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Advances in the Biomechanics of the Hand and Wrist pp 41–57Cite as

The Mechanical Properties of Finger Flexor Tendons and Development of Stronger Tendon Suturing Techniques

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Part of the book series: NATO ASI Series ((NSSA,volume 256))

Abstract

As the finger flexor tendons pass distally from the flexor muscles of the forearm through the wrist and fingers to their insertions in the phalanges they are progressively constricted into tighter surrounding tissues. This passage through the carpal tunnel and into the fibro-osseous canals of the fingers is accompanied by progressively increasing difficulty in repairing the tendons and obtaining good functional results afterwards, so much so that the area between the distal crease of the palm of the hand and the distal interphalangeal joint was known as “no man’s land” by surgeons for many years.50,51 The paucity of tendon vascularity in much of this zone23 causes a tendency for the surrounding tissues to become linked to the repair site by scar tissue adhesions, which can bring nutrition by vascular perfusion but prevent the tendons from moving adequately.37 Anything less than perfection in surgical technique encourages this tendency, and factors such as rough handling of the surface of the tendon and the presence of suture material on the surface of the tendon have been implicated in causing poor results.33 A further factor is that the tightness of the pulleys, which hold the tendons close to the bones when the finger is flexed,14 means that the surgeon must not make a bulky repair. Knots in the suture material or protruding edges of the cut tendon ends will catch on the edges of the pulleys, preventing finger flexion.3 The requirements for lack of repair bulk and little handling of the tendon mean that surgeons cannot use many strands of thick sutures to try to make their repairs strong, and this leads to repairs failing after the operation.

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Authors and Affiliations

  1. Biomechanics Section, Mechanical Engineering Department, Imperial College, London, SW7 2BX, England

    Andrew A. Amis

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  1. Andrew A. Amis
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Editors and Affiliations

  1. Erasme University Hospital, Brussels, Belgium

    F. Schuind

  2. Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

    K. N. An  & W. P. Cooney III  & 

  3. Hospital General de Catalunya, Sant Cugat, Barcelona, Spain

    M. Garcia-Elias

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© 1994 Springer Science+Business Media New York

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Amis, A.A. (1994). The Mechanical Properties of Finger Flexor Tendons and Development of Stronger Tendon Suturing Techniques. In: Schuind, F., An, K.N., Cooney, W.P., Garcia-Elias, M. (eds) Advances in the Biomechanics of the Hand and Wrist. NATO ASI Series, vol 256. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-9107-5_6

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  • DOI: https://doi.org/10.1007/978-1-4757-9107-5_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-9109-9

  • Online ISBN: 978-1-4757-9107-5

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