TENDON INJURY

INTRODUCTION

 • A tendon is a tough, high tensile-strength

band of dense fibrous connective tissue that
connects muscle to bone.
 Tendons are similar to ligaments; both are
made of collagen. Ligaments connect one
bone to another, while tendons connect
muscle to bone.
 'Tendons are strong cords that connect
muscles to bone.
 When muscles contract, their tendon(s) pull
through the attachments to bone and cause a
joint to move.
TENDON INJURY

 • Tendon Injuries are traumatic injuries to the tendons that can be

caused by laceration or trauma.
 Stages of Tendon Injury Healing
1. Inflammatory stage (48-72 hours) - inflammatory cells move into the site
of injury. 'They increase vascular permeability, initiate angiogenesis and
stimulate proliferation of tenocytes.
2. Proliferation stage (5 days to 4 weeks) - fibroblastic and collagen
producing cells enter and proliferate.
3. Remodelling stage (6 weeks onwards) - tissue repair and fibrosis occur:
Over time, the fibrous tissue is replaced by the scar-like tissue of the
tendon.
TENDONS OF THE HAND

FLEXOR TENDONS
• Each finger has two
flexor tendons, the Flexor
Digitorum Profundus and
the Flexor Digitorum
Superficialis and the
thumb has one (the Flexor
Pollicis Longus).
FLEXOR ZONES
 Zone I - From the insertion of the profundus tendon at the distal phalanx
to just distal to the insertion of the FDS.
 Zone II - This extends from insertion of FDS up to distal palmar crease.
 Zone II has been known as "no man's land“
 Zone III - Extends from distal palmar crease up to flexor retinaculum.
 • Zone IV - This zone lies under flexor retinaculum
 - Zone V - Extends from proximal border of flexor retinaculum to musculo
tendinous junction of flexor muscles.
 - T1 - distal to the interphalangeal joint (IP) in the thumb
 • T 2 - between the metacarpophalangeal (MCP) and interphalangeal
(IP) joints
 • T 3 - proximal to the metacarpophalangeal (MCP) to palmar flexion
crease
Five flexor zones:

zone 1
 From the insertion of the profundus tendon at the distal phalanx to just
distal to the insertion of the FDS.
Flexor digitorum Profundus Tendon
Injury
 • Disruption of the FDP tendon, also known as jersey finger
 • In an athlete's finger
 - football or rugby.
 • The injury causes forced extension of the DIP joint during active flexion.
(finger lies in slight extension relative to other fingers in resting position)
 • pain and swelling
Treatment

 • Type I injuries (partial rupture of the tendon) can be treated without

surgery with rest, ice and elevation.
 A finger splint is often used to hold the digit in place until healed
 • Type II (full tendon rupture) and
 • Type III (rupture with bone chip attached)
Collateral Ligament Injuries

 • Forced ulnar or radial deviation at any of the IP joints can cause partial or
complete collateral ligament tears.
 • The PIP joint usually is involved in collateral ligament injuries, which are
commonly classified as "jammed fingers.‘
 • pain located only at the affected ligament.
Treatment

 • If the joints are stable and no large fracture fragments are present, the
injury can be treated with buddy taping (i.e., taping the injured finger,
above and below the joint, to an adjacent finger)
Buddy Taping
Zone II

 • Zone II is often referred to as "Bunnell's no man's land." the critical area of

pulleys between the insertion of the FDS and the distal palmar crease.
 • Both flexor tendons interweave in a complex manner, therefore even
minimum swelling can cause adhesions with pulleys & thereby impair the
free motion of the tendon.
Trigger Finger

 •Trigger finger, or flexor tenosynovitis, is a condition in which the tendons

that flex the fingers become swollen and inflamed. This results in pain at the
base of one or more of the fingers
 • Inability of FDS &FDP tendons to slide smoothly under the A1 pulley
TREATMENT

 • Corticosteroids with local anesthetic into the flexor sheath.

TISSUE RELEASE
 • A small (less than 2 cm) incision is made in the skin, and the tight portion
of the flexor tendon sheath is released.
 • After the surgery, a sterile bandage is applied to the site of surgery. • This
bandage is removed after a few days,
 • And full use of the finger may then begin to prevent new adhesions
(scar).
Zone-III

• Extends from the distal edge of the carpal ligament to the proximal edge of
the A1 pulley, which is the entrance of the tendon sheath.

• 'The distal palmar crease superficially marks the termination of zone IlI and
the beginning of zone Il.
Dupuvtren's Contracture

 • This condition is due to inflammation of involving the ulnar side of the

palmar aponeurosis. Localized thickening and shortening of the palmar
fascia.
 • The fascia is thickened to form nodules and it contracts so that the
affected fingers are drawn into flexion.
Treatment

 Subcutaneous Fasciotomy
 Partial selective Fasciotomy
 Complete Fasciotomy
Skin Graft Method

 • A skin graft may be needed if the skin surface has contracted so much
that the finger cannot relax and the palm cannot be stretched out flat.
 • Surgeons graft skin from the wrist, elbow, or groin. The skin is grafted into
the area near the incision to give the finger extra mobility for movement.
Zone IV

 Includes the carpal tunnel and its contents (i.e., the 9 digital flexors and the
median nerve).
 Cause of CTS - The tendons in the wrist swell and put compression on the
median nerve,
 Hand numbness, pain and tingling in the distribution of median nerve.
Treatment

 • During surgery, an incision is made in the palm.

 • The roof of the carpal tunnel is divided to increase the size of the carpal
tunnel and decrease pressure on the median nerve.