Competency: Flexor Tendon Repair

Hello.

My name is iris fraser and I will be presenting today on

flexor tendon repair protocol specifically for zones two and three weeks.

0 to 6.

We're going to start our presentation with

some important anatomy specifically for the flex earners of the hand.

We are also going to go over the zones of the hand.

Some splint ng that is used during flexor tendon repair postoperative.

And then we are going to go into specifics of weekly protocol as well

as tendon glides which are in intervention that are included in the later weeks of

rehab

following a flexor tendon repair.

So let's jump into anatomy.

What anatomy is affected by a flexor tendon injury?

We will get specifically into that when we jump to nerves and

muscles but I want to start off by pointing out the digit numbers

Digit one starts with the thumb. So this is digit one

digit two

digit three

digit four

digit five,

abbreviated as D. One D. Two D. Three D. Four and D. Five.

Important to remember as I will be referring

to them as such throughout the presentation.

And if you are a hand therapist in the future

you will be referring to them as such as well.

Okay let's start with the nerves.

The nerves that are affected in flexor tendon

injuries include the median nerve,

the owner nerve and the radial nerve.

The radial nerve is affected if the thumb

experiences a flexor tendon

rupture

the median nerve is affected if

this

um

past the Mp

and the I. P. Of the thumb that is

experiencing a flexor tendon rupture or repair

As well as d. two d. 3 d. four

Half of the four.

If any of those experience

a flexor tendon repair.

That is the median nerve.

The other half of the ring finger and the pinkie

are innovated by the owner nerve.

In which case if there's a flexor tendon repair or rupture for

those

digits

the owner nerve would be affected

moving on to muscles a little complicated. But

let's start by saying the flexor digit orum superficialities

is superficial to the flexor digit tore. Um Profundis.

In other words

the flexor digit orum superficialities lays on top

of the flexor digit orum profundis.

How can we remember that?

I think of it like this.

So if somebody were to say something profound

it's something that's really deep and intellectual.

So

key word being deep

superficialities

meaning it's superficial.

Just like if you were to say somebody has a superficial personality they

only care about the way they look or the clothes that they wear.

Things are on the outside that's superficial. So

flex er digit orum superficial list. The F. D. S. Let's start with that.

That is the primary flexor of the pipe joints.

These guys here

I also labeled them on this

picture

and it also assists inflection of the M. C. P joints.

The flexor digitize your um profundis flexes the M. C. P.

And D. I. P joints of the index, middle

ring and little fingers.

As you can see in my picture here the FDS is in green

and it only stops or it only goes to the middle.

Filante

the FDP goes all the way to the end.

So the FDP flexes the D. I. P. S. As you can see this is my FTP working right now

and then the FDS

is the primary flexor of the P. I. P. Joints.

As a side note which we will get into right now,

what I'm doing is joint blocking to show you that I am only flexing my P.

I. P. Joint

using my

flex sergio auditorium superficially FDS.

And now I am only flexing my D. I. P. Joint

which is my flexor digitally in Profundis FDP moving that.

Moving on to the thumb.

The flexor policies Bravest which is in that dark blue color flexes the thumb. M. C.

P. Again I'm going to joint block

and the

CMC.

So the C. M. C. And the M. C. P. The reflection of those two

by means of the flexor policies. Bravest. The F. P. B.

Allows for opposition for the thumb to the pinky

the flexor policies longest the FP L.

In light blue there

flexes the I. P. Of the fun again I'm going to joint block.

This is my I. P flexing

through the movement and initiation of my F Pl.

The FTl also contributes to the thumb. M. C. P flexion

and wrist flexion.

So these are the muscles that are affected by a flexor tendon repair,

moving on to the zones of the hand.

There are five

zones

starting from the tip to the wrist

As you can see my picture here. one

two

three

four

and then five.

I think it would be helpful if you were to pause the video right now

and draw this on your hand.

Drawing is

drawing and writing is a cognitive tool

to help you remember things.

So I think it would be beneficial and helpful for you to draw down

your hand to remember.

Um During my hand therapy placement at kora

physical therapy I was asked to do exactly that and it did help. Um

I also want to point out that today we are going to be focusing on zones two and three.

So when I get to the flexor tendon

protocol I'm specifically talking about zones two and three

so go ahead and pause the video

and draw that on.

I think it's pretty self explanatory again. 125 goes this way but it is helpful.

Um It's important to know why why do we even have zones of

the hand because that is a tool for the orthopedic surgeons to let

other medical professionals including occupational therapists

know the location of the flexor

tendon injury as well as of course the surgery to repair.

So at this time you should have already paused the video and drawn that on your hand.

Look at it, do it as much as you need to. Um

These are good to know.

I also want to give you another helpful tip.

There are five zones for the flexors

Flex your

side of your hand has five zones.

There are more zones on the back of your hand

for extensive zone.

But when you learn that down the road, just remember flexor five zones,

flexor five ff, flexor five.

Okay, moving on.

So we're going to get into splint ng.

When we experience our patients experience a flexor tendon rupture repair,

we end up

the orthopedic surgeon ends up putting them in a dorsal blocking splint.

What does that look like?

Here we go.

Um

You can go ahead and read the degrees of

flexion that the dorsal blocking splint is encouraging.

Um

But yes, so we want to kind of

in a flexor pattern.

Why? Why do we want in a flexor pattern? Because it promotes optimal healing.

If we have a flexor

tendon cut in half,

are we going to want to extend it past its limit and potentially snap it again?

Of course not.

You know, if we have a rubber band that's weak,

the more we stretch it, the quicker it is to break. Right?

So the tendons are kind of like rubber bands.

If we stretch it, it's going to break, it's weak, it's still going through healing.

It's preparing we do not want to extend it,

which is why we put it in a dorsal blocking splint.

We want to keep in a flex er pattern.

Another fun way to remember dorsal

um

The dorsal fin

on a dolphin is on their back.

So the dorsal part of your hand is on the back of your hand.

So dorsal blocking splint

in a flexor pattern.

These are the degrees that they promote

that the dBS promotes.

Okay,

when is the dorsal blocking splint discharged

whenever the orthopedic surgeon tells you to?

Um

or tells the patient to essentially? Um

Typically that is in weeks 4-6.

Something between there but ultimately it depends on

the patient's range of motion and scarring.

Um

With that being said if the dorsal blocking splint is discharged,

a postoperative flexor tendon brace may be

prescribed following the dorsal blocking splint.

But again,

that is up to the orthopedic surgeon's discretion and is dependent on

the patient's range of motion and scarring in general healing process.

Okay, so that is the basis of what we have for our flexor tendon repair.

I am going to move on to the weekly protocol

and the tendon glides

in a separate presentation because I am limited on time here. So,

I also think it would be helpful to have them separated for studying reasons. So

this is the end of this specific presentation and I'm

going to go ahead and direct you to the next one

Competency: Flexor Tendon Repair

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