Relativity of the Conventional Hand Tendon Zones and the Actual Glide Zones of Tendon Injury and Repair: A Need for Concept Reappraisal.

ABSTRACT

The conventional hand tendon zones and subzones do not reflect the actual lengths covered by the involved locus of the tendon during full digital and wrist motion, which warrant reappraisal of the tendon zone concept. Because of the tendon excursions many lacerations should be regarded as multiple zone injuries. Furthermore, the length-spans of glide of the distal tendon stump and of the tendon junction (i.e. the glide zones of tendon injury and repair, respectively) are mostly not of the same length because, due to pulley release and bulkiness of the tenorrhaphy, the glide zone of tendon repair is shorter than that of tendon injury. Therefore, it would be practical to notate the glide zones of the lacerated tendon by indicating the anatomic position of the distal tendon stump and tendon junction in full extension and flexion. This data can be provided separately or along with the conventional tendon zones, e.g. II (A4-C2) or II-III (A2-PA), where A, C, and PA stand for the annular, cruciform, and palmar aponeurosis pulleys, respectively. The conventional tendon zone classification could be improved with a tendon glide zone concept. Documentation of the actual excursions of the distal tendon stump and of the tenorrhaphy interface would prevent misinterpretation of the actual level of tendon injury and repair.