Triggering at the Distal A2 Pulley

Abstract

We report two cases with triggering at the distal end of the A2 pulley. One was caused by enlargement of the flexor digitorum profundus (FDP) tendon and the other by enlargement of both slips of the flexor digitorum superficialis (FDS) tendon. Both were relieved by reduction tenoplasty and short releases, or venting, of the distal A2 pulley.

Kinematic evaluation of the finger’s interphalangeal joints coupling mechanism—variability, flexion–extension differences, triggers, locking swanneck deformities, anthropometric correlations

“…Exclusion of flexor tendon triggers: The general cause for clinically treated trigger fingers is obstructed flexor tendon gliding through the ring-shaped flexor pulleys because of local thickening of tendons or conjointly moving tissues, often at the MCP joint pulley (A1 pulley) (Benson and Ptaszek, 1997;Topper et al, 1997;Turowski et al, 1997;Gaffield and Mackay, 2001;Finsen et al, 2003;Akhtar and Burke, 2006;Ryzewicz et al, 2006;Al-Qattan, 2007;Nagaoka et al, 2007;Peters-Veluthamaningal et al, 2008;Rozental et al, 2008;Bodor et al, 2009). As tendon forces are increased to overcome the blockage, elastic energy accumulates and propels trajectory acceleration when the obstruction releases.…”

Les doigts à ressort

“…Sherman et Lane [24] ont décrit deux cas de ressaut au niveau A0 ; la poulie A2 : dans l'article de Nagaoka [25] il est décrit un conflit au bord distal de la poulie A2 dans deux cas. Il est observé un élargissement du doigt concerné ainsi qu'un ressaut palpable à la fois au niveau de A1 mais aussi de A2.…”

“…En cas de conflit distal avec la poulie A2 [25] : Il a été réalisé dans chaque cas une ténoplastie avec ouverture distale sur 4 mm de A2. En effet, la résection distale (25 %) de A2 ne semble pas causer de déficit fonctionnel.…”

Tendon Disorders of the Hand and Wrist

“…30 Although this finding is quite rare, it is important to attempt to clinically determine the site of triggering during preoperative evaluation by examining the entire length of the flexor sheath.…”