CME expires July 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) examines common and complex tendon disorders of the upper extremity, with a focus on flexor and extensor tendons and associated tendinopathy.

Editor 
Chia Wu, MD, FAAOS 

Learning Objectives

• Differentiate between tendinopathies of the upper extremity, including lateral epicondylitis, de Quervain tenosynovitis, and trigger finger, by interpreting clinical presentation, anatomic involvement, and associated risk factors.
• Evaluate flexor and extensor tendon injuries across anatomic zone I through zone V using zone-specific clinical tests (eg, Elson test, Finkelstein test), radiographic indicators, and intraoperative findings to guide surgical decision making.
• Perform primary and staged tendon repair techniques, including flexor digitorum profundus pullout repair with the use of external suture buttons or suture anchors, accounting for zone-specific challenges, such as pulley crowding in patients with a zone II injury and muscle belly retraction in patients with a zone V injury.
• Implement nonsurgical treatment strategies, such as splint immobilization, corticosteroid injections, and physical therapy, for patients with intersection syndrome, extensor compartment tenosynovitis, or early mallet finger, with consideration of patient comorbidities (eg, diabetes mellitus, rheumatoid arthritis).
• Recognize and manage surgical complications, such as digital nerve injury during A1 pulley release, subluxation of the extensor carpi ulnaris (ECU), and boutonnière deformity because of central slip injury, via preventive intraoperative techniques. 
• Interpret high-yield imaging modalities (eg, MRI, ultrasonography) and their diagnostic limitations in evaluating patients with enthesopathy, tendon avulsion, or tendon sheath crowding, using imaging study findings to complement physical examination findings and inform treatment algorithms.
• Apply surgical treatment algorithms for chronic and acute tendon pathology, including the Leddy-Packer classification of flexor digitorum profundus avulsions, and modify treatment plans based on tendon retraction level, vascular compromise, and duration of injury.
• Integrate biomechanical and anatomic knowledge to optimize surgical approaches, such as open versus percutaneous A1 pulley release, first dorsal compartment decompression, and central slip fixation via Kirschner wire or screw techniques.

Earn up to 5 AMA PRA Category 1 CME credits™.