Dr Chaitali Parekh | FDP Tendon Injury #mriteachingcourse #msklearningshorts

Duration: 4:15 863 transcript words EN summary

Video summary

The most prevalent flexor tendon injury discussed is known as "Jersey finger" or "Rugby finger," a condition frequently seen in contact sports like rugby where players grab an opponent's jersey while their fingers are fully flexed. This injury occurs when the force pulling the hand away exceeds the grip strength, causing the flexed finger to suddenly snap into extension and tear the Flexor Digitorum Profundus (FDP) tendon. Unlike injuries involving the FDS tendon, this specific trauma typically results in a non-insertional tear located in Zone 1 of the flexor system, creating a distinct gap between the retracted tendon stump and its insertion point at the distal phalanx. Diagnostic imaging, particularly dynamic ultrasound, plays a crucial role in visualizing the extent of the injury by identifying the gap between the two remaining tendons and confirming the absence of the FDP in the affected region. A critical detail that must be reported is whether the retracted tendon edge is coiled or balled up; this observation is vital because it indicates that the tendon still possesses sufficient length for repair. If a surgeon attempts to pull a chronically torn, non-coiled tendon back into place, it will remain under excessive tension, leading to a flexion deformity and likely failure during rehabilitation, which often necessitates tendon replacement rather than primary repair. Furthermore, the anatomical location of the retracted tendon relative to the carpal tunnel is a decisive factor in surgical planning. If the torn tendon end has retracted into the carpal tunnel, the surgeon must incise the flexor retinaculum to open the tunnel and retrieve the tendon for repair. Conversely, if the retraction occurs proximal or distal to the carpal tunnel, the tunnel does not need to be opened. Accurate reporting of these specific anatomical relationships ensures the surgical team can make informed decisions about whether to perform a complex release procedure or a straightforward repair, ultimately preventing complications and ensuring optimal functional recovery for the patient.

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[Music] So the most common FTP injury is the flexor tendon injuries rather than FDS and it is particularly common in rugby sports and contact sports where two people contact each other, which is rugby is one of them. So it is also called rugby finger or jersey finger. Now, why Jersey Finger or Rugby Finger. As you can see in this image, the player is trying to tackle another player and he is holding the jersey with his hand. You can obviously imagine that this player is trying to run away, and this player is trying to hold him back. There is a lot of contraction in the forearm. A lot of flexion is, ah, being applied onto the fingers to hold the other player back. While this player is using all his strength to run away. And there is an opposite force that is acting. So, when this happens, when this force becomes greater than the force of the other player, this player will actually just, you know, go away, will just run away from there, and the flexed fingers of the first player are going to suddenly go into extension, right? Because he loses the grip of the jersey, and then it will suddenly go into extension. So, that's what happens. Whenever there is an opposite strong force that is applied on a flexed finger, the finger suddenly goes into extension and results in the terror of the FDP tendon and this is called as the Jersey finger. So this is a zone one injury ah ah again of an FDP tendon terror. Where you can see that this is a nice gap very well seen. It's a non- insertional terror. So you would obviously want to give the length of the distal tendon stump. Here you can see you can appreciate the tool. Ah you can appreciate the FDP. And these two are the FDS over here. And as you go further you can only see the two FDS attaching. There is no FDP. Again there is no FDP and then again you begin to see the FDP over here and the insertion will be intact. Again ah you can also appreciate on the ultrasound dynamic examination can also help. So you can appreciate one tendon over here. This is the other tendon over here and this is the tendon stump. And if you see there is a gap in this region. Ok? So this is one tendon. This is another tendon over here and this is the gap between the two tendons on an ultrasound. Similar to the extensor zones you have the flexor zones you can always look at them and report them depending upon what level the injury is. Same thing we've discussed for the extensor tendons. The same points you need to also put in place for your flexor tendon injuries. Now this is a flexor tendon transection injury. Ah what is happened at the level of the hand. So you can see that the tendon is completely missing in this region. The important point is you can see that there is a coil dop tendon over here. So this is important to put in the report when you say that there is a coil dap or a ball dap tendon it means that there is length to this tendon. Remember the surgeon has to bridge this hole gap. If the tendon is a chronic tear and there is no length to it. If the surgeon tries to pull the tendon all the way until here, the tendon will be fixed back in tension. When the patient will begin the physio. One thing is that the patient will land up in a flexion deformity. And if the patient possibly tries to do the physio, the tendon will again give away and it will result in a retear. So if it's a chronic tear in true cases, they want to do a tendon replacement. They will put another tendon and replace it from here and try to fill the cap. But, if there is a coiled up or a boiled up tendon and it's acute tar, the surgeon knows that there is length to this tendon. And probably, the surgeon can straighten this tendon and just fix it back. Right? So, that is important to put in the report. Again the same thing the most important thing is you need to mention that the retracted tendon edge is coiled and at what level it is lined. Remember for the flexor tendon tail it is very important to mean whether the retracted tendon has entered the carpal tunnel or it is distal to the carpal tunnel or it is proximal to the carpal tunnel because the surgeon needs to decide if he needs to open the carpal tunnel for the proximal end or not. If it is distal or proximal to the carpal tunnel, the surgeon will not open up the carpal tunnel. But if the retracted tendon is lying inside the carpal tunnel, the surgeon will have to cut the flexor retinaculum and open up the carpal tunnel in order to get the tendon back. [music]