What is the treatment for a Flexor Digitorum Superficialis (FDS) tendon sprain?

Treatment of Flexor Digitorum Superficialis (FDS) Tendon Sprain

The optimal treatment for an FDS tendon sprain consists of a phased rehabilitation approach including NSAIDs for pain relief, eccentric strengthening exercises, and functional support with a brace while avoiding immobilization. 1

Initial Management (0-4 weeks)

• Pain control and protected range of motion
  • NSAIDs such as naproxen 500mg twice daily or ibuprofen 1.2g daily for short-term pain relief 1
  • Application of ice to reduce inflammation 2
  • Functional bracing to provide support while allowing controlled movement 1
  • Avoid complete immobilization as this may lead to adhesions and stiffness 1, 3

Intermediate Phase (4-8 weeks)

• Progressive strengthening exercises
  • Eccentric strengthening exercises performed relatively pain-free 1, 2
  • Gradual increase in range of motion exercises
  • Continue with pain management as needed
  • Begin more functional hand exercises

Advanced Phase (8-12 weeks)

• Occupation-specific training
  • Functional exercises tailored to daily activities and occupational demands 1
  • Return to full activity when patient demonstrates:
    • Complete resolution of pain
    • Full range of motion
    • Strength symmetry >90% compared to uninjured side
    • Successful completion of occupation-specific functional tests 1

Follow-up Assessment

• Regular assessment at 2,6, and 12 weeks to evaluate:
  • Pain levels
  • Range of motion
  • Functional improvement
  • Signs of recurrent instability 1
• Consider referral to a specialist if no improvement occurs after 6-8 weeks of conservative treatment 1

Surgical Considerations

• Surgical intervention should only be considered when conservative measures fail after 3-6 months of well-managed treatment and significant functional limitation persists 1
• Complete tendon ruptures may require earlier surgical intervention, particularly if they result in functional deficits 4
• In cases of chronic injury with failed conservative management, surgical options may include tenolysis, FDS tendon excision, or capsulotomies of involved joints 4

Common Pitfalls and Caveats

• Delayed diagnosis can lead to flexion contractures and chronic tendon pathology 4
• Overaggressive rehabilitation can worsen the injury
• Undertreatment with prolonged immobilization can lead to adhesions and stiffness 3
• Injectable treatments should only be used as adjuncts to facilitate exercise rehabilitation, not as standalone treatments 2
• Tendon injuries are generally degenerative in nature and can cause significant morbidity if not appropriately managed 2

The evidence strongly supports that exercise rehabilitation is the mainstay of treatment for tendon injuries, with eccentric strengthening exercises being particularly effective when performed with minimal pain 1, 2. This approach, combined with appropriate pain management and functional support, provides the best outcomes for patients with FDS tendon sprains.