Practical Examination - Flexor Tendon Injury
Examination depends on the question given. May be examination of the whole extremity or just the
hand . Be careful !
Exaimination begins after asking 2 questions as allowed . Relevant questions might be after your
own introduction .
1. what happened ?
2.when did it happen ?
one can ask hand dominance and profession during examination to be clever .
Then get permission from patients
If command is to examine the whole upper extremity go as below
Look - Normal alignment of Right Upper extremity
shoulder at slight abduction
elbow flexed, forearm supinated with palm facing up
cascade of fingers not maintained , index finger is extended while others are in flexion
no wasting of muscles on arm , forearm , hand on volar and dorsum side
on hand , there is a transverse scar around 1 cm proximal to metacarpophalangeal joint ,
healed.
color of all fingers look pink on finger tips as well as nail bed
Feel - temperature normal
no soft tissue , bony tenderness
sensation- ulnar / median / radial nerve is intact
digital nerve sensation - intact
Pulsation - Allen's test for fingers
tinel's test for nerve injuries
Lymph nodes palbable or not
Movement - screening quickly active motion of shoulder , elbow and wrist
Finger passive active and passive test at PIP , DIP and MCP
Tests for
FDP of all fingers , FDS of all fingers , Extensor , Adductor ,abductors of fingers
Mention diagnosis as
Flexor Tendon Injury Rt. RF Zone III (Mention the duration of injury in weeks )
Investigations
MRI - to confirm diagnosis
to document the injury
proximal tendon level will be identified in old cases
X-ray - to see joints ,
if there is bony injury as well
Treatment
Physiotherapy to make skin supple , prevent joint stiffness
Surgery
Primary Repair - done within a week
Delayed Primary Repair - done within 14 days
Secondary Repair - 2-5 weeks
Delayed Secondary - after 5 weeks .
hand . Be careful !
Exaimination begins after asking 2 questions as allowed . Relevant questions might be after your
own introduction .
1. what happened ?
2.when did it happen ?
one can ask hand dominance and profession during examination to be clever .
Then get permission from patients
If command is to examine the whole upper extremity go as below
Look - Normal alignment of Right Upper extremity
shoulder at slight abduction
elbow flexed, forearm supinated with palm facing up
cascade of fingers not maintained , index finger is extended while others are in flexion
no wasting of muscles on arm , forearm , hand on volar and dorsum side
on hand , there is a transverse scar around 1 cm proximal to metacarpophalangeal joint ,
healed.
color of all fingers look pink on finger tips as well as nail bed
Feel - temperature normal
no soft tissue , bony tenderness
sensation- ulnar / median / radial nerve is intact
digital nerve sensation - intact
Pulsation - Allen's test for fingers
tinel's test for nerve injuries
Lymph nodes palbable or not
Movement - screening quickly active motion of shoulder , elbow and wrist
Finger passive active and passive test at PIP , DIP and MCP
Tests for
FDP of all fingers , FDS of all fingers , Extensor , Adductor ,abductors of fingers
Mention diagnosis as
Flexor Tendon Injury Rt. RF Zone III (Mention the duration of injury in weeks )
Investigations
MRI - to confirm diagnosis
to document the injury
proximal tendon level will be identified in old cases
X-ray - to see joints ,
if there is bony injury as well
Treatment
Physiotherapy to make skin supple , prevent joint stiffness
Surgery
Primary Repair - done within a week
Delayed Primary Repair - done within 14 days
Secondary Repair - 2-5 weeks
Delayed Secondary - after 5 weeks .
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