Articles

Complications After Treatment of Flexor Tendon Injuries

Lilly, Soma I. MD; Messer, Terry M. MD

Dr. Lilly is Chief Resident, Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Messer is Assistant Professor, Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lilly and Dr. Messer.

Reprint requests: Dr. Messer, Wake Orthopaedics, LLC, 3009 New Bern Avenue, Raleigh, NC 27610.

Journal of the American Academy of Orthopaedic Surgeons 14(7):p 387-396, July 2006.

Abstract

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.