experienced surgeon.
Treatment
Injuries of flexor tendons are treated with a surgery. The method of treatment should be discussed with the patient, because his or her immediate return to work is impossible. The method of treatment depends on the kind of injuries, the patient’s age and the type of occupation. The surgery involves finding the ends of the tendons and tenosuture and preserving or reconstructing the retinacula of the hand. Cells of the tendons have are able to multiply and conditions their knitting. If the surgery is performed too late after the injury, it may be necessary to use artificial tendons or tendon grafts. Sometimes, transpositions of tendons are performed, the so-called Transpositions, in order to restore mobility of the finger.
If nerves or blood vessels are damaged, a surgeon of the hand will reconstruct these structures using microsurgical techniques.
Follow-up
Now a period of a few weeks of rehabilitation begins (4-8 weeks).The hand is immobilized with a special dressing. Very often rubber bands are fixed to fingers, the so-called Kleinert dorsal dynamic splint in order to start rehabilitation controlled by a surgeon or a physiotherapist. This period requires close cooperation of both parties and accurate adherence to the recommendations by the Patient. Secondary rupture of the tendon may sometimes happen or adhesions may develop during rehabilitation or after its completion, which. Another surgery is necessary in such cases.