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Additions and changes in the description of the anatomy of the finger flexor sheath
and pulleys that I published in 1974 and 1975 have prompted me to restudy this system.
Sixty-one fresh human cadaver fingers were dissected using the operating room microscope.
This study demonstrated a flexor synovial sheath composed of visceral and parietal
elements from the neck of the metacarpal to the distal interphalangeal joint, which
was overlaid with a series of retinacular structures (pulleys). The pulleys identified
were the palmar aponeurosis pulley, five annular pulleys, and three cruciform pulleys.
Although significant variations were noted in the morphology of the first annular
and the cruciform pulleys sufficient similarity exists between my first description
and the present study to support the use of the original descriptive terminology.
A significant addition to the pulley system is the palmar aponeurosis pulley described
by Manske and Lesker.
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References
- The pulley system. Proceedings of the American Society for Surgery of the Hand.Orthop Trans. 1980; 4: 4
- Anatomy and biomechanics of the digital flexor tendons.Hand Clinics. 1985; 1: 3-12
- Direct repair and dynamic splinting of flexor tendon lacerations.in: Clinical biomechanics. Churchill-Livingstone, New York1981: 1-23
- Current state of flexor tendon surgery.Ann Chir Main. 1984; 3: 7-17
- Palmar aponeurosis pulley.J Hand Surg. 1983; 8: 259-263
- Digital flexor tendon sheath: an anatomic study.J Hand Surg. 1985; 10A: 785-789
- Flexor tendon repair.Hand Clinics. 1985; 1: 55-67
- Flexor tendon injuries.Orthop Rev. 1986; 15: 21-34
- Micro-constructive studies of human digital flexor tendon and tendon sheath—observation by scanning electron microscope and light microsurgery.Nippon Seikeigeka Gakkai Zasshi. 1982; 56: 133-147
- Macroscopic and functional anatomy of the flexor tendon sheath.J Bone Joint Surg. 1974; 56A: 1094
- The flexor tendon sheath and pulleys: anatomy and reconstruction.in: AAOS Symposium on tendon surgery in the hand. The CV Mosby Co, St. Louis1975: 81-87
- Vacuum embedding of tissues in nitrocellulose.Am J Clin Pathol. 1965; 43: 396-398
- Tendon sheath patterns in the hand an anatomical study based on 367 hand dissections.Surg Gynecol Obstet. 1951; 93: 16-22
- Roentgenographic anatomy of the tendon sheaths of the hand and wrist: tenography.Am J Roentgenol. 1975; 124: 44-51
- Histology and ultrastructure of the human flexor tendon sheath.J Hand Surg. 1987; 12A: 25-29
- The arrangement of the synovial membrane in the palmar digital sheaths.J Anat. 1907; 41: 155-157
- Surgery of the hand.Philadelphia: JB Lippincott. 1944; : 277-278
- The palmar aponeurosis and the central spaces of the hand.J Anat. 1974; 117: 55-68
- The proximal end of the palmar aponeurosis.Hand. 1980; 12: 33-38
- Half a century of flexor-tendon surgery current status and changing philosophies.J Bone Joint Surg. 1972; 54A: 472-491
- Experimental study of optimal location of flexor tendon pulleys.Plast Reconstr Surg. 1969; 43: 125-129
- Anatomie fonctionnelle de la poulie proximal des doigts.Arch Anat Pathol. 1971; 19: 357-366
- Schmidt HM.The fibrous reinforcing arrangements of the digital peritenons in the human hand Gegenbaurs morph Jahrb. 1986; 132: 1-28
- The hand, diagnosis and indications.2nd ed. Churchill Livingstone, Edinburgh1984
- Indications and techniques for repair of the flexor tendon sheath.Hand Clinics. 1985; 1: 85-95
- The vascularization and structure of the human digital tendon sheath as related to flexor tendon function.Scand J Plast Reconstr Surg. 1977; 11: 195-203
- Flexor tendons—late reconstruction.in: Green DP Operative hand surgery. Churchill Livingstone, New York1982: 1423
- The fascia of the distal phalanx.J Bone Joint Surg. 1975; 57A: 784-788
- Dynamic anatomy of the flexor pulley system of the fingers and thumb.in: Presented at 39th annual meeting. American Society for Surgery of the Hand, Atlanta1984
- Synovial fluid analysis.Clin Orthop. 1975; 107: 11-24
Article info
Publication history
Accepted:
September 17,
1987
Received:
June 12,
1987
Footnotes
**No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
***The author wishes to express his gratitude to Doctors Virchel Wood and Gary Frykman, and the Orthopedic Resident staff of Loma Linda University Medical Center for the use of their microsurgical laboratory and for obtaining fresh cadaver specimens for this study.
Identification
Copyright
© 1988 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
