The pulley system suppresses the tendon excursion, and the force of the flexor tendons is transferred efficiently in flexion and hyperextension to The repair should then be observed as it glides beneath the pulley system. I.e. A1, A3 and A5 pulleys may be managed conservatively initially. Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. This video is unavailable. After that my left ring finger felt unsupported and I couldn't weight it. The ﬁnger ﬂexor tendons glide in a sheath reinforced by annular (A1–A5) and cruciform (C1–C3) pulleys. 13.6). I would avoid any finger specific exercises right now. Pulley Injuries. Disruption of the pulley … The A2 and A4 are recommended to be reconstructed using multiple loops of free extrasynovial tendon grafts in the same place where the original digital pulley was. 1. 2. Other pulleys such as the A1, A3, and A5 exert less force on the tendon for the duration of the flexion . The annular pulleys are the most functionally important and commonly injured. The thumb only has two pulleys that are described as A1 and A2. A loud “pop” and then significant swelling and pain often indicate damage to the flexor-tendon pulleys. But every injury is different. 1. Generally, anywhere from A1 to A5 strains can occur. Injury. Watch Queue Queue. Damage to the flexor tendon pulleys is the most common climbing injury. Establishing which pulley is ruptured can be achieved by referring to the site of maximal volar bowstringing along the long axis of the finger. The A1, A3, and A5 pulleys can potentially be sacrificed to improve gliding. Case Report: We describe a closed traumatic annular 2 (A2) through annular 4 (A4) pulley rupture with avulsion of the FDS tendon. But in general pulley injuries tend to heal slowly. The annular and cruciate pulleys are areas of focal thickening of the flexor tendon sheath that are of critical importance to the normal biomechanical function of the finger. Watch Queue Queue depending on the severity of injury, once the initial swelling and inflammation has gone down 1-4 weeks, then you get straight back to climbing, albeit at a slow and measured pace. It was still slightly swollen two months or more after the injury occured, and not pain free and back to normal until four months. proposed a grading system for the diagnosis and management of suspected pulley ruptures with recommendations for management. The main role of the annular pulleys is to stabilize the tendon sheaths to the phalanges. Type 4 injuries are the avulsion fractures of the FDP in which the avulsed fracture fragment does not remain attached to the torn FDP tendon. Your finger pulleys hold the tendon close to the bone and are basically a ligament that rejoins to the same bone rather than cross a joint to neighboring bone. Type 5 injuries are avulsion fractures of the FDP with an extraarticular (type 5a) or intraarticular (type 5b) fracture of the proximal phalanx. Complete A4 or partial A2, A3 tear/rupture 3. There are 5 pulleys, A1-A5. Figure 5. Pulley strain 2. For something minor 3-6 weeks, more severe can take more on the order of months. They comprise a transversely oriented sheath of fibrous tissue that wraps over the flexor superficials and profunda tendons. the pulley injury as the most frequent injury, followed by tenosynovitis and capsulitis of the finger joints ... the A1 and A5 pulleys (27). Four or five such annular pulleys, together with three cruciate pulleys, form a fibro-osseous tunnel on the palmar aspect of the hand through which passes the deep and superficial flexor tendons. The pulleys experience extremely high loads during rock climbing, especially when crimping.
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