The FDS tendons split into two slips at each finger A1 pulley to pass around and insert on the middle phalanx base, allowing the FDP tendon to pass through the FDS split (Camper chiasm) to reach the distal phalanx. FDS specifically flexes the PIP joint and can be tested in isolation by holding the other fingers in extension (preventing FDP contribution). Zone II flexor tendon injuries involve both FDS and FDP in the confined digital sheath.
PIP joint flexion of fingers 2-5
The FDS tendon can be transferred as the motor for opposition reconstruction (FDS ring finger to APB transfer — Bunnell opposition transfer) providing a reliable tendon with excellent excursion for restoring thumb opposition in median nerve palsy.
Ring finger FDS transfer to restore thumb opposition in high median nerve palsy — the Bunnell opposition transfer.
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