FLEXOR TENDON INJURIES

Muscles that provide fingers to bent inside are called flexor muscles. They are connected to finger bones with structures which exits from the current muscles in the forearm and look like chords and called tendons. Flexor muscles start from the elbow and forearm and extends to finger ends by converting into tendons in the middle of the arm (Figure 1). Flexor tendons in the finger passes inside of tunnels called pulleys. Pulleys prevent tendons to move away from the bone by forming tunnels on tendon and they provide active operation of joints.

Flexor tendon injuries may arise after deep cuts of the forearm, wrist, hand and fingers.

Flexor tendons are very close with vessel-nerve structures anatomically. Therefore, in palmar side injuries of the hand, injury is frequently together with vessel, nerve injuries as well as flexor tendons. When tendon injury is occurred, tendon ends move away from each other due to muscle traction. Tendon ends may not be found in the cut area immediately. When flexor tendon cut arises, the patient can not bend his/her finger. If the tendon is not completely cut, bending may be possible by the patient. Generally pain accompanies to this situation. If incomplete tendon cuts are not treated, tendon may be broken away from the cut region.

If tendon ends are not exposed surgically, recovery is not provided. If repair of tendon cuts delays, length of the tendon shorten due to muscle traction and tendon exposing may not be possible. To protect tunnels called pulley that tendons pass in is very important for tendons to perform its functions after the recovery. Vessel-nerve structures which are very close to tendons should be repaired with microsurgerical methods during the surgery. 3-4 weeks of bracing is made to protect sutured structures after the surgical intervention. Movement is not provided just after the plaster is removed. During tendon recovery, cohesion arises to surrounding tissues. Early physical therapy may start with plaster or physical therapy should be given after the plaster. Generally professional physiotherapy is required after flexor tendon injuries. If providing movements are insufficient even after the physiotherapy, cohesion around the tendon should be opened and physiotherapy should start immediately. Early term physiotherapy is important. If physiotherapy does not start on time, to gain movements will be difficult.

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