The FDS tendons produce PIP flexion — each can flex its digit's PIP joint independently because each index and long FDS has a separate muscle belly. The ring and little FDS share a muscle belly (quadriga effect if any component is injured). The FDS splitting into the Camper chiasm and reinserting on the middle phalanx is the anatomical basis of the Zone II flexor tendon repair challenge.
PIP joint flexion independently of the DIP joint — the only PIP flexor independent of the MCP
FDS function is tested by blocking adjacent fingers in extension (preventing FDP contribution) and asking the patient to flex each PIP joint individually. The ring FDS may be absent or shared with the middle in 10-15% of individuals. FDS-to-FDP repair in Zone II is the most technically demanding flexor tendon scenario requiring meticulous multi-strand technique.
FDS division in no man's land requiring combined repair with FDP using multi-strand technique and early active motion rehabilitation.
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