Flexor Pulley System: Anatomy, Injury, and Management

Zafonte, Brian T.; Rendulic, Dora; Szabo, Robert M.

doi:10.1016/j.jhsa.2014.06.005

Cited by 71 publications

(62 citation statements)

References 34 publications

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“…An example of this is the supraspinatus (SSP) tendon, which connects the SSP muscle located in the scapula to the head of the humerus, and works to guide the activity of the prime mover deltoid, pectoralis and latissimus dorsi muscles of the glenohumeral joint (Ward et al 2006). In addition to playing an important functional role in joint movement, these four tendons are also among the most frequently injured tendons of the upper and lower extremities (Zwerver et al 2011;Colvin et al 2012;Zafonte et al 2014;Ganestam et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Widespread diversity in the transcriptomes of functionally divergent limb tendons

Disser

Ghahramani

Swanson

et al. 2019

Preprint

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r Tendon is a hypocellular, matrix-rich tissue that has been excluded from comparative transcriptional atlases. These atlases have provided important knowledge about biological heterogeneity between tissues, and our study addresses this important gap.r We performed measures on four of the most studied tendons, the Achilles, forepaw flexor, patellar and supraspinatus tendons of both mice and rats. These tendons are functionally distinct and are also among the most commonly injured, and therefore of important translational interest.r Approximately one-third of the filtered transcriptome was differentially regulated between Achilles, forepaw flexor, patellar and supraspinatus tendons within either mice or rats. Nearly two-thirds of the transcripts that are expressed in anatomically similar tendons were different between mice and rats.r The overall findings from this study identified that although tendons across the body share a common anatomical definition based on their physical location between skeletal muscle and bone, tendon is a surprisingly genetically heterogeneous tissue.Abstract Tendon is a functionally important connective tissue that transmits force between skeletal muscle and bone. Previous studies have evaluated the architectural designs and mechanical properties of different tendons throughout the body. However, less is known about the underlying transcriptional differences between tendons that may dictate their designs and properties. Therefore, our objective was to develop a comprehensive atlas of the transcriptome of limb tendons in adult mice and rats using systems biology techniques. We selected the Achilles, forepaw digit flexor, patellar, and supraspinatus tendons due to their divergent functions and Nathaniel Disser graduated in 2018 from Gonzaga University in Spokane, WA, where he obtained a Bachelor of Science degree in Human Physiology. He is now participating in a two-year Post-Baccalaureate Research Program at the Hospital for Special Surgery in New York, NY. His current research interests include studying the mechanobiology of tendon and muscle during tissue growth and repair. As an aspiring physician-scientist, he hopes to improve the understanding and treatment of debilitating musculoskeletal injuries and diseases. N. P. Disser and others J Physiol 598.8 high rates of injury and tendinopathies in patients. Using RNA sequencing data, we generated the Comparative Tendon Transcriptional Database (CTTDb) that identified substantial diversity in the transcriptomes of tendons both within and across species. Approximately 30% of filtered transcripts were differentially regulated between tendons of a given species, and nearly 60% of the filtered transcripts present in anatomically similar tendons were different between species. Many of the genes that differed between tendons and across species are important in tissue specification and limb morphogenesis, tendon cell biology and tenogenesis, growth factor signalling, and production and maintenance of the extracellular matrix. This study indicate...

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Section: Introductionmentioning

confidence: 99%

Widespread diversity in the transcriptomes of functionally divergent limb tendons

Disser

Ghahramani

Swanson

et al. 2019

Preprint

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“…However, near-normal hand function could only be achieved when both A2 and A4 were present. 2,3 Bowstringing results in an increased requirement of muscle activation to reach the same amount of finger flexion. This precludes full finger flexion and also alters kinematics of the adjacent joints.…”

Section: Methodsmentioning

confidence: 99%

Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft

Jakubietz

Meffert

Schmidt

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present.Methods:A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley.Results:Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness.Conclusions:The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.

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“…The A1, A3 and A5 pulleys are located over the MCP, PIP and DIP joints, respectively. The A1, A3 and A5 pulleys are narrow, flexible and insert mostly into the volar plates . The A2 and A4 pulleys are wider and insert directly into the bone over the proximal and middle phalanges, respectively.…”

Section: Anatomy and Function Of The Flexor Digitorum Apparatusmentioning

confidence: 99%

“…The cruciate pulleys of C1, C2 and C3 lie between the A2–A3, A3–A4 and A4–A5 annular pulleys, respectively. The major function of the pulley system is to stabilise and prevent volar bowstringing of the flexor tendons during finger flexion . The A2 pulley is the strongest and is the primary restraint to bowstringing of the flexor tendons during finger flexion under load .…”

Section: Anatomy and Function Of The Flexor Digitorum Apparatusmentioning

confidence: 99%

“…The major function of the pulley system is to stabilise and prevent volar bowstringing of the flexor tendons during finger flexion . The A2 pulley is the strongest and is the primary restraint to bowstringing of the flexor tendons during finger flexion under load . Bowstringing displacement of the flexor tendons will diminish their mechanical efficiency and compromise flexion strength …”

Section: Anatomy and Function Of The Flexor Digitorum Apparatusmentioning

confidence: 99%

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Ultrasound of flexor digitorum apparatus in acute and chronic pathology

Sirlyn¹,

Bird²

2018

Sonography

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The flexor digitorum apparatus (FDA) of the finger consists of two flexor tendons located within their osteofibrous tunnel, reinforced by the pulley apparatus and the supporting volar plates. The FDA is essential for facilitating hand grasping functions, and pathology affecting the FDA can result in functional impairment of the hand. These injuries can be open or closed in nature and are commonly the sequelae of acute trauma or chronic overuse. This article includes an overview of the anatomy of the FDA, ultrasound scanning technique and common pathologies that sonographic assessment may encounter. The anatomy of the finger and its variants is complex, and an ultrasound can only be accurate if the operator possesses comprehensive knowledge of these structures.Funding: None. Conflict of interest: None.Sonography 5 104-114

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Flexor Pulley System: Anatomy, Injury, and Management

Cited by 71 publications

References 34 publications

Widespread diversity in the transcriptomes of functionally divergent limb tendons

Widespread diversity in the transcriptomes of functionally divergent limb tendons

Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft

Ultrasound of flexor digitorum apparatus in acute and chronic pathology

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