Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger

Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering.

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Localized Amyloid Deposition in Trigger Finger

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0571 ◽

2001 ◽

Vol 26 (4) ◽

pp. 380-383 ◽

Cited By ~ 7

Author(s):

S. CORDINER-LAWRIE ◽

J. DIAZ ◽

P. BURGE ◽

N. A. ATHANASOU

Keyword(s):

Flexor Tendon ◽

Tendon Sheath ◽

Amyloid Deposition ◽

Trigger Finger ◽

Elderly Adults ◽

Amyloid Deposits ◽

Flexor Tendon Sheath ◽

Sulphated Glycosaminoglycans ◽

A1 Pulley ◽

Fibrinoid Degeneration

Trigger finger is due to degeneration and thickening of the proximal portion (A1 pulley) of the flexor tendon sheath, which causes constriction of the flexor tendon. This study reports the presence of localized amyloid deposition in the tendon sheath of 11 of 47 cases (23%) of idiopathic primary trigger finger. Amyloid deposits were only found in patients aged over 46 years old and were present around cells and at sites of mucinous and fibrinoid degeneration which contained highly sulphated glycosaminoglycans. The pathogenic significance of these deposits is uncertain but their small size and presence only in middle-aged and elderly adults suggests that they represent a form of age-associated amyloid deposition.

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A Case of Trigger Finger by Flexor Tendon Sheath Ganglion

Korean Journal of Clinical Geriatrics ◽

10.15656/kjcg.2015.16.2.81 ◽

2015 ◽

Vol 16 (2) ◽

pp. 81-83

Author(s):

Seok-Kyun Park ◽

Soo Uk Chae

Keyword(s):

Flexor Tendon ◽

Tendon Sheath ◽

Trigger Finger ◽

Flexor Tendon Sheath

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OUTCOME OF TRACTION TENOLYSIS IN OPEN TRIGGER FINGER RELEASE — A RETROSPECTIVE REVIEW

Hand Surgery ◽

10.1142/s0218810413500421 ◽

2013 ◽

Vol 18 (03) ◽

pp. 375-379 ◽

Cited By ~ 1

Author(s):

Muntasir Mannan Choudhury ◽

Shian Chao Tay

Keyword(s):

Flexor Tendon ◽

Group Versus ◽

Trigger Finger ◽

Flexor Digitorum Profundus ◽

Flexor Digitorum Superficialis ◽

Active Motion ◽

Total Active Motion ◽

The Mean ◽

Flexor Digitorum ◽

A1 Pulley

Surgical treatment for trigger finger involves division of the A1 pulley. Some surgeons perform an additional step of traction tenolysis by sequentially bringing the flexor digitorum superficialis and flexor digitorum profundus tendons out of the wound gently with a Ragnell retractor. There is currently no study which states whether flexor tendon traction tenolysis should be routinely performed or not. The objective of this study is to compare the outcome in patients who have traction tenolysis performed (A group) versus those who did not have traction tenolysis (B group) performed. It was noted that even though the mean total active motion (TAM) for the B group in our study was lower preoperatively, it was consistently higher than the A group in all the 3 post-operative visits demonstrating a better outcome in the B group. Even though it was not statistically significant, our data also showed that patients with traction tenolysis appeared to have more postoperative pain compared to those without.

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Biomechanics of the Human Flexor Tendon Sheath Investigated by Tenography

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80163-9 ◽

1995 ◽

Vol 20 (4) ◽

pp. 500-504 ◽

Cited By ~ 10

Author(s):

S. MESTER ◽

B. SCHMIDT ◽

K. DERCZY ◽

J. NYARADY ◽

V. BIRO

Keyword(s):

Synovial Fluid ◽

Flexor Tendon ◽

Tendon Sheath ◽

Moment Arm ◽

Continuous Change ◽

Flexor Tendons ◽

Flexor Tendon Sheath ◽

Flexion And Extension

Tenography has been performed on eight detached lingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

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Comparison of tenoscopic and ultrasonographic methods of examination of the digital flexor tendon sheath in horses

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632957 ◽

2005 ◽

Vol 18 (04) ◽

pp. 209-214 ◽

Cited By ~ 14

Author(s):

