Annular Pulleys

Fig. 11.19a-c.US appearance of annular pulleys experimental setting, a Longitudinal 15-7 MHz US image obtained over the proximal phalanx (PP) of a cadaver during insertion of a needle (arrowheads) into the sheath of the flexor tendons (ft). Saline was injected inside the tendon sheath and in the subcutaneous tissue located just superficial to it. b Longitudinal and c transverse 15-7 MHz US images obtained after withdrawal of the needle give excellent depiction of the A2 pulley (curved arrow) outlined by hypoechoic fluid (arrowheads)... 

Annular pulleys can be damaged by either chronic micro trauma or acute injuries. Chronic repetitive movements of the finger may lead to stenosing tenosynovitis of the flexor tendons with thickening of the... 

Acute tears of the annular pulleys are mainly secondary to maximal resisted flexion of the fingers. These injuries are typically encountered in rock climbers, who must hold the body weight on the flexed fingers during climbing (Bollen 1990). In... 

US findings of annular pulley tears correlate well with the MR imaging findings (Bodner et al. 1999). 

Other imaging modalities, such as MR imaging and CT scan, are able to identify annular pulley tears (Le Viet et al. 1996 Parelleda et al. 1996 Hauger et al. 2000), but are expensive and time-consuming. US can be considered an effective and less expensive alternative, capable of static and dynamic observations. 

Bodner G, Rudish A, Gabl M et al (1999) Diagnosis of digital flexor tendon annular pulley disruption comparison of high frequency ultrasound and MRI. Ultraschall Med 20 131-136... 

Manthey DE,StorrowAB,Milbourn JM et al (1996) Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Ann Emerg Med 28 7-9 Markham DE, Wood MR (1980) Ultrasound for Dupuytren s contracture. Physiotherapy 66 55-58 Martinoli C, Bianchi S, Derchi LE et al (2000) Sonographic evaluation of digital annular pulleys tears. Skeletal Radiol 29 387-391... 

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