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 .
   













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