Damage to the flexor tendons of the fingers. Clinic, diagnosis, treatment. Injuries to the flexor and extensor tendons of the fingers Extensor pollicis longus

In trauma practice, hand injuries are the most common; 30% of the total number of patients consult doctors with hand injuries. This is due to the fact that a person performs almost all types of work with the help of his hands. There are frequent cases of damage and rupture of the extensor tendons of the fingers. Thanks to special anatomical structure, minimal amount of fat and muscle tissue, at first glance, a not deep cut can not only damage the skin, but also reach the tendons.

The hand is conventionally divided into three sections:

• Wrist – consists of 8 small bones arranged in two rows. These bones are located in different planes, due to this, an anatomical depression is formed on the inner surface of the palm, a groove where the tendons of the finger flexor muscles are located.
• Metacarpus – formed by 5 short tubular bones (corresponding to the number of fingers).
• Finger bones - 4 out of 5 fingers consist of three phalanges, the longest (proximal) is closer to the metacarpus, then comes the middle one, and the nail or distal phalanx ends the finger. The thumb is an exception, having only two phalanges, excluding the middle one.

33 different muscles are involved in providing motor functions of the hand, most of which originate in the forearm, then muscle fibers form tendons, ligaments that cross the surface of the palm, joints, located on inside fingers.

There are no muscles on the outside of the palm. The inner side has three muscle groups, their names correspond to the group of fingers whose movements they provide:

• muscles of the thumb;
• little finger muscle complex;
• middle muscle group.

Extension movements are possible thanks to the tendons located on the outer surface of the hand; flexion is provided by those located on the inside of the palm.

According to statistics, ruptures and injuries of the extensor tendons are more common.

Classification of tendon ruptures

An important factor in classifying hand injuries is the time elapsed from the moment of injury to the time of contacting a traumatologist. Fresh injuries are those that are less than three days old; after this time, stale injuries are diagnosed. Old injuries include hand injuries that occurred more than 21 days ago.

The number of damaged flexor and extensor tendons of the fingers also affects the determination of the injury class; the following are possible:

• isolated rupture (the integrity of one of the fibers is broken);
• multiple (rupture of several tendons);
• combined (involving different kinds tissues - nerve endings, blood vessels, ligaments, tendons).

A subcutaneous tendon rupture is classified as a closed injury; if there are cuts to the skin, it is classified as an open injury.

Depending on the factor that caused the violation of the integrity of the tendon, the acute or degenerative form of the injury is determined. Acute becomes a consequence of cuts, bites, degenerative occurs due to wear (degeneration) of fibers with constant, same type physical activity or due to diseases that cause changes in the structure of tissues.

Diagnostics

Primary diagnosis is associated with determining the nature of the injury; the survey conducted by the doctor at the emergency room is aimed not only at identifying and identifying the traumatic object, it is important to know the associated factors. Unfortunately, many patients are injured while intoxicated, which is a contraindication to the use of many medications, including some painkillers.

Having collected a thorough history, the specialist proceeds to a visual examination and palpation of the patient.

The so-called hammertoe shape of the finger is the result of a fall on the hands with straightened fingers or a wound caused by a sharp object. In this case, it is visually noticeable that the finger is slightly bent at the joint located between the middle and nail phalanx (proximal interphalangeal joint). With the cutting nature of the condition, partial separation of the distal phalanx is possible.

If the victim's finger(s) are bent in all phalanges, we can talk about damage to the hand on the outside and damage to the wrist. Open wound surfaces leave no doubt; in cases of closed injuries, the doctor makes a diagnosis, determines the location of the rupture, based on visible symptoms.

A proximally bent finger is described as a boutonniere deformity. In this case, it is clear to the doctor that the rupture occurred in the central part of the tendons, the lateral ones are not affected. From instrumental studies, it is recommended to take an x-ray of the finger from several angles.

If the cause of the rupture of the tendons of the hand is destructive processes in the body, additional tests are prescribed to determine the cause and nature of the inflammatory process.

Treatment options

When choosing a treatment method, the decisive factors are the class of injury and the speed at which the victim seeks medical help.

Surgery can be avoided in cases of early, closed, isolated, incomplete ruptures. Methods used conservative treatment. Immobilization is carried out, symptomatic drug therapy. After the splint (plaster) is removed, rehabilitation procedures are prescribed.

