Flexar tendon

Zones

• 1: distal to FDS
• 2: FDS to A1
• 3: a1 to Flexar retinaculum
• 4: Carpal tunnel
• 5: prox to carpal tunnel
• T1: FPL to A2
• T2: A2 to A1
• T3: A1 to CT

Repair stages

• Inflammation 5 days
• Proliferation 5-28
• Remodelling >28 days

Aim of repair

• Sufficient strength to post op mobilisation
• minimum gap
• minimum damage to tendon
• Weak at 6-12 days
• Only done if cut > 60%
• 60-75%: only epitendinous sutures

Technique

• Core
  • 4-6 strands
  • 10mm depth
  • Dorsal is more strong
  • Hold only at one point
• Epitendinous
  • Decrease gap
  • tidy the repair
  • Increase strength by 20%

Wide awake

• Assessment of gap
• Decreases the need for future tenolysis

Reconstruction

• Hunter technique
  • 2 stage
    • 1: silicon rod
    • 2:remove the rod and graft fixed by pulvertaft weaver technique proximally and end to end distally

FDS avulsion Leddy

• 1: Tendon in palm with rupture of vinculae
• II: Tendon at PIP by long viculae
• III: Held at A4 by bony fragment
• IV: Avulsed off bony fragment

Rehab

• Duran
  • Active extension with patient assisted finger flexion
• Klenert
  • Active extension with dynamic finger flexion
• Both low force low excursion