Sonographic Location of Distal A1 Pulley by Means of a Bony Acoustic Landmark on the Proximal Phalanx: An Anatomic Study

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

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Dorsal and Volar Surgical Approaches to the Metacarpophalangeal Joint: A Comparative Anatomic Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500332 ◽

2017 ◽

Vol 22 (03) ◽

pp. 297-302

Author(s):

Eitan Melamed ◽

Nicholas Calotta ◽

Ricardo Bello ◽

Richard M Hinds ◽

John T Capo ◽

...

Keyword(s):

Surface Area ◽

Articular Surface ◽

Insertion Site ◽

Proximal Phalanx ◽

Extensor Tendon ◽

Joint Surface ◽

Surgical Approaches ◽

Collateral Ligament ◽

Volar Approach ◽

A1 Pulley

Background: We compared 3 surgical approaches to the MP joint: a dorsal extensor tendon–splitting approach, a dorsal extensor tendon–reflecting parasagittal approach, and the volar A1 pulley approach. We quantitatively compared each of these approaches by measuring the amount of articular cartilage exposed on the base of the proximal phalanx. We hypothesize that visualization of the articular cartilage of the proximal phalangeal base is enhanced with the volar approach. Methods: The MP joints of the 32 available digits were randomly assigned to 1 of 3 surgical approaches: extensor tendon splitting (A), extensor tendon reflecting (B), or volar approach (C). After each approach, the visible articular surface of the base of the proximal phalanx was stained with methylene blue. The MP joints were then disarticulated, and the proximal phalanges were digitally mapped using a 3-dimensional digitizer. Three-dimensional computer software was used to analyze and calculate the dyed exposed surface area and total surface area of each specimen. Results: The mean % exposed joint surface area for the dorsal extensor splitting, dorsal extensor reflecting and volar approaches were 62%, 67% (over the dorsal side of the proximal phalanx) and 54% (over the volar side of the proximal phalanx), respectively. Multiple linear regression showed statistical significance for a smaller percentage of articular surface area exposed with the volar approach. However, this was not clinically significant. A significant association was found between location in the small finger and greater % exposed joint surface, compared to approaches in the index finger. In all volar approach specimens, the collateral insertion site was visible, but not in the dorsal approach specimens. Conclusions: Knowledge of the limits of each exposure is essential for planning the most appropriate surgical approach. The A1 pulley approach provided greater access to the volar 50% of the joint and collateral ligament insertion without violating the extensor mechanism. The amount of joint surface visualized through all 3 approaches was not significantly different. However, based on the accessibility to the collateral ligament insertion site among three different approaches, we recommend the volar A1 pulley approach for treatment of avulsion fractures of the base of the proximal phalanx. For other injuries of the MP joint, including the intra-articular proximal phalanx base fractures, and metacarpal head fractures, the dorsal approaches are still indicated.

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Trigger finger due to phalangeal osteochondroma of an adult: A case report

Journal of Orthopaedic Surgery ◽

10.1177/2309499020969991 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096999

Author(s):

Hoi Young Kwon ◽

Hong Je Kang

Keyword(s):

Pediatric Patients ◽

Proximal Phalanx ◽

Middle Finger ◽

Trigger Finger ◽

X Rays ◽

Solitary Osteochondroma ◽

Stenosing Tenosynovitis ◽

Left Middle ◽

A1 Pulley ◽

Rule Out

Trigger finger is stenosing tenosynovitis that occurs in A1 pulley. It usually occurs idiopathically in patients’ 40s and 50s. On the other hand, pediatric trigger finger usually occurs before 8 years old in pediatric patients. Even though being rare, a tumor occurred in the soft tissue or bone near flexor tendons can cause a trigger finger. Trigger finger due to osteochondroma is very rare. Furthermore, most cases of trigger finger due to osteochondroma occur in pediatric patients with hereditary multiple osteochondromatosis (HMO). The authors report this case of a trigger finger caused by a solitary osteochondroma that occurred in the proximal portion of the proximal phalanx of the left middle finger, of a 21-year-old patient. The symptoms were relieved after excision of the osteochondroma. If a patient with unusual demographics visits, the cause of trigger finger may not be idiopathic. Evaluation methods such as x-rays and ultrasonography can be helpful to rule out other causes, such as tumors.

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Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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An Anatomic Study of the S2 Iliac Technique for Lumbopelvic Screw Placement

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(09)79161-6 ◽

2010 ◽

Vol 2010 ◽

pp. 291-292

Author(s):

R. Riesenburger

Keyword(s):

Screw Placement ◽

Anatomic Study

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Secondary Fractures Following Internal Fixation in Two Horses

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633209 ◽

1989 ◽

Vol 02 (03) ◽

pp. 125-128

Author(s):

E. M. Gaughan ◽

N. G. Duchar

Keyword(s):

Internal Fixation ◽

Sagittal Plane ◽

Proximal Phalanx ◽

Fracture Repair ◽

Fracture Line ◽

Carpal Bone ◽

Fracture Plane ◽

The Third ◽

Lag Screw ◽

Secondary Fractures

SummaryImplant associated fractures have not been reported in horses. Two horses were evaluated for fractures in the fore limbs, occurring subsequent to previous fracture repair. Previously, the horses had sustained fractures of unusual configurations which were repaired using internal fixation. Following repair and healing of the fractures, secondary fractures occurred in the same bone, but in a different (more common) configuration. The first horse was evaluated ten months following lag screw fixation of a longitudinal fracture of the proximal phalanx in a frontal plane. This horse presented with a more typical comminuted fracture in the sagittal plane with the screws from the first fixation lying in the fracture line. This fracture was successfully treated with a cast. The second horse was examined eightteen months after repair of a medial sagittal slab fracture of the third carpal bone. The horse presented with a more typical dorsal slab fracture of the third carpal bone with the previously placed lag screw lying in the fracture line. The screw was removed and a lag screw was placed perpendicular to the new fracture plane through the dorsal surface of the third carpal bone to repair the fracture.

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