Surgical management of the manica flexoria

Surgery of the MF is best undertaken using tenoscopy. The arthroscope is introduced using the standard approach to the digital sheath, immediately distal to the proximal sesamoid bones and can be undertaken in lateral or dorsal recumbency. An Esmarch bandage is used, terminated above the tarsus (or carpus) to minimise interference with the arthroscope and instruments. Lateral recumbency is the most commonly used technique but this author prefers dorsal recumbency because, although it is a more uncomfortable position for the surgeon, it provides easier access to both sides of the sheath for transection of the attachments of the MF to the superficial digital flexor tendon (SDFT). The disadvantage with dorsal recumbency is that there is greater tension on the deep digital flexor tendon (DDFT) and hence it is easier to cause iatrogenic damage to the DDFT ...