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Archives of Orthopaedic and Trauma Surgery

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01-06-2021 | Handsurgery

Viscoelastic properties of the human A2 finger pulley

Authors: C. K. Spies, J. Heuvens, M. F. Langer, P. Eysel, L. P. Müller, D. Grevenstein, J. Oppermann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2021

Abstract

Introduction

Biomechanical evaluation of the viscoelastic properties tissue deformation, stiffness, and maximum breaking load of the human A2 pulley. We hypothesized that the A2 pulleys of index, middle, and ring fingers exhibit no difference regarding the aforementioned biomechanical parameters.

Methods

Forty-one A2 pulleys of 14 upper extremities (8 body donors) were assessed. Cyclic and load-to-failure testing were performed. The biomechanical parameters tissue deformation during cyclic and load-to-failure testing, stiffness, and maximum breaking load were determined.

Results

No significant differences between the fingers could be detected regarding the biomechanical parameters. A significant negative correlation could be detected between stiffness and deformation of the pulley. Significant positive correlations could be identified between stiffness and maximum breaking load and between maximum breaking load and deformation of the pulleys.

Conclusions

Assessment of the viscoelastic properties of the A2 finger pulley promotes precise diagnosis of pulley lesions and will help to optimize treatment.

Peterson WW, Manske PR, Bollinger BA, Lesker PA, McCarthy JA (1986) Effect of pulley excision on flexor tendon biomechanics. J Orthop Res 4(1):96–101. https://doi.org/10.1002/jor.1100040112CrossRefPubMed

Bowers WH, Kuzma GR, Bynum DK (1994) Closed traumatic rupture of finger flexor pulleys. J Hand Surg Am 19(5):782–787. https://doi.org/10.1016/0363-5023(94)90183-XCrossRefPubMed

Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S (1998) Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med 26(5):651–655CrossRef

Schöffl VR, Einwag F, Strecker W, Schöffl I (2006) Strength measurement and clinical outcome after pulley ruptures in climbers. Med Sci Sports Exerc 38(4):637–643. https://doi.org/10.1249/01.mss.0000210199.87328.6aCrossRefPubMed

Barton NJ (1969) Experimental study of optimal location of flexor tendon pulleys. PlastReconstrSurg 43(2):125–129

Lin GT, Amadio PC, An KN, Cooney WP (1989) Functional anatomy of the human digital flexor pulley system. J Hand Surg Am 14(6):949–956CrossRef

Van Demark RE, Kimber KA, Jorgensen BD (2014) A4 annular flexor pulley injury in a baseball pitcher. J Hand SurgEur 40(6):649–651. https://doi.org/10.1177/1753193413518700CrossRef

Vandeputte G, Dubert T (2001) Closed traumatic rupture of the flexor pulleys of a long finger associated with avulsion of the flexor digitorum superficialis. J Hand SurgEur 26(3):266–268. https://doi.org/10.1054/jhsb.2001.0559CrossRef

Langer MF, Oeckenpöhler S, Hartensuer R, Herrmann K, Wieskötter B (2015) Pulley reconstruction in the hand. Orthopäde 44(10):757–766CrossRef

10.

Doyle JR (1988) Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg Am 13(4):473–484CrossRef

11.

Doyle JR (1989) Anatomy of the flexor tendon sheath and pulley system: a current review. J Hand Surg Am 14(2 Pt 2):349–351CrossRef

12.

Leeflang S, Coert JH (2014) The role of proximal pulleys in preventing tendon bowstringing: pulley rupture and tendon bowstringing. J PlastReconstrAesthetSurg 67(6):822–827. https://doi.org/10.1016/j.bjps.2014.01.041CrossRef

13.

Bassemir D, Unglaub F, Hahn P, Müller LP, Bruckner T, Spies CK (2015) Sonographical parameters of the finger pulley system in helathy adults. Arch Orthop Trauma Surg 135(11):1615–1622CrossRef

14.

Lin GT, Cooney P, Amadio PC, An KN (1990) Mechanical properties of human pulleys. J Hand SurgEur 15B(4):429–434CrossRef

15.

Marco RA, Sharkey NA, Smith TS, Zissimos AG (1998) Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. J Bone Joint Surg Am 80(7):1012–1019CrossRef

16.

Schöffl V, Hochholzer T, Winkelmann HP, Strecker W (2003) Pulley injuries in rock climbers. Wilderness Environ Med 14(2):94–100CrossRef

17.

Hohendorff B, Unglaub F, Spies CK, Wegmann K, Müller LP, Ries C (2019) Surgical approaches to the hand. OperOrthopTraumatol 31(5):372–383

18.

Armitage P, Berry G, Matthews JNS (2002) Statistical methods in medical research, 4th edn. Blackwell Scientific Ltd, OxfordCrossRef

19.

Martinoli C, Bianchi S, Nebiolo M, Derchi LE, Garcia JF (2000) Sonographic evaluation of digital annular pulley tears. Skeletal Radiol 29(7):387–391CrossRef

20.

Bodner G, Rudisch A, Gabl M, Judmaier W, Springer P, Klauser A (1999) Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI. Ultraschall Med 20(4):131–136. https://doi.org/10.1055/s-1999-8904CrossRefPubMed

21.

Stauffer A, Schwarz Y, Uranyi M, Schachinger F, Girsch W, Ganger R, Farr S (2020) Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability. Arch Orthop Trauma Surg 140(2):275–282CrossRef

22.

Klauser A, Bodner G, Frauscher F, Gabl M, ZurNedden D (1999) Finger injuries in extreme rock climbers Assessment of high-resolution ultrasonography. Am J Sports Med 27(6):733–737CrossRef

23.

Uludag A, Tosun HB, Celik S, Serbest S, Kayalar M, Aytac G, Sindel M, ErbayElibol FK, Demir T (2020) Comparison of various tendon repair techniques in extensor zone 3 injuries: an experimental biomechanical cadaver study. Arch Orthop Trauma Surg 140(4):583–590CrossRef

24.

Klauser A, Frauscher F, Bodner G, Halpern EJ, Schocke MF, Springer P, Gabl M, Judmaier W, ZurNedden D (2002) Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology 222(3):755–761. https://doi.org/10.1148/radiol.2223010752CrossRefPubMed

25.

Pillukat T, Kalb K, Fuhrmann R, Windolf J, van Schoonhoven J (2019) Reconstruction of the middle phalangeal base of the finger using an osteocartilaginous autograft from the hamate. OperOrthop Trauma 31(5):393–407CrossRef

26.

Langer MF, Wieskötter B, Öckenpöhler S, Unglaub F, Spies C, Grünert JG (2020) Secondary reconstruction of flexor tendons. Unfallchirurg 123(2):114–125CrossRef

27.

Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD, Resnick D (2000) Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 217(1):201–212. https://doi.org/10.1148/radiology.217.1.r00oc40201CrossRefPubMed

Title: Viscoelastic properties of the human A2 finger pulley
Authors: C. K. Spies
J. Heuvens
M. F. Langer
P. Eysel
L. P. Müller
D. Grevenstein
J. Oppermann
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03781-8

At a glance: The STEP trials

Springer Medicine

Viscoelastic properties of the human A2 finger pulley

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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