Management

The image shows FDP and FDS rupture due to glass injury in Zone II of the little finger. Management of flexor tendon injuries involves the following:

Asessment

In assessing tendon function, the full range of motion of each tendon against resistance should be assessed.

Up to 90% of a tendon can be lacerated with preservation of the range of active motion without resistance.

Treatment

Early surgical treatment of flexor tendon lacerations, followed by a postoperative passive-motion rehabilitation programme [15], are necessary to achieve satisfactory outcomes.

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Partially lacerated flexor tendons – physiologic loads may be tolerated by a tendon that has a partial laceration involving up to 75% of the cross-sectional area. Although an unreliable sign, suspect it if there is pain on resisted flexion.

Wounds

Open hand wounds, due to sharp or penetrating objects, such as glass, need careful clinical evaluation. ED assessment must include clinical examination of tendon, nerve and vascular function.

Furthermore, all penetrating wounds that breach the deep fascia or palmar aponeurosis need to be identified. Such injuries require formal surgical exploration with suitable anaesthesia and tourniquet control because clinical examination alone will not confidently exclude significant injuries to tendons, nerves or blood vessels.

Partial flexor tendon lacerations involving less than 60% of the tendon are not always repaired [15], although they should still be referred for evaluation, as they may benefit from tendon debridement and postoperative rehabilitation.

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In the unconscious or uncooperative patient, compression of the forearm flexor muscles can also be used to test the integrity of the flexor tendons in the hand.

As the forearm is compressed, the digits are drawn into flexion. The digits also extend and flex when passively moving the hand and wrist through flexion and extension. Neither of these tests will exclude a partial tendon injury.