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Combined Nerve and Tendon Injury in the Palm

Robert R. Rix, MD
JAMA. 1971;217(4):480. doi:10.1001/jama.1971.03190040072031.
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To the Editor.—  In order to qualify as a mid-palm injury the distal cut end of the flexor profundus tendon must lie in the narrow zone between the digital sheath and the carpal tunnel, with the finger fully extended. This is not a common injury (about 10% of flexor tendon lacerations), but when it does occur it is a major problem because it is almost always accompanied by severance of one or more digital nerves.There is no general agreement on handling combined nerve and tendon injuries in clean-cut wounds of the palm. Most authorities recommend immediate primary repair of both structures. While this is undoubtedly ideal treatment, it is also difficult to accomplish. If the nerve injury is repaired first, the manipulations incident to the tendon suture may endanger the delicate nerve repair. If the tendon injury is repaired first, and the finger is flexed to take the strain

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