Treatment is possible in combination with medication folk remedies, with tendinitis good effect produces curcumin, it is used as a seasoning in cooking. This remedy leads to a reduction in swelling and pain. An anti-inflammatory and restorative remedy is a decoction of bird cherry berries (one tablespoon is poured into 250 ml of boiling water), drink several sips throughout the day.

A mixture of crushed ginger root and sarsaparilla is steamed with a glass of boiling water, drink 2 tsp. every 6 hours, the infusion has a beneficial effect on inflammation of the tendons; it can be used during the rehabilitation period after a rupture of the extensor finger. Application of funds traditional medicine must be agreed with your doctor, uncontrolled use medicinal herbs may lead to complications.

In other cases, surgery is indicated. The sooner the operation is performed, the more positive the prognosis for the restoration of motor functions upper limb.

The operation is aimed at:

• connecting broken sections of fibers;
• fixation of the tendon fiber when separating it from the site of anatomical attachment;
• according to indications, the wound surface is sanitized, necrotic tissue areas are removed (for wounds with a large area of ​​damage);
• fixation or removal of bone fragments;
• internal splinting;
• Work is underway to stitch up and restore the capsule of the damaged finger joint.

To avoid postoperative ruptures and complications, a splint made of polymer materials or a plaster cast is applied. The duration of wearing the fixing bandage is 4 weeks or more. With early removal of immobilization agents, tendon sutures may be cut, scars that have not yet formed may be ruptured, and pathological flexion of the fingers will resume.

In the future, the patient does not require constant medical supervision and is transferred to a day hospital regime.

Rehabilitation after injury

To restore full function after a rupture of the tendon(s) on the finger, strict adherence to the prescriptions of a rehabilitation doctor is required. The specialist selects a set of exercises physical therapy, prescribes massage, coordinates with the attending physician the use of restorative medications.

You can begin to develop your fingers after surgery only after the inflammation of the tendons has completely resolved. In cases where in postoperative period anti-inflammatory drugs were prescribed, the recovery of the finger tendons is slower.

Good results in developing fingers can be achieved by performing a simple exercise of clenching the hand into a fist and then opening the palm, fixing each position for 10-30 seconds. The exercise should be performed without jerking, slowly, and repeat approaches as often as possible.

Extensor digitorum

Extensor digitorum, m. extensor digitorum(see Fig. , , ), has a fusiform abdomen, and in the direction of the muscle bundles it is bipinnate. The muscle lies directly under the skin, closer to the lateral edge of the dorsum of the forearm, and borders on the ulnar side with m. extensor carpi ulnaris and m. extensor digiti minimi, and with radial – with mm. extensores carpi radiales longus et brevis.

The muscle starts from the lateral epicondyle of the humerus, articular capsule elbow joint and fascia of the forearm. In the middle of its length, the muscle belly turns into 4 tendons, which, passing under the extensor retinaculum, are surrounded together with the extensor tendon of the index finger sheath of the extensor tendons of the fingers and index finger, vagina tendinum mm. extensoris digitorum et extensoris indicis, reaching approximately the middle of the metacarpal bones.

Moving onto the hand, the tendons are connected to each other by unstable thin intertendinous joints, connexus intertendinei, and at the base of the proximal phalanx, from the index finger to the little finger, each tendon ends in a tendon extension that fuses with the articular capsule of the metacarpophalangeal joint. Tendon stretches are divided into 3 legs, of which the lateral ones are attached to the base of the distal phalanx, and the middle one is attached to the base of the middle phalanx.

Function: extends the fingers, also taking part in the extension of the hand at the wrist joint.

Innervation: n. radialis (C VI -C VIII).

Blood supply: a. interossea posterior.

Causes: mainly incised wounds of the hand and fingers.

Signs: typical location of the wound and the inability to actively flex the finger. To determine damage to the deep flexor digitorum, it is necessary to fix the middle phalanx: the absence of active flexion of the nail phalanx indicates damage to the deep flexor tendon. In cases of damage to both flexors with a fixed proximal phalanx, active flexion in both interphalangeal joints is absent (Fig. 87). The study using these methods must be carried out carefully, since an attempt to forcefully contract the muscle can contribute to the formation of significant diastasis between the ends of the damaged tendon.

Treatment.

If damage to the flexor tendons is suspected, patients are hospitalized in a specialized department. The ends of the tendons are sutured with special sutures using microsurgical techniques. The primary dressing should be applied with all fingers of the hand in a semi-bent position. After surgery, the hand is immobilized for 6 weeks.

Rehabilitation - 2 weeks.

Working capacity is restored after 2 months.

