Abstract
Purpose
The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture.
Materials and methods
MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured.
Results
Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm.
Conclusion
Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture.
Similar content being viewed by others
References
Schöffl V, Schöffl I. Injuries to the finger flexor pulley system in rock climbers–current concepts. J Hand Surg. 2006;31(4):647–54.
Schöffl V, Jüngert J. Closed flexor pulley injuries in non-climbing activities. J Hand Surg. 2006;31(5):806–10.
Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers. Wilderness Environ Med. 2003;14(2):94–100.
Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S. Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med. 1998;26(5):651–5.
Vigouroux L, Quaine F, Paclet F, Colloud F, Moutet F. Middle and ring fingers are more exposed to pulley rupture than index and little during sport-climbing: a biomechanical explanation. Clin Biomech (Bristol, Avon). 2008;23(5):562–70.
Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217–23.
Schoffl I, Oppelt K, Jungert J, Schweizer A, Neuhuber W, Schoffl V. The influence of the crimp and slope grip position on the finger pulley system. J Biomech. 2009;42(13):2183–7.
Doyle JR, Blythe W. The finger tendon flexor sheath and pulleys: anatomy and reconstruction. AAOS symposium of tendon surgery in the hand. St.Louis: Mosby; 1975. pp. 81–7.
Doyle JR. Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg. 1988;13(4):473–84.
Doyle JR. Palmar and digital flexor tendon pulleys. Clin Orthop. 2001;383:84–96.
Goodman HJ, Choueka J. Biomechanics of the flexor tendons. Hand Clin. 2005;21(2):129–49.
Klauser A, Frauscher F, Bodner G, Halpern EJ, Schocke MF, Springer P, et al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology. 2002;222(3):755–61.
Martinoli C, Bianchi S, Nebiolo M, Derchi LE, Garcia JF. Sonographic evaluation of digital annular pulley tears. Skeletal Radiol. 2000;29(7):387–91.
Martinoli C, Bianchi S, Cotten A. Imaging of rock climbing injuries. Semin Musculoskelet Radiol. 2005;9(4):334–45.
Watanabe H, Hashizume H, Inoue H, Ogura T. Collagen framework of the volar plate of human proximal interphalangeal joint. Acta Med Okayama. 1994;48(2):101–8.
Williams EH, McCarthy E, Bickel KD. The histologic anatomy of the volar plate. J Hand Surg [Am]. 1998;23(5):805–10.
Zhao CF, Amadio PC, Berglund L, An KN. The A3 pulley. J Hand Surg. 2000;25(2):270–6.
Tang JB, Xie RG. Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing. J Hand Surg. 2001;26(5):855–61.
Schöffl VR, Schoffl I. Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness. 2007;47(1):70–8.
Gabl M, Reinhart C, Lutz M, Bodner G, Angermann P, Pechlaner S. The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger. J Hand Surg (Br). 2000;25(1):98–101.
Bowers WH, Wolf Jr JW, Nehil JL, Bittinger S. The proximal interphalangeal joint volar plate. I. An anatomical and biomechanical study. J Hand Surg. 1980;5(1):79–88.
Medicine ACoS. ACSM’S guidlines for exercise testing and prescription. 7 ed: Lippincott Williams & Wilkins; 2005.
Bayer T, Fries S, Schweizer A, Schoffl I, Janka R, Bongartz G. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study. Skeletal Radiol. 2014.
Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD, et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology. 2000;217(1):201–12.
Leeflang S, Coert JH. The role of proximal pulleys in preventing tendon bowstringing: pulley rupture and tendon bowstringing. J Plast Reconstr Aesthet Surg: JPRAS. 2014;67(6):822–7.
Saito S, Suzuki Y. Biomechanics of the volar plate of the proximal interphalangeal joint: a dynamic ultrasonographic study. J Hand Surg [Am]. 2011;36(2):265–71.
Bayer T, Schweizer A, Muller-Gerbl M, Bongartz G. Proximal interphalangeal joint volar plate configuration in the crimp grip position. J Hand Surg [Am]. 2012;37(5):899–905.
Schoffl I, Oppelt K, Jungert J, Schweizer A, Bayer T, Neuhuber W, et al. The influence of concentric and eccentric loading on the finger pulley system. J Biomech. 2009;42(13):2124–8.
Schweizer A, Frank O, Ochsner PE, Jacob HA. Friction between human finger flexor tendons and pulleys at high loads. J Biomech. 2003;36(1):63–71.
Lin GT, Cooney WP, Amadio PC, An KN. Mechanical properties of human pulleys. J Hand Surg (Br). 1990;15(4):429–34.
Bollen SR. Soft tissue injury in extreme rock climbers. Br J Sports Med. 1988;22(4):145–7.
Tropet Y, Menez D, Balmat P, Pem R, Vichard P. Closed traumatic rupture of the ring finger flexor tendon pulley. J Hand Surg. 1990;15(5):745–7.
Schöffl V, Einwag F, Strecker W, Schöffl I. Strength measurement after conservatively treated pulley ruptures in climbers. Med Sci Sports Exerc. 2006;38(4):637–43.
Schoffl V, Kupper T, Hartmann J, Schoffl I. Surgical repair of multiple pulley injuries—evaluation of a new combined pulley repair. J Hand Surg [Am]. 2012;37(2):224–30.
Arora R, Fritz D, Zimmermann R, Lutz M, Kamelger F, Klauser AS, et al. Reconstruction of the digital flexor pulley system: a retrospective comparison of two methods of treatment. J Hand Surg (Br). 2007;32(1):60–6.
Le Viet D, Rousselin B, Roulot E, Lantieri L, Godefroy D. Diagnosis of digital pulley rupture by computed tomography. J hand Surg. 1996;21(2):245–8.
Goncalves-Matoso V, Guntern D, Gray A, Schnyder P, Picht C, Theumann N. Optimal 3-T MRI for depiction of the finger A2 pulley: comparison between T1-weighted, fat-saturated T2-weighted and gadolinium-enhanced fat-saturated T1-weighted sequences. Skeletal Radiol. 2008;37(4):307–12.
Conflict of interest
No conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bayer, T., Adler, W., Schweizer, A. et al. Evaluation of finger A3 pulley rupture in the crimp grip position—a magnetic resonance imaging cadaver study. Skeletal Radiol 44, 1279–1285 (2015). https://doi.org/10.1007/s00256-015-2160-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-015-2160-2