Where is Zone 2 in flexor tendon repair?
This zone extends from the proximal margin of the A1 pulley to the insertion point of flexor digitorum superficialis (FDS). The zone is characterised by a tight fibro-osseous tunnel with closely related pulleys and a complex interweaving of tendons.
What tendons are in Zone 2 of the hand?
We hypothesize that a region of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons in zone 2 exists that, when involved in a laceration repair, will reliably catch on the A2 pulley after surgery.
Why is flexor tendon Zone 2 called No Man’s Land?
Bunnell, in 1918, coined the term “no man’s land” to describe zone 2 in the hand because at that time it was felt that no man should attempt repair within this zone.
Which pulleys are most important in the flexor tendon system?
Injury to the flexor tendon system can lead to significant morbidity for patients. Most important ones are the A2 and the A4 pulleys.
Why Zone 2 is no man’s land?
Zone 2 is also called as no man’s land. The historic derivation of “no man’s land” dates back to 14th century. It was used to describe an area outside London used for executions. Sterling Bunnel used this term in hand surgery who most probably derived it with his experience in the World War 1.
How do you treat a flexor tendon injury?
Flexor tendon injuries do not heal by themselves and frequently require surgery to put the injured tendon back to its normal position. When surgery is required, a splint and hand therapy may be used after the procedure to protect you and to aid in recovery.
Where is zone 2 in the hand?
Zone II. Zone II extends from the middle of the middle phalanx to distal palmar crease. It contains both flexor tendon superficialis and flexor tendon profundus. Proximal to zone II, the flexor digitorum superficialis tendons lie superficial to the FDP tendons.
What is flexor tendon?
Flexor tendons run from the forearm to the ends of the fingers across the palm side of the hand. They control the ability to bend fingers down to the palm (for example to make a fist, grip, or pinch objects). When these tendons are cut or injured, it can be impossible to bend the fingers or thumb.
What is an A2 pulley?
The A2 pulley is located distal to the metacarpophalangeal (MCP) joints of digits 2 through 5, and functions to “hug” the flexor tendons close to the proximal phalanx, allowing it to essentially function as a fulcrum.
Is the A2 pulley a tendon?
That’s where your pulleys come into play. The A2 is one of five pulleys in each finger that holds the flexor tendon tight up against the bones. So when you flex your finger, the tendon slides back and forth under the pulley while the pulleys keep it in position.
How serious is flexor tendonitis?
If a tendon becomes torn, any tension on it will create a rubber band effect and cause it to weaken. This makes the healing process slow. If a deep cut occurs, damage to nerves or blood vessels may occur. This is very serious and requires immediate surgery to remedy.
Can a flexor tendon heal without surgery?
Do flexor digitorum profundus tendons in Zone 2 reliably catch on the A2 pulley?
We hypothesize that a region of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons in zone 2 exists that, when involved in a laceration repair, will reliably catch on the A2 pulley after surgery. Knowledge of this region will guide surgeons regarding the need for partial release of the A2 pulley.
What are the pulleys of a flexor tendon?
J Bone Joint Surg Am 42 (A): 647-657, 1960, Ref. 5). FIGURE 15-2 Flexor tendon pulley system. The annular pulleys are designated A1 through A5, with cruciate pulleys C1, C2, and C3. This specimen has a relatively thin A4.
Is partial release of the A2 pulley necessary after Z one 2 flexor tendon laceration?
Knowledge of this high-risk region of flexor tendon repair will guide surgeons regarding the potential need for partial release of the A2 pulley. Z one 2 flexor tendon lacerations are common injuries that are notoriously difficult to treat.
What is Zone 2 of the A1 pulley?
Zone II spans from the proximal aspect of the A1 pulley to the insertion of the FDS on the middle phalanx and can be further divided into subzone A through D ( 11) ( Fig. 15-2 ). FIGURE 15-3 Vincula—Note the location of the vincula, which provide a vascular supply to the tendons to aid in intrinsic tendon healing.