Damage to the flexor tendons at the forearm level often accompanied by damage to the nerve trunks (median and ulnar nerves). If tendons are damaged at the level of the palm and fingers, damage to the common digital or intrinsic nerves may occur. Therefore, sensitivity testing is mandatory. The operation can be performed under intraosseous or general anesthesia, depending on the extent of the intervention. The operation should be performed by a surgeon experienced in hand surgery, so in some cases it is advisable to postpone the operation, performing only primary surgical treatment of the wound.

Extensor tendon injuries

The extensors are located on the hand and fingers under the skin, directly on the bone. Because of this, they can be damaged even with a minor cut to the skin. Often the tendons are torn from the place of attachment to the bone of the nail and middle phalanges. This occurs without damaging the skin, with a closed injury. After a tendon injury, finger extension is impaired. The goal of treatment is to restore lost function.

Most common injuries. When the tendon is torn off from the nail phalanx, the latter ceases to fully extend, and the finger takes on the appearance of a hammer. In the absence of treatment, hyperextension of the middle phalanx occurs, and the finger takes on the appearance of a “swan neck”. In some cases, the tendon comes off with a bone fragment. In this case, the extension of the phalanx also falls out. A special splint is applied to fix the fingertip in extension. We usually splint for 6 weeks if the injury is less than 3 weeks old. If the damage occurred more than 3 weeks from the date of contacting us, then 8 weeks. During treatment, we recommend monitoring the splint and the position of the finger in it. When the tendon is torn from the middle phalanx, a Boutonniere deformity develops. In this case, flexion of the middle and hyperextension of the nail phalanges occurs (Fig. 3). For this type of injury, we splint the finger for 6-10 weeks. The specific period of fixation is determined by many factors and is determined individually for each patient.

Treatment.

In case of open tendon injuries, they need to be sutured. Subcutaneous tendon ruptures are usually treated conservatively. A special splint is placed on the finger, which allows the ends of the damaged tendon to be brought as close as possible. The fixing splint must be worn without removing it for the entire period specified for each level of damage. Otherwise, the tendon will not heal and will not work effectively. Depending on the time elapsed since the injury, we extend the time of finger fixation.

64. Muscles that flex and extend the hand and fingers.

Bend the hand: flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, flexor digitorum profundus, flexor longus thumb, palmaris longus muscle.

Flexor carpi ulnaris starts from the medial epicondyle of the humerus, from the ulna and the fascia of the forearm. The distal end reaches the pisiform bone, to which it is attached. From the pisiform bone to the hamate and to the 5th metacarpal bones there are ligaments that are a continuation of the traction of this muscle.

Flexor carpi radialis starts from the medial epicondyle of the shoulder and intermuscular septum, the muscle passes onto the hand under the flexor retinaculum ligament and is attached to the base of the 2nd metacarpal bone. Being a multi-articular muscle, it is involved not only in the movements of the hand, but also in flexing the forearm at the elbow joint.

Flexor digitorum superficialis starts from the medial epicondyle of the humerus, as well as from the ulna and radius. It has four tendons that pass to the hand through the carpal canal, located under the flexor retinaculum ligament, and reach, each splitting into two legs, the lateral surfaces of the middle phalanges of the 2-5th fingers, to which they are attached. The function of this muscle is to flex the middle phalanges. Being multi-articular, the muscle also causes flexion in all joints of the hand, except for the distal interphalangeal joints.

Flexor digitorum profundus lies directly on the anterior surface of the ulna and on the pronator quadratus; starts from the upper two thirds of the palmar surface of the ulna and partly from the interosseous membrane. It is divided into four tendons, which pass in the carpal canal to the distal phalanges of the 2nd-5th fingers of the hand through the splitting of the tendons of the superficial flexor digitorum. Being a multi-articular muscle, it produces flexion in all joints of the hand, including the distal interphalangeal joints. The tendons fan out on the hand towards the fingers, due to which this muscle not only flexes the fingers, but also adducts them.

Flexor pollicis longus- a single-pinnate muscle with a fusiform shape. It starts from the palmar surface of the radius, passes through the carpal tunnel in a separate synovial sheath and reaches the distal phalanx of the thumb, to which it is attached. The muscle produces flexion in all joints around which it passes (in particular, it flexes the distal phalanx of the thumb).

Palmaris longus muscle is not constant. Starting from the medial epicondyle of the humerus and from the fascia of the forearm, this muscle is located on its anterior side so superficially that during contraction it is easy to see it under the skin and palpate the tendon. Attaching to the palmar aponeurosis and pulling it, with strong contraction it can also take some indirect part in flexing the fingers.

