Evaluation Process


Assess for any external abnormalities such as deformity, open wounds, bruising and swelling, which may indicate the nature of the injury. Pallor or cyanosis of a digit suggests vascular compromise.


Observe the posture of the hand at rest, as with flexor tendons intact the fingers assume a partially flexed position at rest, with a cascade of increasing flexion from index through to the little fingers in the image.

Loss of cascade

Loss of cascade may indicate a flexor tendon injury. In small children, uncooperative or obtunded patients, squeezing the forearm muscles while observing the fingers can also be used to assess tendon continuity.

The status

The status of hand tendons can also be assessed by passively flexing and extending the wrist. With intact extensors, passive wrist flexion causes finger extension. When flexor tendons are intact wrist extension leads to flexion of the fingers.