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Digital avulsion injuries: the shish kebab effect of the fibrous flexor sheath
Abstract:
On debriding a hand from which four fingers with all their flexor tendons had been avulsed, a sizeable quantity of 'minced' muscle was found in the palm. Further cadaver investigations showed that the avulsed flexor tendons disrupted proximal to the musculo-tendon junction, and that a significant amount of devitalized forearm muscle tissue was left in the palm as the tendons passed through the proximal fibrous flexor sheath. A case of early development of carpal tunnel syndrome following avulsion injury of the little finger is illustrated in which later surgical exploration of the palm revealed detached muscle tissue compromising the median nerve. It is suggested that exploration of the palm is indicated in all cases of proximal avulsions of the flexor tendons.
Insights
Proximal flexor tendon avulsions can leave minced muscle in the palm, potentially causing carpal tunnel syndrome. Surgical exploration of the palm is recommended for these hand injuries.
Area of Science:
- Hand surgery
- Orthopedic surgery
- Traumatology
Background:
- Flexor tendon avulsion injuries can be complex, involving significant tissue disruption.
- Understanding the anatomical consequences of these injuries is crucial for effective treatment.
Observation:
- Minced muscle tissue was discovered in the palm after debriding a hand with four avulsed flexor tendons.
- Cadaver studies revealed that avulsed flexor tendons disrupt proximal to the musculo-tendon junction.
- Devitalized forearm muscle tissue remained in the palm as tendons passed through the proximal fibrous flexor sheath.
Findings:
- A case of carpal tunnel syndrome developed early after a little finger avulsion injury.
- Surgical exploration identified detached muscle tissue compressing the median nerve in the palm.
- The disruption point of flexor tendons is proximal to the musculo-tendon junction.
Implications:
- Exploration of the palm is indicated in all proximal flexor tendon avulsion cases.
- Early identification and removal of detached muscle tissue may prevent complications like carpal tunnel syndrome.
- This finding highlights the importance of thorough surgical assessment in severe hand trauma.