Unbend the hand: extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum, extensor pollicis longus, extensor of the little finger, extensor of the index finger.

Extensor carpi radialis longus starts from the lateral edge of the humerus, the intermuscular septum and the lateral epicondyle, passes under the extensor retinaculum ligament and the extensor pollicis longus tendon and is attached to the base of the 2nd metacarpal bone. Due to the fact that the resultant of this muscle passes very close to the transverse axis of the elbow joint, its participation in flexion of the forearm is insignificant. Being a strong extensor of the hand, it also produces some abduction during isolated contraction.

Extensor carpi radialis brevis starts from the lateral epicondyle of the humerus, fascia of the forearm and attaches to the base of the 3rd metacarpal bone. Being an extensor of the hand, the muscle also abducts it.

Extensor carpi ulnaris originates from the lateral epicondyle of the humerus, collateral radial ligament and fascia of the forearm. Descending onto the hand, the muscle runs between the head and the styloid process of the ulna and attaches to the base of the 5th metacarpal bone. Being an extensor of the hand, the extensor carpi ulnaris also adducts it.

Flex the thumb: flexor pollicis longus, flexor pollicis brevis.

Extensor digitorum originates from the lateral epicondyle of the humerus, radial collateral ligament, annular ligament of the radius, and fascia of the forearm. In the middle of the forearm, this muscle passes into tendons running under the extensor retinaculum ligament to the dorsum of the proximal phalanges of the 2-5th fingers. Each tendon, in turn, has three legs, of which the middle one is attached to the middle phalanx, and the two lateral ones reach the distal phalanx of the fingers.

Extensor pollicis longus starts from the posterior surface of the ulna and radius, the interosseous membrane of the forearm and attaches to the distal phalanx of the thumb. The tendon of this muscle passes under the extensor retinaculum ligament in a separate channel, crossing the tendons of the extensor carpi radialis. By extending the distal phalanx, the muscle simultaneously pulls the thumb back somewhat. If it is fixed, then the muscle is involved in abduction of the entire hand.

Extensor of the little finger starts from the lateral epicondyle of the humerus, radial collateral ligament, annular ligament of the radius and fascia of the forearm, goes down and attaches to the dorsal aponeurosis of the 5th finger. By extending this finger, the muscle also extends and slightly adducts the entire hand.

Extensor index finger starts from the dorsum of the ulna and the interosseous membrane. This muscle, with its tendon, merges with the extensor tendon of the digitorum, which goes to the 2nd finger, reaches the dorsal aponeurosis of the index finger and is attached to its distal and middle phalanges. It extends the index finger and also promotes extension of the entire hand.

Also in progress flexion and extension of fingers muscles involved: extensor pollicis brevis, lumbrical muscles, palmar interosseous muscles, dorsal interosseous muscles, abductor pollicis brevis, flexor pollicis brevis, oppons pollicis brevis, adductor pollicis brevis, palmaris brevis muscle, abductor digiti minimi, flexor digiti minimi brevis, opponens minimi muscle.

Extensor pollicis brevis starts from the posterior surface of the ulna and radius, attaches to the proximal phalanx of the thumb, which it extends, simultaneously abducting the entire finger. If the finger is fixed, then the muscle is involved in abduction of the entire hand.

Vermiform muscles begin from the tendon of the deep flexor digitorum. These muscles go to all fingers, with the exception of the 1st. They are attached to the dorsal aponeurotic extensions of the proximal phalanges. The function of these muscles is that they flex the proximal phalanges of the 2-5th fingers.

Palmar interosseous muscles(there are 3 of them) are located in the spaces between the metacarpal bones of the 2-5th fingers and start from these bones. They are attached to the articular capsules of the metacarpophalangeal joints and to the dorsal aponeurosis of the 2nd, 4th and 5th fingers. By bending their proximal phalanges, these muscles simultaneously lead these fingers to the middle finger.

Dorsal interosseous muscles four in number are located in the spaces between the metacarpal bones. The place of their origin is the lateral surfaces of the metacarpal bones facing each other. Reaching the dorsal surface of the proximal phalanges, they are woven with thin tendons into the aponeurotic stretch of the extensor fingers. The function of these muscles is that, while bending the proximal phalanges of the 2-5th fingers, they simultaneously contribute to the extension of the middle and distal phalanges of these fingers. Additionally, they retract the 2nd and 4th fingers away from the 3rd and tilt the 3rd finger toward both the radius and ulna.

