Flexor Forces and Rheumatoid Metacarpophalangeal Deformity

Smith, Edwin M.

doi:10.1001/jama.1966.03110150078022

Cited by 31 publications

(9 citation statements)

References 8 publications

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“…8 Furthermore, a division of the A1 pulley increases the ulnar-directed forces on the proximal phalanx during active finger flexion. 10 The weakened radial proper collateral ligament stretches, allowing for ulnar drift, which is more pronounced in the RA joint. 11 Furthermore, development of bow stringing after a trigger finger release, although uncommon, has certainly been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Trigger Finger Release With Stepwise Preservation of the A1 Pulley: A Functional Pulley-Preserving Technique

Niumsawatt

Mao

Salerno

et al. 2013

International Surgery

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The first annular (A1) pulley is an important structure of the hand, providing a biomechanical support to the metacarpophalangeal joint and maintaining joint stability and flexor tendon alignment. Albeit uncommon, disruption of this pulley can result in dislocation or ulnar drift of the digit, particularly pronounced in patients with rheumatoid arthritis. Despite this, the A1 pulley is commonly divided without reconstruction in trigger finger. Several annular pulley reconstructive techniques have been developed to preserve its function. However, development of recurrent triggering has been observed due to fibrosis, largely due to inadequate release of the pulley. We have developed a technique to increase the volume within the flexor sheath while preserving the A1 pulley by way of stepwise lengthening. This has enabled an increase in the diameter of the pulley to 4 times its original size. A prospective study was performed comprising 10 trigger finger releases with stepwise lengthening of the A1 pulley. In all patients, there were no complications, and good hand function was achieved with no recurrence of triggering at 6 weeks of follow-up. This technique can thus safely achieve trigger release without sacrifice of the function of the A1 pulley.

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Section: Discussionmentioning

confidence: 99%

Trigger Finger Release With Stepwise Preservation of the A1 Pulley: A Functional Pulley-Preserving Technique

Niumsawatt

Mao

Salerno

et al. 2013

International Surgery

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show abstract

“…Smith et al geometrically demonstrated that the fl exor tendon exerts a force at the metacarpoglenoidal ligament that is six times the pinch force exerted at the fi ngertip (Fig. 20.6 ) [ 2 ]. Furthermore, in the long and index fi nger, the tendons exert an ulnar force at the entrance of the fl exor tendon sheath (Fig.…”

Section: Metacarpophalangeal Mechanicsmentioning

confidence: 99%

“…The fi brocartilaginous volar plate covers the palmar aspect of the MCP joint capsule and resists hyperextension. The volar plate consists of the proximal membranous portion adherent to the metacarpal and the distal, robust cartilaginous portion that adheres to the proximal phalanx [ 2 ]. The metacarpoglenoid (accessory collateral) ligament extends from the volar plate forming a sling that suspends the fl exor digitorum profundus and fl exor digitorum superfi cialis as they pass between the metacarpal tubercles and enter the fl exor tendon sheath (Fig.…”

Section: Metacarpophalangeal Joint Anatomymentioning

confidence: 99%

“…In 1966, Smith et al proposed that the metacarpoglenoidal ligament acts as a pulley and prevents bowstringing of the fl exor tendons during grasp or pinch grip. Figure 20.6 demonstrates the oblique course of the fl exor tendons of the index and long fi nger as they enter the fl exor tunnel and how the metacarpoglenoid ligament prevents fl exor tendon bowstringing in both palmar and ulnar directions [ 2 ].…”

Section: Metacarpophalangeal Joint Anatomymentioning

confidence: 99%

“…In 1966, Smith et al provided insight on the mechanical infl uence of the fl exor tendons on ulnar deviating forces acting at the MCP joint [ 2 ]. With pinch and grasp activities, the fl exor tendons transmit large forces on the sling arrangement of the metacarpoglenoidal ligament and fl exor tendon sheaths.…”

Section: Metacarpophalangeal Mechanicsmentioning

confidence: 99%

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