Varied Anatomy of the Thumb Pulley System: Implications for Successful Trigger Thumb Release

Schubert, Manuel F.; Shah, Vandan S.; Craig, Clifford L.; Zeller, John L.

doi:10.1016/j.jhsa.2012.08.005

Cited by 42 publications

(38 citation statements)

References 31 publications

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“…T2-weighted (TR 2400 ms, TE 66 ms) fat-suppressed MR image in the sagittal plane demonstrates focal tendinosis at the level of the A1 pulley (thin arrow). Constriction of the tendon by the A1 pulley is evident with surrounding tenosynovitis (thick arrow) postulated that incomplete release of the Av pulley in these cases could contribute to recurrence of triggering, which has been reported to be as high as 7 % [24]. To our knowledge, ours is the first report where imaging was used to visualize the thickened Av pulley in a trigger digit, which highlights an additional potential role for imaging in recurrent cases.…”

Section: Discussionmentioning

confidence: 69%

“…In 2012, an extensive cadaveric study by Schubert et al was undertaken to complete the line of studies on the anatomy of the thumb pulley system [24]. It was concluded in convincing fashion that the Av pulley is a distinct structure that is present in about 93 % of hand specimens with three possible arrangements: transverse, oblique, or fused with the A1 pulley [24]. Using MRI, Hirschmann et al visualized the A1, Av, oblique, and A2 pulleys in 100 % of their 34 asymptomatic volunteers [30].…”

Section: Discussionmentioning

confidence: 99%

“…6 Varied configurations of the thumb pulley system as described by Schubert et al [24]. Type I (a) demonstrates three pulleys and absence of the Av pulley.…”

Section: Discussionmentioning

confidence: 99%

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MR imaging findings of trigger thumb

2015

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Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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MR imaging findings of trigger thumb

2015

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“…Another recent anatomical study, also in adults, demonstrated that the variable annular pulley, located between the A1 and oblique pulleys, was present in 70 of 75 thumbs dissected. 18 Because this pulley has not been described in surgical studies of pediatric trigger thumbs, it is difficult to interpret the clinical correlation of this finding.…”

Section: Trigger Thumbmentioning

confidence: 99%

Pediatric Trigger Digits

Bauer,

Bae

2015

The Journal of Hand Surgery

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“…There are usually two annular pulleys (A1 and A2) located over the MCP and IP joints, and the oblique pulley over the basal phalanx, running in the direction from proximally ulnar to distally radial. Newer investigations have identified an accessory pulley between the A1 and the oblique pulleys called the variable annular (vA) pulley, with some variations in location and thickness (Schubert et al, 2012). The course of the flexor tendons is divided into five anatomic zones ( Figure 3).…”

Section: Anatomy and Physiologymentioning

confidence: 99%

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

Rigó

Haugstvedt

Ludvigsen

et al. 2012

Journal of Plastic Surgery and Hand Surgery

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There is a need for a strong suture technique that allows early active mobilisation after repair of flexor tendons, but the best method has not yet been found. The aim of this study was to compare the modified Kessler suture biomechanically with a newer, two-strand suture. Eighteen porcine tendons were cut and repaired according to either the grasping modified Kessler suture or the combined side-locking loop technique (Yotsumoto) and interlocking horizontal mattress suture (Dona). The specimens were tested linearly to failure. The 2 mm gap force, yield force, ultimate force, stiffness, energy to yield, and energy to failure were all significantly higher (p value = 0.005, 0.003, <0.001, 0.001, 0.004, and 0.001, respectively) in the Yotsumoto-Dona group (median values (IQR): 30.9 (28.1-39.5) N, 82.7 (64.9-114.1) N, 82.7 (76.6-114.1) N, 12.5 (10-14.5) N/mm, 0.45 (0.2-0.5) J, and 0.45 (0.35-0.5) J) than in the modified Kessler group (25.8 (12.2-28.1) N, 35 (24.6-54.4) N, 50.9 (34.4-55.1) N, 7 (5.8-91) N/mm, 0.09 (0.06-0.18) J, and 0.21 (0.18-0.28) J). All Yotsumoto-Dona specimens had a yield force exceeding 35 N, while in the Kessler group only four did. The early yielding rate was 6/9 and 2/9 in the modified Kessler and the Yotsumoto-Dona groups, respectively (p = 0.15). Most of the core sutures failed by breakage, but three Yotsumoto knots loosened. All the simple running and six of the Dona epitendinous sutures failed predominantly by pulling-out, and by breakage at the intersections in three of the latter. The relatively easy two-strand Yotsumoto-Dona suture is likely to withstand the loads of active finger flexion, whereas the modified Kessler suture is probably not.

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Varied Anatomy of the Thumb Pulley System: Implications for Successful Trigger Thumb Release

Cited by 42 publications

References 31 publications

MR imaging findings of trigger thumb

MR imaging findings of trigger thumb

Pediatric Trigger Digits

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

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