Abductor pollicis brevis muscle, has an extensive origin on the flexor retinaculum ligament and on the scaphoid bone. Attached to the proximal phalanx of the thumb, it promotes its abduction.

Flexor pollicis brevis starts from the flexor retinaculum ligament and trapezius bone. This muscle is attached to the sesamoid bone and, bending the 1st phalanx of the thumb, promotes (due to the tension of the antagonists) the extension of its 2nd, distal, phalanx. The muscle is also involved in opposing the thumb.

The muscle that opposes the thumb to the hand starts from the flexor retinaculum ligament and trapezium bone, and attaches to the 1st metacarpal bone. Its function is that it opposes the thumb to all the others.

Adductor pollicis muscle, has two heads - transverse and oblique. The transverse one starts from the palmar surface of the body of the 3rd metacarpal bone, the oblique one - from the base of the 2nd and 3rd metacarpal bones and the capitate bone. The muscle attaches to the sesamoid bone located in front of the metacarpophalangeal joint of the thumb, as well as to the capsule of this joint and the proximal phalanx of the finger. Its function is that, by bringing the thumb to the median plane of the palm, it promotes its opposition to the other four fingers.

Palmaris brevis starts from the palmar aponeurosis and attaches to the skin. When clenching the hand into a fist or when striking with the palmar surface of the hand, this muscle helps protect the vessels and nerves running along the ulnar side from the front surface of the forearm to the hand.

Abductor digiti minimi muscle begins on the pisiform bone and attaches to the base of the proximal phalanx of the 5th finger. The function of the muscle is to abduct this finger, flex its proximal phalanx and extend the middle and distal phalanges.

Flexor digiti brevis starts from the flexor retinaculum ligament and hamate bone and attaches to the ulnar edge of the base of the proximal phalanx of the 5th finger. The function of the muscle is to flex and adduct.

Opponus little finger muscle, begins together with the previous muscle, and is attached to the body and head of the 5th metacarpal bone, which it bends slightly and brings closer to the middle of the palm.

Muscles of the hand, right (tendons of the superficial flexor digitorum are partially removed)

1 - flexor retinaculum; 2 - muscle that abducts the little finger; 3 - short flexor of the little finger; 4 - tendons of the deep flexor of the digitorum; 5 - muscle opposing the little finger; 6 - lumbrical muscles; 7 - tendons of the superficial flexor of the fingers; 8 - adductor pollicis muscle; 9 - flexor pollicis longus tendon; 10 - short muscle that flexes the thumb; eleven - short muscle abductor thumb.

EXTENSORS OF THE HAND AND FINGERS consist of numerous small muscles that lie on the back of the forearm. They are attached by a single common tendon to lateral epicondyle ku. This tendon is the site of the inflammatory syndrome known as epicondylitis. The lower attachment points of the wrist extensors are several metacarpal bones (these are long bones connecting the wrist to the fingers).

This muscle group serves to extend the wrist. Pain that accompanies stress points in the wrist extensors is often diagnosed as epicondylitis. It can cover everything back forearms and wrists. The lateral epicondyle may also become extremely sensitive to contact. A weak and unreliable grip is a sign that often accompanies this pain. It is not surprising that stress points here are so often diagnosed as epicondylitis. Sufferers use anti-inflammatory treatments to cope with the pain, but they do not target the muscles and are therefore often unsuccessful.

Repeated and forceful gripping is a common source of stress points in the wrist extensors. Athletes who use a wrist grip in sports are most susceptible to injury to the forearm muscles. This risk also exists for tennis players and players of any kind. sports competitions with a racket, golfers and baseball players, skiers and water skiers, travelers who use support, weightlifters.

A detailed understanding of the specific muscles involved is not necessary to provide relief using manual pressure techniques. Locate any tight bands or tension points on the back of your forearm. When you find the location of each muscle on your hand, straightening your fingers and wrist in turn, then begin to massage them from beginning to end to find painful points. Having determined their location, do not press too hard on them for a while and at the same time bend your hand. Use this gentle stretch by bending your arm to help the muscle feel relief. You can achieve complete relief from pain by doing more stretching.

Stretch 1: Extend your elbow in front of you with your palm facing up and then bend your wrist. Point the tip of your middle finger toward the front of your forearm.

Stretching the 2 extensors of the hand and fingers

Stretch 2: Sit in a chair. Keeping your elbow straight, place the back of your hand on the seat next to you, palm up, stretching the back of your forearm.