title: Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath.
abstract: OBJECTIVE
  To describe the normal anatomy of the finger flexor tendon pulley system, with anatomic correlation, and to define criteria to diagnose pulley abnormalities with different imaging modalities.
  
  
  METHODS
  Three groups of cadaveric fingers underwent computed tomography (CT), magnetic resonance (MR) imaging, and ultrasonography (US). The normal anatomy of the pulley system was studied at extension and flexion without and with MR tenography. Pulley lengths were measured, and anatomic correlation was performed. Pulley lesions were created and studied at flexion, extension, and forced flexion. Two radiologists reviewed the studies in blinded fashion.
  
  
  RESULTS
  MR imaging demonstrated A2 (proximal phalanx) and A4 (middle phalanx) pulleys in 12 (100%) of 12 cases, without and with tenography. MR tenography showed the A3 (proximal interphalangeal) and A5 (distal interphalangeal) pulleys in 10 (83%) and nine (75%) cases, respectively. US showed the A2 pulley in all cases and the A4 pulley in eight (67%). CT did not allow direct pulley visualization. No significant differences in pulley lengths were measured at MR, US, or pathologic examination (P: =.512). Direct lesion diagnosis was possible with MR imaging and US in 79%-100% of cases, depending on lesion type. Indirect diagnosis was successful with all methods with forced flexion.
  
  
  CONCLUSIONS
  MR imaging and US provide means of direct finger pulley system evaluation.
authors.affiliation: Department of Radiology, University of California, San Diego, Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
authors.forename: O
authors.initials: O
authors.lastname: Hauger
authors.forename: C B
authors.initials: CB
authors.lastname: Chung
authors.forename: N
authors.initials: N
authors.lastname: Lektrakul
authors.forename: M J
authors.initials: MJ
authors.lastname: Botte
authors.forename: D
authors.initials: D
authors.lastname: Trudell
authors.forename: R D
authors.initials: RD
authors.lastname: Boutin
authors.forename: D
authors.initials: D
authors.lastname: Resnick
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D003287:Contrast Media; D005260:Female; D005385:Fingers / Q000033:anatomy & histology* / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013708:Tendon Injuries / Q000175:diagnosis; D013710:Tendons / Q000033:anatomy & histology* / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media