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Assessment of the distal extent of the A1 pulley release: a new technique.

Hazani R, Engineer NJ, Zeineh LL, Wilhelmi BJ - Eplasty (2008)

Bottom Line: A complete release of the pulley was achieved in all specimens with preservation of the A2 pulley.Percutaneous marking of the distal extent of the A1 pulley is a safe and reliable method that not only ensures complete release of the A1 pulley but also preserves the A2 pulley.The placement of a small gauge needle adds no morbidity to this minimally invasive technique.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, School of Medicine, University of Louisville, Louisville, KY, USA. Ronmdsurg@hotmail.com

ABSTRACT

Objective: Sharp division of the A1 pulley is a time-honored technique for the treatment of flexor tendon entrapment; however, this procedure is not without complications. The anatomy of the A1 pulley system has been carefully investigated. Knowledge of superficial anatomic landmarks can assist with demarcating the distal edge of the A1 pulley and prevent damage to the critical A2 pulley.

Methods: Nine fresh cadaveric hands were dissected with the aid of loupe magnification. On the basis of known anatomic landmarks of the proximal portion of the cruciate (C0) pulley, percutaneous placement of a 25-gauge needle 5 mm proximal to the palmar digital crease marked the distal extent of the trigger finger release. Sharp division of the A1 pulley was performed with a scalpel until the needle was encountered, thus completing the release.

Results: A complete release of the pulley was achieved in all specimens with preservation of the A2 pulley. No digital nerve or artery injuries were noted with open inspection of the flexor sheath.

Conclusion: Percutaneous marking of the distal extent of the A1 pulley is a safe and reliable method that not only ensures complete release of the A1 pulley but also preserves the A2 pulley. The placement of a small gauge needle adds no morbidity to this minimally invasive technique.

No MeSH data available.


Related in: MedlinePlus

Hand surface landmark ratio of proximal interphalangeal distance to palmar digital crease (PDC) distance, used to predict the proximal A1 pulley edge. The distal edge of the A1 pulley is predicted 5 mm proximal to the PDC.
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Figure 1: Hand surface landmark ratio of proximal interphalangeal distance to palmar digital crease (PDC) distance, used to predict the proximal A1 pulley edge. The distal edge of the A1 pulley is predicted 5 mm proximal to the PDC.

Mentions: Nine fresh cadaveric hands were dissected with the aid of loupe magnification. The skin was marked based on known anatomic landmarks for trigger finger release as described earlier by Wilhelmi et al.16 A hand surface landmark ratio of the proximal interphalangeal (PIP) crease to palmar digital crease (PDC) distance was used to predict the proximal edge of the A1 pulley (Fig 1). On average, the PIP to PDC distance was 2.42 cm for the index, long, and ring fingers. After measurement of the PIP to PDC distance, an equal distance was marked proximal to the PDC. The proximal portion of the cruciate (C0) pulley defined the distal edge of the A1 pulley at 0.46 cm proximal to the PDC. Percutaneous placement of a 25-gauge needle 5 mm proximal to the PDC marked the distal extent of the release (Fig 2). A transverse incision was made overlying the proximal edge of the A1 pulley, allowing clear visualization of the anatomy. The pulley release was performed sharply with a scalpel until the 25-gauge needle was encountered, thus completing the release (Fig 3).


Assessment of the distal extent of the A1 pulley release: a new technique.

Hazani R, Engineer NJ, Zeineh LL, Wilhelmi BJ - Eplasty (2008)

Hand surface landmark ratio of proximal interphalangeal distance to palmar digital crease (PDC) distance, used to predict the proximal A1 pulley edge. The distal edge of the A1 pulley is predicted 5 mm proximal to the PDC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2519967&req=5

Figure 1: Hand surface landmark ratio of proximal interphalangeal distance to palmar digital crease (PDC) distance, used to predict the proximal A1 pulley edge. The distal edge of the A1 pulley is predicted 5 mm proximal to the PDC.
Mentions: Nine fresh cadaveric hands were dissected with the aid of loupe magnification. The skin was marked based on known anatomic landmarks for trigger finger release as described earlier by Wilhelmi et al.16 A hand surface landmark ratio of the proximal interphalangeal (PIP) crease to palmar digital crease (PDC) distance was used to predict the proximal edge of the A1 pulley (Fig 1). On average, the PIP to PDC distance was 2.42 cm for the index, long, and ring fingers. After measurement of the PIP to PDC distance, an equal distance was marked proximal to the PDC. The proximal portion of the cruciate (C0) pulley defined the distal edge of the A1 pulley at 0.46 cm proximal to the PDC. Percutaneous placement of a 25-gauge needle 5 mm proximal to the PDC marked the distal extent of the release (Fig 2). A transverse incision was made overlying the proximal edge of the A1 pulley, allowing clear visualization of the anatomy. The pulley release was performed sharply with a scalpel until the 25-gauge needle was encountered, thus completing the release (Fig 3).

Bottom Line: A complete release of the pulley was achieved in all specimens with preservation of the A2 pulley.Percutaneous marking of the distal extent of the A1 pulley is a safe and reliable method that not only ensures complete release of the A1 pulley but also preserves the A2 pulley.The placement of a small gauge needle adds no morbidity to this minimally invasive technique.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, School of Medicine, University of Louisville, Louisville, KY, USA. Ronmdsurg@hotmail.com

ABSTRACT

Objective: Sharp division of the A1 pulley is a time-honored technique for the treatment of flexor tendon entrapment; however, this procedure is not without complications. The anatomy of the A1 pulley system has been carefully investigated. Knowledge of superficial anatomic landmarks can assist with demarcating the distal edge of the A1 pulley and prevent damage to the critical A2 pulley.

Methods: Nine fresh cadaveric hands were dissected with the aid of loupe magnification. On the basis of known anatomic landmarks of the proximal portion of the cruciate (C0) pulley, percutaneous placement of a 25-gauge needle 5 mm proximal to the palmar digital crease marked the distal extent of the trigger finger release. Sharp division of the A1 pulley was performed with a scalpel until the needle was encountered, thus completing the release.

Results: A complete release of the pulley was achieved in all specimens with preservation of the A2 pulley. No digital nerve or artery injuries were noted with open inspection of the flexor sheath.

Conclusion: Percutaneous marking of the distal extent of the A1 pulley is a safe and reliable method that not only ensures complete release of the A1 pulley but also preserves the A2 pulley. The placement of a small gauge needle adds no morbidity to this minimally invasive technique.

No MeSH data available.


Related in: MedlinePlus