2017 Sep 1;42(9):722-6. Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. Jane S. Tan, Laura Oh, Dean S. Louis (2009). Surgical repair is necessary in order to regain function that has been lost. Maintain a firm grip on the dumbbells as you walk back and forth with them. Squeeze the dumbbells to engage your forearms and maintain this hold for 30 seconds. Singh, V. (2010). Repeat for 3-4 sets of 10-12 reps. You might also want to use chalk if youre doing this exercise for muscle growth, because in that case, youll be lifting heavier. Palastanga NP, Field D, Soames R. Anatomy and Human Movement: Structure and Function. Available from, Rehab My Patient. Origin of Flexor digitorum superficialis muscle. The evolution of arm care programs has been an exciting journey. At the wrist joint, the tendons pass deep to the flexor retinaculum through the carpal tunnel, after which they diverge into two pairs. Wrist flexion exercises are ideal for strengthening flexor digitorum superficialis. Symptoms of groin inflammation Symptoms include:, A TFCC tear is an injury to the triangular fibrocartilage complex found in the wrist. Other products that therapists may use include Coban, but a good, comfortable, clean and a dry dressing is acceptable as well. The prime function of flexor digitorum superficialis is flexion of the digits 2-5 at the PIP and MCP joints. Flexor digitorum superficialis is innervated by the median nerve (C8-T1) and vascularized by the ulnar and radial arteries. Use of this type of splint showed improved outcomes, while still preserving repair integrity. Multiple studies rank this exercise as the most effective serratus anterior exercises reaching between 90 to 104% MVC.1113 The NISMAT Arm Care program also recommends incorporating the use of elastic resistance to increase the MVC while performing the exercise.3,11. Hand/Fingers/Thumb Massaging the scar as much as possible is necessary and getting the skin to glide freely from the underlying tendons, It is important to prevent adhesions right from the beginning. Position your band in a loop, without slack, bring the band out to shoulder width. I would honestly say that Kenhub cut my study time in half. Extensor Carpi Radialis Longus is, as the name suggests, the longer of the two extensor carpi radialis muscles as its origin is the ridge above the lateral epicondyle of the humerus, unlike the other wrist extensors which attach to the epicondyle itself. Variations of the Flexor Digitorum Superficialis As Determined by an Expanded Clinical Examination. When deciding how to best train a muscle, its important to think about the functions that that muscle is responsible for. The repair may be performed under general anaesthetic or regional anaesthetic (injection of local anaesthetic at the shoulder). loss of active flexion strength or motion of the involved digit(s), evidence of malalignment or malrotation may indicate an underlying fracture, assess skin integrity to help localize potential sites of tendon injury, look for evidence of traumatic arthrotomy, passive wrist flexion and extension allows for assessment of the, normally wrist extension causes passive flexion of the digits at the MCP, PIP, and DIP joints, maintenance of extension at the PIP or DIP joints with wrist extension indicates flexor tendon discontinuity, active PIP and DIP flexion is tested in isolation for each digit, important given the close proximity of flexor tendons to the digital neurovascular bundles, partial lacerations < 60% of tendon width, may be associated with gap formation or triggering, flexor tendon reconstruction and intensive postoperative rehabilitation, minimal interference with tendon vascularity, sufficient strength throughout healing to permit application of early motion stress to the tendon, delayed treatment leads to difficulty due to tendon retraction, incisions should always cross flexion creases transversely or obliquely to avoid contractures (never longitudinal), meticulous atraumatic tendon handling minimizes adhesions, linear relationship between strength of repair and # of sutures crossing repair, 4-6 strands provide adequate strength for early active motion, high-caliber suture material increases strength and stiffness and decreases gap formation, ideal suture purchase is 10mm from cut edge, core sutures placed dorsally are stronger, improves tendon gliding by reducing the cross-sectional area, improves strength of repair (adds 20% to tensile strength), allows for less gap formation (first step in repair failure), produces less gliding resistance than other techniques, theoretically improves tendon nutrition through synovial pathway, clinical studies show no difference with or without sheath repair, most surgeons will repair if it is easy to do, historically believed to be critical to preserve, however recent biomechanical studies have shown, can be incised with little resulting functional deficit, 100% of A4 can be incised with little resulting functional deficit, in zone 2 injuries, repair of one slip alone improves gliding, weakest between postoperative day 6 and 12, repair site gaps > 3mm are associated with an increased risk of repair failure, usually epinephrine 1:100,000 and 7mg/kg lidocaine, 1% lidocaine with 1:100,000 epi for a 70kg person, dilute with saline (50:50) to get 0.5% lidocaine, 1:200,000 epi, if 100-200cc is needed for large fields (tendon transfer, spaghetti wrist), dilute with 150cc saline to get 0.25% lidocaine and 1:400,000 epi, add 10cc of 0.5% bupivacaine with 1:200,000 epi, allows intraoperative assessment for repair gaps by getting awake patient to actively flex digit, reduces need for postop tenolysis by allowing intraoperative assessment of whether repair will fit through pulleys, allows on-the-spot debulking of bunched repairs, allows division of A4 pulley and venting (partial division) of A2 pulleys, allows repair of tendons inside tendon sheaths as patients can demonstrate that the inside of the sheath has not been inadvertently caught, begin active midrange motion after day 3 (form a partial fist with 45 degree flexion at MP, PIP and DIP joints, or "half a fist 45/45/45 regime"), full passive range of motion of adjacent joints, only perform if the flexor sheath is pristine and the digit has full ROM, Stage I - SR is placed to create a favorable tendon bed, Stage II (3-4 months) - SR is retrieved and a tendon graft is placed, through the mesothelium-lined pseudosheath, pulvertaft weave proximally and end-to-end tenorrhaphy distally, SR is placed in the flexor sheath, pulleys are reconstructed (as needed), and a loop between the proximal stumps of FDS and FDP is created in the palm, SR is retrieved, FDS is cut proximally and reflected distally through the pseudosheath and either attached directly to FDP stump or secured with a button, graft (FDS) size is known at the time of silicone rod selection, less graft diameter-rod diameter mismatch, fewer adhesions than extrasynovial grafts, relies on only 1 tenorrhaphy site (distal or proximal) to heal at any one time (vs. Hunter technique where 2 tennoprhaphy sites are healing simultaneously), graft tensioning is at the distal end during stage II, the proximal end has already healed after stage I, extensor digitorum longus to 2nd-4th toes, pulley reconstruction should occur first if a tendon graft is being used, subsequent tenolysis is required more than 50% of the time, localized tendon adhesions with minimal to no joint contracture and full passive digital motion, may be required if a discrepancy between active and passive motion exists after therapy, wait for soft tissue stabilization (> 3 months) and full passive motion of all joints, careful technique to preserve A2 and A4 pulleys, Postoperative controlled mobilization has been the major reason for improved results with tendon repair, limits restrictive adhesions and leads to increased tendon excursion, indicated for children and non-compliant patients, casts/splints are applied with the wrist and MCP joints positioned in flexion and the IP joints in extension, active finger extension with patient-assisted passive finger flexion and static splint, active finger extension with dynamic splint-assisted passive finger flexion, adds active wrist motion which increases flexor tendon excursion the most, moderate force and potentially high excursion, dorsal blocking splint limiting wrist extension, perform place and hold exercises with digits, most common complication following flexor tendon repair, perform if 4-6 months after tendon repair and significant loss of excursion, if < 1cm of scar is present, resect the scar and perform primary repair, if > 1cm of scar is present, perform tendon graft, if the sheath is intact and allows passage of a pediatric urethral catheter or vascular dilator, perform primary tendon grafting, if the sheath is collapsed, place Hunter rod and perform staged grafting, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease).
