Finger Pulley Injuries
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The hands are complex instruments. They have many bones, ligaments, tendons and joints to allow a wide variety of function and use. With all the tiny and intricate movements that the hand and fingers can make, there are intricate tendon and pulley systems to control the movements. An injury in 1 of the little pulley systems can have dramatic effects on daily life.
Anatomy of Finger Pulley Systems
In each digit or finger of your hand consists of a pulley system. The main purpose of the pulley system is to keep the tendons attached to the bones of your fingers and to prevent bowstringing when you bend your fingers and grip with your hand.
There are two main flexor tendons that arise from your forearm and enter through the carpal tunnel of your wrist that attach to your finger bones and allow each individual finger to flex or bend. The flexor digitorum superficialis attaches to the middle joint of your finger also known as the proximal interphalangeal joint or PIP joint, while the deeper flexor digitorum profundus attaches to the top joint of each finger also known as the distal phalangeal joint or DIP joint. As for the thumb, a separate muscle called the flexor pollicis longus is responsible for bending the thumb down. These tendons are encased in fibrous sheath that allow for smooth gliding and movement.
Tendons involved in finger pulley injuries
The pulley system consists of five annular pulleys and 3 cruciate pulleys for each digit. The thumb consists of two annular pulleys. The annular pulleys are ring-shaped ligaments that reinforce thickened areas of fibrous sheaths the tendons are encased in, and the cruciate pulleys are cross-shaped ligaments that provide further reinforcement to maintain tendon positioning as mentioned earlier. Damage or an injury to these pulleys can make it difficult and painful to bend your fingers.
Finger Pulley Injuries: Trigger Finger
Trigger finger is one of the most common finger pulley injuries involving the fingers or thumb where the tendon becomes inflamed or swollen causing it to get stuck in these pulleys which can cause the finger to lock down or trigger when bending or gripping. Trigger finger is usually an overuse type injury where repetitive motions are required with certain occupations or sports.
The most common pulley associated with trigger finger is the A1 pulley located at the base of each finger. The tendons are not able to pass through this pulley and sometimes must be straightened forcibly or manually using your other hand which can be quite painful. If the triggering is not addressed this can lead to long term damage to the tendon, causing it to fray in addition to stiffness as patients are reluctant to bend their fingers.
Climber’s Finger
Climber’s finger is another common injury to the A2 pulley that lies between the base of your finger and middle joint. These are usually seen with rock climbers as they require a lot of force to grip or pinch. Treatment options can vary from:
- Splint wear
- Anti-inflammatory medications
- Steroid injections
- Surgery to repair the damaged pulley or release it completely
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