Inside the body: the hand

The hand and Zone II

Zone II is a segment of anatomy in the hand from the mid-palm where the flexor tendons of each finger glide back and forth inside a tight tunnel structure called the flexor tendon sheath, or pulley, system. The complexity of repairing a tendon in Zone II is alluded to by the name given to this area by hand surgeons, “no man’s land.”

Repairs in No Man’s Land

In essence, a tendon is like a rope, woven of individual collagen fibers. As long as the tendon is inside the flexor tendon sheath and under some tension, the tendon is healthy. When a lacerated tendon retracts outside the pulley system (flexor tendon sheath), the tendon swells and frays, such that it may be very difficult to place it back into its sheath. Simultaneously, the empty flexor tendon sheath begins to contract, until the sheath becomes practically obliterated.

Risk factors for flexor tendon injuries

Sports and activities that may cause flexor tendon injuries

In addition to lacerations, certain sports activities can cause flexor tendon injuries. These injuries often occur in football, wrestling, and rugby. “Jersey finger” is one of the most common of these injuries and can happen when one player grabs another’s jersey and a finger (usually the ring finger) gets caught and pulled, resulting in the tendon pulling off the bone. Tendons and/or their sheaths can also be stretched or torn in sports requiring a great deal of arm and hand strength, such as rock climbing.

Other conditions that may weaken flexor tendons

Certain health conditions, such as rheumatoid arthritis, weaken the flexor tendons and make them more likely to tear. Oddly enough, this can happen without warning or injury – a person may simply notice that his or her finger no longer bends, but cannot recall how it could have happened.

Limitations of traditional surgery systems

Because tendons tear in different ways – such as straight across, at an angle, or pulled right off of the bone – there are many different methods for surgeons to repair them. All the methods of repair, however, involve suturing the tendon back together. Surgery is usually performed on an outpatient basis and patients are often encouraged to begin movement immediately. The procedure can, however be extremely frustrating especially in the “no man’s land” area and there is risk of soft tissue trauma. In addition to this, tendon injuries usually cannot be treated successfully beyond three weeks from laceration.

Toby Ortho Flexor

Toby Flexor® for flexor tendon repair

The Toby Flexor® is the world leader in flexor tendon repair, having developed the industry’s first ever tools for such surgeries. The devices are intended to help the surgeon repair and/or reconstruct lacerated flexor tendons. The pre-sterile kit contains two components: a transparent funnel retractor and a suture retriever / sheath dilation tool. With the assistance of these tools, flexor tendon repair surgery can now be performed even up to 6 or 8 weeks after the initial injury; something previously unheard-of.

How to aid recovery

This injury normally takes 12 weeks to heal and your caregiver will provide you with a detailed rehabilitation program post-surgery that must be followed rigorously.

Typically, you will be given exercises to carry out on a daily basis to strengthen muscles. The objective is to keep the hand moving to prevent stiffness but not to aggravate the injury and you will typically be provided with a splint for the early stages of rehabilitation.

Generally you should not use the hand to do any functional tasks and you may find holding your hand up helps reduce swelling. In addition to this you may find it useful to apply cold ice packs to sore areas. Quitting smoking is recommended, as it has been shown to prolong healing processes.

* TOBY is an implant manufacturer and does not practice medicine. Only a healthcare professional can properly advise regarding anatomy, treatment options, and a patient’s specific injury and needs. TOBY makes no representations or warranties regarding the information contained on this website.