MANUAL MINORS
Flexor injuries of the hand are serious injuries that affect the ability to flex the fingers and the wrist. These tendons enable fine and essential movements such as gripping, so an injury can significantly compromise hand function.
The flexors are located deeper than the extensors but are also vulnerable to injuries from cuts, tears, or blunt trauma. Given their functional importance, rapid diagnosis and appropriate treatment are essential to avoid permanent sequelae.
Diagnosis
The diagnosis of a flexor tendon injury is based on the medical history and physical examination. The patient usually presents with an inability to flex one or more fingers or, in more severe cases, the wrist. Clinically, the integrity of the tendons is assessed by testing the active flexion of each finger individually.
In cases of deep flexor tendon injury (Flexor Digital Profundus), there is an inability to flex the distal phalanx, while involvement of the superficial flexor tendon (Flexor Digital Superficialis) will impede flexion of the proximal interphalangeal joint. If a tendon injury is suspected, ultrasounds or magnetic resonance imaging may be used to assess the severity of the injury.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Partial Tendon Laceration | Partial difficulty in flexing the fingers | Limited movement but not completely absent |
Complete Flexor Tendon Rupture | Total inability to flex one or more fingers | Complete absence of active flexion in the affected finger |
Tendon Avulsion (Jersey Finger) | Inability to flex the distal phalanx | History of trauma due to forced hyperextension |
Phalangeal or Metacarpal Fracture | Associated pain, deformity, or swelling | Radiographic confirmation of fracture |
Infectious Tenosynovitis | Pain, warmth, redness, and swelling along the tendon path | History of previous infection or contaminated wound |
Emergency Management
The initial management of flexor tendon injuries includes carefully immobilising the hand to prevent further damage. If the injury is open, it is important to irrigate the wound with sterile saline solution and debride any non-viable tissue.
Administration of analgesics and application of local anaesthesia are essential for a more accurate evaluation. Antibiotic prophylaxis is indicated in cases of open wounds to prevent infections. It is crucial to avoid attempting active mobilisation of the injured fingers before assessment by a specialist, as this may worsen the injury.
Definitive Treatment
The definitive treatment of flexor tendon injuries generally requires surgical intervention, especially if there is a complete tendon rupture. During surgery, the ends of the injured tendon are repaired using specific techniques to ensure proper healing and function.
After surgery, the patient should immobilise the hand for several weeks and then begin a rehabilitation programme with physiotherapy to restore mobility and strength. In certain cases, such as partial injuries, conservative management with immobilisation may be attempted, but surgery is usually the treatment of choice.
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