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Suspected partial flexor tendon laceration — MSRA MCQ

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HardSoft Tissue InjurySuspected partial flexor tendon lacerationMSRA

A 36-year-old right-hand-dominant chef presents to a GP-led urgent treatment centre 10 hours after a broken wine glass caused a 1.5 cm transverse laceration over the volar aspect of his right ring finger at the proximal interphalangeal joint. The finger was flexed around the glass at the time of injury. He irrigated the wound immediately and applied a dressing. The wound is clean, with no spreading erythema or purulent discharge. Capillary refill and two-point discrimination are normal. He can actively flex both the proximal and distal interphalangeal joints, but isolated distal interphalangeal joint flexion is painful and clearly weaker than on the left when tested against resistance. Plain radiographs show no fracture or radiopaque foreign body. His tetanus immunisation is up to date. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Apply a protective dressing and splint, and arrange same-day assessment by the on-call hand/plastic surgery service

Explanation lettering: E = shown as A · A = shown as E

This is a suspected partial flexor tendon laceration requiring urgent specialist assessment. The volar laceration occurred while the finger was flexed, placing the flexor mechanism at risk. Preserved active flexion does not exclude tendon injury: a partially divided tendon may remain functional, but pain on use or stretch, especially weakness and pain against resistance, is characteristic. Normal sensation and perfusion exclude an evident digital nerve or vascular injury but do not make tendon injury low risk. A is inappropriate because delayed routine review risks progression to rupture, impaired function and delayed definitive management. B is initially plausible after a hand laceration, but there are no clinical features of infection and antibiotics do not address the suspected structural injury. C may be considered in selected equivocal cases, but should not delay urgent hand-specialist assessment when examination already suggests a partial flexor injury. D is unsuitable because unrestricted active exercise and an extension splint do not protect a potentially divided flexor tendon. The priority is protection from further tendon loading and urgent assessment by the appropriate hand/plastic surgery service.

Reference: Hand Injuries (Published 26 November 2025) — https://www.rightdecisions.scot.nhs.uk/media/jujp5l25/hand-injuries-dec-24.pdf