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Restoration of function of the thumb flexor apparatus requires repair of the oblique and one adjacent flexor tendon pulley
Author(s) -
Esplin V. S.,
Tencer A. F.,
Hanel D. P.,
Cosio M. Q.
Publication year - 1996
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.1100140124
Subject(s) - pulley , flexor muscles , thumb , oblique case , anatomy , tendon , geology , medicine , structural engineering , engineering , philosophy , linguistics
Abstract Damage to the pulleys of the thumb flexor apparatus may cause bow‐stringing of the tendon and affect muscle function. An experiment using the hands and distal forearms of cadavers was designed to determine which damaged pulleys increase excursion length of the flexor tendon with constant tendon and resisting loads. Each specimen was mounted to a loading frame with a dead weight pinned to the tip of the thumb. The thumb flexor tendon was clamped to an actuator that applied a fixed load and measured excursion of the tendon. Ranges of motion of the thumb joint were also measured. The thumb flexor apparatus of each specimen was tested intact first, with the hand in flexed, neutral, and extended positions; then it was tested with progressive sectioning of pulleys from proximal to distal in one group and from distal to proximal in a second group. The length of excursion increased significantly with all pulleys cut but there was no effect on on overall range of motion of the thumb. With proximal to distal sectioning, no change in tendon excursion occurred when the flexor retinaculum and the first annular pulleys were cut, until the oblique pulley was sectioned, leadving only the second annular pulley intact (range, 1.17–1.31 times that of intact excursion, dependent on position of the hand). With distal to proximal sectioning, tendon excursion was not affected when the second annular and oblique pulleys were cut but did increase when the first annular pulley was sectioned, leaving only the flexor retinaculum intact (range, 1.28–1.36 times that of intact excursion). Dependent on the location of damage, therefore, an intact oblique or first annular pulley can maintain normal excursion of the tendon.