Digital avulsion injuries: the shish kebab effect of the fibrous flexor sheath.
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.
D000328:Adult; D000673:Amputation, Traumatic / Q000473:pathology* / Q000601:surgery; D005383:Finger Injuries / Q000473:pathology / Q000601:surgery; D006230:Hand Injuries / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation / Q000379:methods; D013708:Tendon Injuries / Q000473:pathology* / Q000601:surgery; D013710:Tendons / Q000601:surgery