G. Möbius ◽

J. Ferguson ◽

J. Edinger

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Flexor Tendon ◽

Tendon Sheath ◽

Qualitative Assessment ◽

Annular Ligament ◽

Sonographic Examination ◽

Flexor Tendons ◽

Superficial Digital Flexor Tendon ◽

Flexor Tendon Sheath

SummaryThe purpose of this study was to compare sonographic and tenoscopic findings with the purpose of establishing the accuracy and limitations of ultrasonography as a non-invasive diagnostic modality in evaluating the DFTS and its enclosed tendons. The medical records from 22 horses which underwent tenoscopic desmotomy of the palmar/plantar annular ligament were evaluated in a retrospective study. The qualitative assessment of sonographic and tenoscopic findings were documented for the digital flexor tendon sheath (DFTS), the palmar/plantar annular ligament (PAL), the superficial digital flexor tendon (SDFT) and the deep digital flexor tendon (DDFT). The abnormalities diagnosed sonographically within the DFTS were verifiable tenoscopically with a sensitivity of 90.9% and a specificity of 53.8%. The positive predictive value of sonographic examination at the DFTS was 62.5%. The sensitivity of the sonographic examination at the PAL was 68.8%, the specificity was 50% and the positive predictive value 73.3%. Sonographic examination of the SDF tendons revealed abnormal findings in 12 tendons. The tenoscopic examination confirmed these findings on six tendons when they had a pronounced fibrillated or rough tendon surface or tear on the border. Six superficial flexor tendons and seven deep digital flexor tendons had abnormalities seen tenoscopically which were not visible on sonographic examination. Sonographic examination located lesions of the DDFT in four limbs. On tenoscopic examination the lesions could be detected in seven other DDF tendons, including signs of inflammation at the tendon surface that were not seen ultrasonographically (sensitivity 36.4%). Recognition of the limitations of sonographic results should be kept in mind so as not to misinterpret findings, especially if echogenic materials are observed.

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Triggering Secondary to an Untreated Partially-Cut Flexor Tendon

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_89_90159-9 ◽

1989 ◽

Vol 14 (4) ◽

pp. 419-421

Author(s):

P. R. FREWIN ◽

L. R. SCHEKER

Keyword(s):

Flexor Tendon ◽

Tendon Sheath ◽

Flexor Digitorum Superficialis ◽

Flexor Tendons ◽

A2 Pulley ◽

Post Traumatic ◽

Flexor Digitorum ◽

Proximal Border ◽

Partial Division

A case is reported where a flap cut of the radial slip of the flexor digitorum superficialis triggered on the proximal border of the A2 pulley within a healed intact tendon sheath. Shaving the flap resolved the problem. This illustrates another post-traumatic mechanical cause of triggering after partial division of flexor tendons.

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Rupture of the Flexor Pollicis Longus Tendon after 30 Years due to Migration of a Retained Foreign Body

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(95)80052-2 ◽

1995 ◽

Vol 20 (6) ◽

pp. 803-805 ◽

Cited By ~ 15

Author(s):

S. S. YANG ◽

B. J. BEAR ◽

A. J. WEILAND

Keyword(s):

Foreign Body ◽

Flexor Tendon ◽

Ring Finger ◽

Tendon Sheath ◽

Glass Fragment ◽

Flexor Pollicis Longus ◽

Retained Foreign Body ◽

Flexor Tendon Sheath ◽

Flexor Pollicis Longus Tendon ◽

Flexor Digitorum

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

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A Relatively Atraumatic Method of Retrieving Retracted Digital Flexor Tendons

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80037-x ◽

1997 ◽

Vol 22 (1) ◽

pp. 122-124 ◽

Cited By ~ 13

Author(s):

A. ADENIRAN ◽

A. Z. BABAR

Keyword(s):

Reliable Method ◽

Flexor Tendon ◽

Tendon Repair ◽

Tendon Sheath ◽

Feeding Tube ◽

Hypodermic Needle ◽

Flexor Tendons ◽

Usual Manner ◽

Flexor Tendon Sheath

A relatively atraumatic, simple and very reliable method of retrieving the proximal end of a severed flexor tendon of a finger or thumb is described. The technique involves passing a Silastic feeding tube into the flexor tendon sheath, placing the retracted tendon within its lumen, and securing it in place with a single stitch. The feeding tube is then withdrawn until the tendon presents within the distal wound. Hypodermic needle fixation and tendon repair is then carried out in the usual manner.

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