55.11 Tendon injuries

Rupture of the belly of a muscle usually causes little disability, but rupture of its tendon or the junction of tendon with muscle is usually serious. The result depends greatly on whether or not the tendon is surrounded by a sheath. For example, if one of the flexor tendons of a patient’s wrist is cut, its ends retract, become rounded, fail to heal and lie loose inside their sheath. Repair will be easier and the result is better if a tendon has no sheath, as with the extensors of the wrist. Tendon injuries most commonly involve the hand, so they are further discussed in Sections 75.20 and 75.21. Here we only discuss the general principles. The main one is the method for inserting sutures.

REPAIRING TENDONS

See elsewhere for injuries of a patient’s Achilles tendon (82.10), and his hand-his flexor tendons need special methods (75.21).

Figure 55.11: SUTURING A TENDON. This method keeps knots away from the cut ends of the tendon. Kindly contributed by Peter Bewes.

MATERIALS Non–irritating sutures, such as fine stainless steel wire, preferably braided, or monofilament nylon, preferably 5/0. Don’t use catgut.

Thread both ends of a length of the suture material onto two straight needles, and pass this through the patient’s cut tendon, as in A, Fig. 55-11.

Hold the cut end of the tendon in a pair of artery forceps and suture 1 or 2 cm down the tendon. Pass both needles through it diagonally two or three times.

Bring both ends of the suture out onto the cut ends of the tendon. Then thread them in a similar way into the cut surface of the other end of the tendon. Finally, pull the sutures tight and tie them.

CAUTION! Take care to identify the cut ends correctly. Don’t join a profundus to a sublimis tendon, or a nerve to a tendon!

POSTOPERATIVE CARE Immobilize the patient’s limb for 3 weeks in the position which will cause least tension on his cut tendon. Encourage as much active movement as imobilization will allow.

The critical period for rupture of the repair is immediately you remove the splints. So start movements gradually, and try to devise some form of check strap to prevent sudden movements which may rupture his newly repaired tendon. His limb will be stiff and painful, but it should improve steadily over many weeks.