Finger A2 Pulley Lesions in Rock Climbers

ObjectiveDactylitis is a hallmark of psoriatic arthritis (PsA) where flexor tenosynovitis is common. This study explored the microanatomical basis of dactylitis using high-resolution MRI (hrMRI) to visualise the small entheses around the digits.MethodsTwelve patients with psoriatic dactylitis (4 fingers, 8 toes), and 10 healthy volunteers (6 fingers, 4 toes) had hrMRI of the digits using a ‘microscopy’ coil and contrast enhancement. All structures were evaluated including the tendons and ligaments, related enthesis organs, pulleys, volar/plantar plates and tendon sheaths.ResultsIn dactylitis, collateral ligament enthesitis was seen in nine digits (75%), extensor tendon enthesitis in six digits (50%), functional enthesitis (5 digits, 42%), abnormal enhancement at the volar plates (2/5 joints, 40%) and the plantar plate (1/5 joints, 20%). Nine cases (75%) demonstrated flexor tenosynovitis, with flexor tendon pulley/flexor sheath microenthesopathy observed in 50% of all cases. Less abnormalities which were milder was observed in the normal controls, none of whom had any signal changes in the tendon pulleys or fibrous sheaths.ConclusionsThis study provides proof of concept for a link between dactylitis and ‘digital polyenthesitis’ including disease of the miniature enthesis pulleys of the flexor tendons, further affirming the concept of enthesitis in PsA.

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“… 19 Indeed the MRI changes in injury in rock climbers bear some remarkable similarities with the changes reported in the present study. 20 …”

Section: Discussionmentioning

confidence: 99%

High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis

Tan¹,

Fukuba²,

Halliday³

et al. 2015

Annals of the Rheumatic Diseases

102

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“…Clinical examination was used three times as an index test. 29 39 45 The Se, Sp, accuracy, PPV and NPV of physical examination in hand and finger injuries ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. MRI was used once as an index test.…”

Section: Resultsmentioning

confidence: 98%

“…Eight studies were retrospective [23][24][25][26][27][28][29][30] nine studies were prospective [31][32][33][34][35][36][37][38][39] and six studies [40][41][42][43][44][45] gave no description of the study design. Eight studies 23 25 27 31 33 36 43 45 included more than 60 participants; six of these studies 23 25 27 31 33 36 described wrist pathologies and two 43 45 described hand pathologies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Table 4 describes the accuracy of the diagnostic tests for non-chronic hand and finger injuries. 28 29 38 39 43-45 Two studies concerned flexor tendon injuries, 44 45 while the other studies concerned collateral ligament tears of the metacarpophalangeal joint of the fingers, 28 A2 pulley lesions, 29 finger pulley injuries 43 and ulnar collateral ligament (UCL) injuries. 38 39 None of the studies involved history taking.…”

Section: Accuracy Of Diagnostic Tests Concerning Wrist Injuriesmentioning

confidence: 99%

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Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

et al. 2020

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ObjectiveThe diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist.MethodsMedline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted.ResultsNone of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively.ConclusionsThere is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.

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“…Applying external pressure over the affected area and asking the patient to flex the digit may reduce his or her pain further supporting the diagnosis. While pulley ruptures are not evident on plain radiographs, MRI or US may be helpful in confirming the diagnosis [ 113 – 116 ].…”

Section: Introductionmentioning

confidence: 99%

Sports-related wrist and hand injuries: a review

2016

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BackgroundHand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population.Main bodyThe following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided.ConclusionKnowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.

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Finger A2 Pulley Lesions in Rock Climbers

Abstract: MRI at 3 T allows reliable direct visualization and characterization of traumatic A2 pulley lesions.

Cited by 17 publications

References 26 publications

High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis

High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

Sports-related wrist and hand injuries: a review

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