scholarly journals Small stiff swelling over the flexor aspect of the finger: Digital ganglion arising from the A2 pulley

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Sonal Saran ◽  
Manvendra Gaur
Keyword(s):  
A2 Pulley

Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C

2016 ◽  
Vol 41 (8) ◽  
pp. 822-828 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
K. Hara ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Clinical Results ◽  
The Other ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
A2 Pulley ◽  
Active Mobilization ◽  
Finger Motion

We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang’s criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. Level of evidence: IV

DYNAMICS OF A2 FINGER PULLEY RUPTURE

2007 ◽  
Vol 07 (01) ◽  
pp. 75-87 ◽  
Author(s):  
MING A. TAN ◽  
FRANZ K. FUSS ◽  
GÜNTHER NIEGL
Keyword(s):  
Mechanical Properties ◽  
Mathematical Model ◽  
Initial Rate ◽  
Constant Force ◽  
Common Occurrence ◽  
Pulley System ◽  
Convergence Test ◽  
A2 Pulley ◽  
The Common ◽  
Rupture Mechanism

A mathematical model of the A2 pulley system will enable us to have a better understanding of the mechanics of the pulley-tendon system and provide us with insights of the pulley rupture mechanism. The A2 pulley was modeled based on parallel pulley fibers attached to a phalanx with a tendon passing them. Mechanical properties of the pulleys such as stiffness, strength and friction were included in the model. A convergence test was done to ensure the accuracy of the test. The model managed to show high loads on flexed finger may lead to pulley ruptures. Further studies on the rupture mechanism showed that pulley ruptures are self-propagating when a constant force is applied and the rate of rupture increases, as fewer intact fibers are present to support the load. The initial rate of propagation is much slower and this accelerates as more fibers are ruptured. This explains the common occurrence of partial pulley ruptures.

scholarly journals Improving Strength and Quality of Epitendinous Repairs

Hand ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 495-501
Author(s):  
Angel Farinas ◽  
Michael Stephanides ◽  
Steven Schneeberger ◽  
Alonda Pollins ◽  
Nancy Cardwell ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Analysis Of Variance ◽  
Statistical Significance ◽  
Single Factor ◽  
Single Thread ◽  
A2 Pulley ◽  
Suture Thread ◽  
Single Factor Analysis ◽  
Single Suture

Background: Epitendinous sutures not only join the 2 severed tendon edges but also supply strength and support to the repair. Multiple techniques have been described, but none of them include another thread of suture. This could potentially increase the strength of the repair without affecting gliding. Methods: Caprine tendons were harvested, transected, and sutured with 6-0 Prolene. Four groups were created: single thread running (SR), single thread locking (SL), double thread running (DR), and double thread locking (DL). An Instron 5542 was used to pull the repaired tendons apart, and the energy at the break was calculated (gf/mm). For gliding resistance, we harvested a human A2 pulley. A pre- and postrepair value was obtained, and a ratio was elaborated. A single-factor analysis of variance and independent sample t tests were performed. Results: The SR group had a mean energy at break of 9339.71 ± 1630.212 gf/mm; the SL group, 9629.96 ± 1476.45 gf/mm; and the DR group, 9600.221 ± 976.087 gf/mm, with no statistical significance. The DL group was significantly higher at 14 740.664 ± 2596.586 gf/mm ( P < .05). When comparing SR with DL for gliding, SR had less than half of the resistance than DL (0.018 ± 0.004 and 0.049 ± 0.015 N/mm, respectively), with statistical significance ( P < .05). Conclusion: Using a single suture thread for running epitendinous repair is no different than locking with a single thread or using an extra thread in a running fashion. Performing a double suture thread with a locking technique is significantly stronger than the previously mentioned repairs, with the disadvantage of more resistance at the pulley.

Pulley, Flexor, and Extensor Tendon Injuries of the Hand

2021 ◽  
Vol 25 (02) ◽  
pp. 203-215
Author(s):  
Andrea B. Rosskopf ◽  
Mihra S. Taljanovic ◽  
Luca M. Sconfienza ◽  
Salvatore Gitto ◽  
Carlo Martinoli ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Resonance Imaging ◽  
First Line ◽  
A2 Pulley ◽  
Dynamic Examination ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Extensor Tendon Injuries

AbstractTendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.

scholarly journals Flexor Digitorum Superficialis Repair Outside the A2 Pulley After Zone II Laceration: Gliding and Bowstringing

2015 ◽  
Vol 40 (4) ◽  
pp. 653-659
Author(s):  
Michael B. Geary ◽  
Christopher English ◽  
Zaneb Yaseen ◽  
Spencer Stanbury ◽  
Hani Awad ◽  
...  
Keyword(s):  
Flexor Digitorum Superficialis ◽  
A2 Pulley ◽  
Zone Ii ◽  
Flexor Digitorum

Outcomes of repair of the lacerated A2 pulley with extensor retinaculum during primary flexor tendon repair

2017 ◽  
Vol 42 (9) ◽  
pp. 903-908 ◽  
Author(s):  
A. El-Shebly ◽  
M. El Fahar ◽  
H. Mohammed ◽  
A. Bahaa Eldin
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Extensor Retinaculum ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Fair Result ◽  
Active Range Of Motion ◽  
A2 Pulley ◽  
Active Mobilization ◽  
A1 Pulley

We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits. Using the Strickland and Glogovac criteria, there were four excellent, five good and one fair result. One finger was graded excellent, eight good, and one fair according to Tang’s criteria. No clinical bowstringing was observed. We conclude that extensive pulley lacerations reconstructed with extensor retinaculum primarily ensure functional recovery after tendon repair. Level of evidence: IV

Closed traumatic A2 pulley rupture: rare mechanism of injury

2009 ◽  
Vol 34 (4) ◽  
pp. 548-549 ◽  
Author(s):  
Michael B. Dowd ◽  
Erick O. Fuentes
Keyword(s):  
Mechanism Of Injury ◽  
A2 Pulley

scholarly journals Flexor Tendon Sheath Ganglions: Results of Surgical Excision

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 94-100 ◽  
Author(s):  
Peter J. L. Jebson ◽  
Edwin E. Spencer
Keyword(s):  
Telephone Interview ◽  
Flexor Tendon ◽  
Surgical Excision ◽  
Tendon Sheath ◽  
Additional Patient ◽  
Dominant Hand ◽  
Digital Nerve ◽  
A2 Pulley ◽  
Flexor Tendon Sheath

The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient's medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath.

A New Type of Flexor Tendon Repair

1995 ◽  
Vol 20 (5) ◽  
pp. 578-583 ◽  
Author(s):  
R. J. N. WILLIAMS ◽  
A. A. AMIS
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Cyclic Loads ◽  
Failure Strength ◽  
Flexor Tendon Repair ◽  
Ultimate Failure ◽  
A2 Pulley ◽  
Active Mobilization ◽  
New Type ◽  
Better Than

Experiments were performed to evaluate biomechanical aspects of the performance of a “deep-biting peripheral suture” for flexor tendon repair, either when used alone or with a square or modified Kessler core stitch, and the technique was compared to the Kleinert repair. Tests included progressively increasing cyclic loads, force to pull the repair into the A2 pulley, and ultimate failure strength. 50% of the Kleinert repairs failed under 30 N cyclic loading, while 100% of the DBPS plus Kessler core stitch repairs survived. There was no discernable difference in gliding function or repair bulk between these sutures, but ultimate strength increased significantly with the DBPS repairs. We concluded that the DBPS plus Kessler-type core stitch will survive active mobilization better than the Kleinert method.

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