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41 Cards in this Set
- Front
- Back
Flexor tendon blood supply is via vincula entering (dorsally or volarly?)
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Dorsally
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By what methods are tendons nourished?
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Synovial nutrition
Longitudinal intertendinous vessels Vessel branches in vincula |
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This process of synovial nutrition is also known as what?
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lmbibition
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The two terminal slips of FDS join at what location?
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Camper’s chiasm
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What structure passes over this point?
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FDP
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What is the relationship of the FDP to the FDS at all locations except at Camper’s chiasm?
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FDP deep to FDS in the palm and digits except at Campers chiasm
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What pulleys are considered critical to normal finger function? Why?
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A2
A4 These are the most critical for preventirrg flexor tender bow-stringing |
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What pulleys are located over the joints of the digits?
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A1
A3 A5 |
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When exposing the PIP volar plate, what pulleys can be sacrificed safely?
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Distal part of C1
Entire A3 Proximal part of C2 |
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What are the zones of flexor tendon injury?
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I: distal to FDS insertion (PDP only)
II: from A1 pulley (both FDP and FDS, no-man’s land") to FDS insertion lll: proximal to A1 pulley distal to carpal tunnel IV: within carpal tunnel V: wrist/forearm |
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What is the treatment for flexor tendon injury involving <25% tendon diameter?
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Trim torn fragment
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What is the treatment for injury involving 25 to 50% of tendon diameter?
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Epitenon repair
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What is the treatment for injury involving over 50% of tendon diameter?
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Core and epitenon repair
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Clinically obvious bow—stringing suggests what associated injuries?
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Flexor tendon sheath disruption likely involving A2 and A4 pulleys
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What are the three flexor tendon healing phases, and characteristics of each?
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Inflammatory (days, 0 to 5): minimal strength, suture imparts tendon repair strength
Fibroblastic (day 5 to 3-6 weeks): increasing strength, fibroblasts proliferate Remodeling (>day 28): collagen cross-linking |
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At which time point is the repair weakest?
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Days 6 to 12 (end of inflammatory phase)
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The majority of the repaired tendon strength returns by what time?
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28 days (end of fibroblastic phase)
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When is the maximum strength of the repair achieved?
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6 months (end of remodeling phase)
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What is the most important factor in determining strength of repair?
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Number of crossing core suture strands
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The addition of epitendinous suture increases repair strength by how much?
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50%
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Is there a reported advantage to pulley release at the time of flexor tendon repair?
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Increased tendon excursion
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Rehabilitation protocols emphasize what type of motion?
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Patient—controlled passive motion
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If an active motion rehabilitation program is planned, how many crossing suture strands are necessary?
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At least six strands
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What are the two general types of rehabilitation protocols?
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Duran (active extension, patient flexes passively)
Kleinert (active extension, dynamic T splint flexes passively) |
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What is the classic position for hand and wrist splinting after flexor tendon repair?
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Wrist flexed 30 degrees
Metaphalangeals (MCPs) flexed 70 degrees |
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What is the advantage of a continuous passive motion (CPM) device postoperatively?
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Decreased rate of adhesions
Maintains joint motion |
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What is the frequency of symptomatic flexor tendon adhesions at 3 months after repair?
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50% of patients require tenolysis at 3 months
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What clinical exam findings are suggestive of postoperative tendon adhesions?
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Full passive range of motion (ROM)
Decreased active ROM |
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What is the reported advantage of antiadhesion gel application?
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Improved active PIP motion
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Has polyvinyl alcohol been shown to be effective against adhesions?
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No, increases risk of rupture
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Repairs rupture most commonly at what location?
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Knot
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Rupture is most often secondary to what?
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Gap formation
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What two pulleys are most important?
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Oblique
A1 |
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Is early motion advocated after flexor pollicis longus (FPL) repairs?
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No
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Why not?
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Because FPL rupture rate is up to 20% (versus 2 to 5% for other digits)
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What is the most commonly affected finger?
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Ring finger
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If the avulsed FDP remains attached to a bony fragment, to what location does
it commonly retract? |
A4 pulley
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What is the treatment method of choice for an FDP avulsion with an attached fracture fragment?
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Open reduction with internal fixation (ORIF) of fragment
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If no fracture fragment is attached, what is the most important consideration in planning tendon repair and why?
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Location of the retracted tendon
Dictates the timing of the repair |
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What is the timing for repair of an avulsed FDP retracted all the way to the palm? Why?
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Repair within 7 to 10 days
Because vascular supply to retracted tendon is poor |
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If FDP retracts only to the PIP joint, what is the recommended timing of repair? Why?
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Within 3 months (does not need to be as acute)
Because vincula are intact |