The pulley system of the thumb: anatomic and biomechanical study
- PMID: 12132087
- DOI: 10.1053/jhsu.2002.34008
The pulley system of the thumb: anatomic and biomechanical study
Abstract
To examine the precise conformation of the annular and oblique pulleys of the thumb flexor sheath, anatomic dissections were undertaken on 14 hands. In all specimens a distinct pulley was found between the A1 and oblique pulleys. This is named the variable annular pulley or Av pulley. There appear to be 3 discrete forms of this pulley designated type I to III. The biomechanical study was done on 8 limbs by using linear strain transduction techniques. The analysis showed that the strain in the oblique pulley was greater in extension than in flexion of the thumb. This statement remains true even after division of either the A1 or Av pulley and after section of both pulleys. The oblique pulley does not prevent bowstringing of the flexor pollicis longus when A1 and Av pulleys have been sectioned. These studies challenge current concepts of both the anatomy and mechanics of the thumb pulley system with implications for clinical procedures such as trigger thumb release and pulley reconstruction.
Similar articles
-
Varied anatomy of the thumb pulley system: implications for successful trigger thumb release.J Hand Surg Am. 2012 Nov;37(11):2278-85. doi: 10.1016/j.jhsa.2012.08.005. J Hand Surg Am. 2012. PMID: 23101525
-
Biomechanics of the thumb flexor pulley system.J Hand Surg Am. 1994 May;19(3):475-9. doi: 10.1016/0363-5023(94)90066-3. J Hand Surg Am. 1994. PMID: 8056978
-
[Pulleys of the tendon sheath of the flexor pollicis longus muscle].Handchir Mikrochir Plast Chir. 1999 Nov;31(6):362-6. doi: 10.1055/s-1999-13553. Handchir Mikrochir Plast Chir. 1999. PMID: 10637724 German.
-
Flexor pulley system: anatomy, injury, and management.J Hand Surg Am. 2014 Dec;39(12):2525-32; quiz 2533. doi: 10.1016/j.jhsa.2014.06.005. Epub 2014 Nov 21. J Hand Surg Am. 2014. PMID: 25459958 Review.
-
Triggering of the lesser toes at a previously undescribed distal pulley system.Foot Ankle Int. 1998 Feb;19(2):113-7. doi: 10.1177/107110079801900211. Foot Ankle Int. 1998. PMID: 9498585 Review.
Cited by
-
Trigger Thumb, Trigger Finger and Clasped Thumb.Children (Basel). 2024 Mar 1;11(3):294. doi: 10.3390/children11030294. Children (Basel). 2024. PMID: 38539329 Free PMC article. Review.
-
Surgical Treatment for Trigger Thumb Using a Radial Approach.J Hand Microsurg. 2022 Jun 6;15(5):388-394. doi: 10.1055/s-0042-1749421. eCollection 2023 Dec. J Hand Microsurg. 2022. PMID: 38152679 Free PMC article.
-
MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review.Skeletal Radiol. 2024 Jul;53(7):1243-1254. doi: 10.1007/s00256-023-04531-0. Epub 2023 Dec 7. Skeletal Radiol. 2024. PMID: 38057436 Review.
-
Morphometric study of pulleys of the thumb.Anat Cell Biol. 2018 Jun;51(2):71-78. doi: 10.5115/acb.2018.51.2.71. Epub 2018 Jun 27. Anat Cell Biol. 2018. PMID: 29984050 Free PMC article.
-
Thumb ultrasound: Technique and pathologies.Indian J Radiol Imaging. 2016 Jul-Sep;26(3):386-396. doi: 10.4103/0971-3026.190408. Indian J Radiol Imaging. 2016. PMID: 27857468 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources