MANUAL MINORS
The flexors of the fingers are a group of muscles and tendons responsible for finger and wrist flexion, playing a crucial role in functions like gripping objects, pinching, and performing fine movements. These tendons run along the front of the forearm, wrist, and hand, and are protected by synovial sheaths that facilitate smooth gliding.
Injuries to the finger flexors are common in penetrating trauma, sports accidents, and occupational activities. If not properly treated, these injuries can result in significant loss of hand function.
Diagnosis
Diagnosis of finger flexor tendon injuries is based on a history of trauma, particularly deep cuts to the palm or fingers, or overuse. Physical examination reveals an inability to flex one or more joints of the affected finger, swelling, and pain on the anterior side of the hand or forearm.
Imaging tests like X-rays may be helpful to rule out associated fractures, while ultrasound or MRI may be necessary to assess the extent of tendon damage.
Differential Diagnosis
Injury | Distinctive Features |
|---|---|
Flexor tendon rupture | Inability to flex the interphalangeal joints, especially after penetrating trauma or laceration. |
Flexor tenosynovitis | Pain and inflammation along the tendon, without complete loss of flexion function. |
Trigger finger (stenosing tenosynovitis) | Finger locking or snapping during flexion or extension due to inflammation in the tendon sheath. |
Joint dislocation | Pain and deformity without significant loss of flexion, visible on X-rays. |
Phalangeal fracture | Severe pain with palpable or visible bone deformity on X-ray, without direct tendon involvement. |
Emergency Management
Emergency management of flexor tendon injuries requires immediate evaluation of tendon function. In cases of deep lacerations, the hand should be immobilised and pain relief provided. Early surgical repair of tendon ruptures is critical, as delays can compromise functional outcomes. For tenosynovitis, nonsteroidal anti-inflammatory drugs (NSAIDs) and rest are recommended.
Definitive Treatment
Definitive treatment depends on the type of injury. Complete ruptures of the flexor tendons require surgical intervention to repair the damaged tendon. After surgery, immobilisation and intensive rehabilitation with physical therapy are essential to restore mobility and strength. In less severe cases, such as tenosynovitis, conservative treatment with NSAIDs, corticosteroid injections, and physical therapy is usually sufficient to fully restore the function of the affected finger.
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