Flexor Tendon Injury and Repair with Dr. Sonu Jain

Expert Interviews

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  • History and Physical Examination
    • What are the key elements of the patient’s history to ask when assessing a patient with a suspected flexor tendon injury?
    • What are you looking for on a physical exam?
  • Surgical technique and timing
    • What is the time frame for surgical repair of isolated flexor tendon injuries
    • Method of repair – modified Kessler vs. cruciate vs. M-tang
      • Number of core sutures
      • Where to place knot? Outside vs. inside
      • Suture type
    • The role of epitendinous suture
      • What type of suture, how far from the repair site
    • What are your techniques for proximal tendon retrieval if it has retracted away from the site of injury?
    • Do you perform flexor tendon repairs under wide-awake local anesthesia, no tourniquet (WALANT)? Do you find it’s easier to set the correct tension with an interactive patient?
    • What is your preferred technique for chronic flexor tendon lacerations- pedicled FDS, palmaris, plantaris etc.
      • What is a reasonable expectation in terms of ROM after a 2-stage flexor tendon repair
  • Specific types of flexor tendon injuries based on Zone
    • Jersey finger- when do you repair, do you use suture anchors if there’s a small distal stump
      • Chronic- DIP fusion vs 2-stage repair
    • Zone 2 – how much do you vent the pulleys, concern for bowstringing
    • Are there circumstances in which you think it’s important to repair partial lacerations (< 50%)
  • Postoperative care
    • What is your typical postoperative rehabilitation plan? Does the rehab protocol differ depending on number of core sutures or zone of injury
  • Complications
    • Adhesions
      • Timing of tenolysis if patients have limited movement after initial repair?
    • Have you found that there are any patient or operative factors that increase the likelihood of rupture
  • Memorable case/good save regarding flexor tendon repair?
  • Favorite hand procedure

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