Hand Cases to Consider.

Last updated Friday, February 11, 2005

Case 2

Answer to case 2

Diagnosis: Bowstringing of the flexor tendon

In the fingers, the flexor tendons are enclosed in a fibrous sheath. This pulley system is necessary for normal flexion of the fingers. The sheath is divided into 5 annular (A1-5) and 3 crusiform pulleys (C 1-3).

In open injuries to the flexor tendons these pulleys can get damage and can result in a condition called bowstringing. This condition results in the flexor tendon being displaced volar on flexion. If there is need for tendon repair as well as extensive pulley reconstruction, then a staged tendon procedure is indicated.

Some methods for reconstruction of the pulley system include:

• Using part of the FDS. The distal incertion is left intact and the free end is brought over to the other side of the FDP (or rod).
• Tendon graft encircling the phalanx. This tendon graft is brought superficial to the extensor tendon around the middle phalanx and deep to the extensor tendon around the proximal phalanx.
• Using segment of the extensor retinaculum from the dorsum of the wrist. This is passed around the phalanx similar to the tendon graft.
• Artificial material.

References

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