Flexor Tendon Injuries are traumatic injuries to the flexor digitorum superficialis and flexor digitorum profundus tendons that can be caused by laceration or trauma.

• Zone I extends from just distal to the insertion of the sublimis tendon to the site of insertion of the profundus tendon. • Zone II is in the critical area of pulleys (Bunnell’s “no man’s land”) between the distal palmar crease and the insertion of the sublimis tendon.

There are 5 Flexor and 9 Extensor Zones of the Hand. They are used to describe the location of a tendon injury, guide post-operative therapy and predict prognosis.

Tendon repair in zones other than zone 2 has generally better outcome and less risk of retraction or adhesion. In zone 2, the standard tendon repair technique is using 4- or 6- strand sutures.

Flexor Tendon Zones of the Hand Basic sciences - Flexor tendon zones Ortho M8 Watch on Courtesy: Harry Benjamin Laing, Ortho M8, FRCS (Tr and Orth) Tutorials

Each flexor tendon zone protocol is uniquely different and has its own treatment guideline and orthosis considerations. In this course we go through each of the major protocols, individually, and cover everything you need to know about treating a patient with a flexor injury.

Both the flexor digitorum profundus and flexor digitorum superficialis tendons run together inside tight sheaths, making scarring and stiffness more likely. Zone III: From the palm crease to the lower edge of the carpal tunnel. Tendon repairs here are easier than Zone II but can be complicated if nearby nerves or blood vessels are also injured.

Zone VI Area over dorsum of hand Tendons in this area are superficial; even minor-appearing lacs are associated with tendon injuries Treatment typically requires operative fixation with K wires Zone VII Area over the wrist Repair can be difficult because of presence of extensor retinaculum Zone VIII Area of the distal forearm

Any flexor tendon hand injuries are classified based on Verdan’s zones (Fig. 1). They are important to determine in any suspected tendon injury, as they affect management and overall prognosis.

Flexor tendons are cord-like structures running from the forearm across the wrist and palm and into the fingers, allowing you to bend your fingers and thumb to grasp an object or make a fist.