Flexor Tendon Pulley Injury in a Bowler

Abstract

Closed traumatic flexor injuries of the hand involving the pulley mechanism are a relatively common injury seen in rock climbers but are very rare in nonclimbers, including bowlers. The injury was first described in 1990. Since then, several studies have shed more light on the diagnostic and therapeutic considerations. Early diagnosis of pulley injuries is crucial since delayed diagnosis can lead to limited range of motion, particularly at the proximal interphalangeal joint. Flexion contractures at the proximal interphalangeal joint have also been cited in the literature. We discuss a case of pulley injury in a bowler and briefly review the anatomy of the pulley architecture, mechanism of injury, imaging manifestations, and clinical management of this injury.

A Potentially Inexpensive Diagnostic Method for A2 Pulley Ruptures

“…The A2 pulley is located distal to the metacarpophalangeal (MCP) joints of digits 2 through 5, and functions to “hug” the flexor tendons close to the proximal phalanx, allowing it to essentially function as a fulcrum. The A2 and A4 pulleys are of significant importance and have been demonstrated to be the primary force bearing elements of the flexor pulley system and are critical for preventing bowstringing [5-6]. During a pinch or grasp, the A2 pulley is one of the strongest pulleys and withstands the most force.…”

Diagnostic Imaging of A2 Pulley Injuries: A Review of the Literature

“…Consequently, eccentric flexor tendon loading is generally considered to be one of the greatest risk factors for A2 pulley injury 3 . A2 pulley injuries have been reported in rock climbers, baseball players, bowlers, and other persons who engage in activities that involve a sudden extension force applied to an acutely flexed digit 4–7 . Pulley injuries have also been frequently reported in patients who have received multiple steroid injections near the pulley site 8 .…”

“… 3 A2 pulley injuries have been reported in rock climbers, baseball players, bowlers, and other persons who engage in activities that involve a sudden extension force applied to an acutely flexed digit. 4 , 5 , 6 , 7 Pulley injuries have also been frequently reported in patients who have received multiple steroid injections near the pulley site. 8 Cadaver studies have further investigated the biomechanics of loading within the pulley system to determine which pulley is most prone to injury, with one study reporting that the A2 pulley is most likely to rupture, followed by the A3, A4, and A1 pulleys.…”

A near infrared technique for tendon imaging in human hand

“…Theo một nghiên cứu cho thấy, chấn thương bàn tay chiếm 14% -30% các chấn thương trong các phòng cấp cứu, trong đó, chấn thương liên quan đến gân chiếm 29%, đứng thứ 2 so với các chấn thương liên quan đến bàn tay [1,2]. Sau khi khám lâm sàng, các phương pháp y học hỗ trợ chẩn đoán hiện đại hơn như siêu âm, chụp cắt lớp vi tính và chụp cộng hưởng từ đã được chứng minh là công cụ chẩn đoán quan trọng [3][4][5] [7,8], chẩn đoán của phù não [9,10] và cũng chụp nhũ ảnh [11,12]. Kỹ thuật này cũng được sử dụng để xác định hình ảnh tĩnh mạch [6,[10][11][12] hay để nghiên cứu hình ảnh lòng bàn tay [13].…”

“…Kỹ thuật này cũng được sử dụng để xác định hình ảnh tĩnh mạch [6,[10][11][12] hay để nghiên cứu hình ảnh lòng bàn tay [13]. [5,6]. Trong hình 4 A, hệ thống tĩnh mạch được hiển thị dưới dạng mạng lưới, còn gân được hiển thị dưới dạng đường thẳng bắt đầu từ cổ tay đến ngón tay, chúng được gọi là gân cơ duỗi.…”