title: Flexor pulley system: anatomy, injury, and management.
abstract: Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function.
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
authors.forename: Brian
authors.initials: B
authors.lastname: Zafonte
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
authors.forename: Dora
authors.initials: D
authors.lastname: Rendulic
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA. Electronic address: rmszabo@ucdavis.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Szabo
mesh_terms: D001696:Biomechanical Phenomena; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000033:anatomy & histology* / Q000502:physiology; D006801:Humans; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000033:anatomy & histology* / Q000502:physiology
keywords: Flexor pulley; annular pulley; pulley reconstruction; pulley rupture; rock climbing