Brachial Plexus Injuries
Carpal Avascular Necrosis
Flexor / Extensor Tendon Injuries
Proximal Interphalangeal (PIP) Joint Injury
Ulnar Collateral Ligament (UCL) of the Thumb
Flexor / Extensor Tendon Injuries
A tendon is a band of tough fibrous tissue that connects muscle to bone or other muscle. It is capable of withstanding a great deal of tension. Working together, tendons and muscles exert only a pulling force.
Tendons have the ability to glide over bone and through tissue - and they are generally placed into two main categories, flexor and extensor. Flexor tendon injuries are classified by zones: zones I through III include areas of the hand; IV consists of the wrist; and V involves the forearm.
While flexor tendon injuries have less impact on hand function, because there are several others to assist when one is damaged, there is only one extensor tendon responsible for the function of the second through the fifth finger. Therefore, an injury to this tendon has a greater impact on hand function. Extensor tendon injuries are classified into eight zones - zones I through VI involve various areas of the hand, zone VII involves the wrist and multiple tendons, and zone VIII are injuries located in the distal forearm.
There are various degrees of injury as well. When glass or knives are involved the injury is called an "open injury." And "closed injuries" are often caused by sports that overstress the tendons but do not disrupt the skin.
The complete detachment of a tendon results in the loss of its function, which can be permanent if not repaired. Patients are usually aware when a tendon becomes detached and will experience difficulty moving a finger and pain when trying to use the tendon.
Accidents or forceful activity can cause injury to a tendon, which is why tendon injuries are common. They can happen to any one at any age.
Diagnosis and Treatment
The manner in which the injury was incurred, the affected area and the subsequent symptoms play a large role in the diagnosis of a tendon injury. Following a thorough review of patient history a physical examination of the hand is performed, which entails examining the posture of the hand at rest, as well as in passive and active motion.
In assessing passive movement, gentle pressure applied to each fingertip or the muscles in the forearm can identify a loss of tension or weakness of a joint. Moving the wrist, which prompts finger movement, will also indicate areas of weakness. In assessing active movement, patients are asked to use the tendon and affected joint while abnormal observations are recorded.
The best type of treatment for tendon injuries depends on the zone classification and extent of the injury. Conservative treatment is almost always the initial course of action and may consist of splinting, and the use of absorbable sutures if a cut is involved. More serious injuries may require hand surgery.
When lacerations accompany flexor tendon injuries repair should take place within 12 hours of the injury, though it is possible to splint with the fingers flexed for delayed repair - up to four weeks. Since the synovial sheaths increase the risk of infection, particular care is taken in the repair of these tendons.
And extensor tendon lacerations are delicately addressed during surgical repair, because they can retract into the hand when they are cut.
Rehabilitation is an important part of any treatment for tendon damage. Following a tendon repair there is a risk that the repair adheres to the surrounding tissues - preventing the tendon from gliding properly. In order to avoid this, protected mobilization is used in conjunction with a series of exercises specific to the injured area.
Recovery and return to work can range from six to 12 weeks, depending on the severity of the injury and type of work the patient performs.