Scientific articleCorrelations Between Clinical Presentations of Adult Trigger Digits and Histologic Aspects of the A1 Pulley
Section snippets
Materials and Methods
We obtained 55 normal A1 pulleys from all digits of 11 fresh-frozen adult cadaver hands. The proximal border of the pulley was at the metacarpophalangeal skin crease of the thumb, proximal palmar crease of the index finger, halfway between the proximal and distal palmar creases for the long finger, and distal palmar crease for the ring and little finger.11 To recognize the distal border of the pulley, we searched for the separation between the A1 and A2 pulleys, present in 95% according to
Results
In normal A1 pulleys, we observed a 3- layer structure (Fig. 1A, B). The innermost layer (I), forming the gliding surface in contact with the flexor tendons, was characterized by collagen bundles oriented parallel to the long axis of the digit. Ovoid cells (cartilage-like cells),8 arranged in a unicellular or bicellular layer, were strongly stained with Alcian blue. They were grouped in a striking linear orientation with the long axis of the collagen bundles (Fig. 1C). The immediately palmar
Discussion
The precise histologic structure of the normal flexor tendon pulleys has not been well established in the literature. Amis and Jones5 reported that the membranous portion of the sheath has no insertion on the proximal or distal borders of the annular pulleys. In contrast, Lundborg and Myrhage7 observed that the membranous portion inserts on the palmar superficial surface of the pulleys. A concept of 2 layers, 1 superficial, membranous portion and 1 deep, fibrocartilaginous retinacular layer,
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