Fact-sheet: FInger pulley injury


Updated on 06/12/2024 at 8:44 AM

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Definition

Pulley rupture of one of the five fingers, most often occurring during trauma to a flexed finger (climbing, gripping)

Anatomic review. The pulleys:

  • A1, A3, A5: cross the palmar aspect of the joints (MCP, PIP, DIP)
  • A2, A4: cross the palmar aspect of the phalanges (P1, P2)

The most frequently ruptured pulley is A2

Clinical features

Pain and functional impairment

Bowstringing of the flexor tendons

Radiography

No role in the positive diagnosis: Soft tissue thickening.

Generally performed to rule out a fracture.

Ultrasound

Bilateral comparative dynamic ultrasound

  • Hematoma and/or pulley rupture(s)
  • Volar displacement of the flexor tendons with bowstringing in cases of complete rupture
  • Hypoechoic thickening of the pulley(s) in cases of partial rupture

MRI

T1 and PD (T2) FatSat sequences. Value of axial and sagittal images.

  • Visualization of the rupture site on axial images
  • Volar displacement of the flexor tendons with bowstringing in cases of complete rupture
  • Thickening and T2 hyperintensity of the pulley(s) without tendon displacement in cases of partial rupture