The A3 pulley lies directly over the PIP joint, the smallest of the five annular pulleys. Its intimate relationship with the PIP joint volar plate means that PIP joint fracture-dislocations may involve A3 disruption. Unlike A2 and A4, A3 sacrifice rarely causes functional deficit because the adjacent C1 cruciate pulley maintains congruent tendon position.
Provides congruent tendon glide at the PIP joint; the smallest annular pulley, located at the PIP joint; can be sacrificed if necessary without bowstringing.
A3 pulley disruption occurs in PIP joint fracture-dislocations and in severe flexor tendon injuries. In total flexor tendon reconstruction, A3 may be vented to allow tendon passage without bowstringing. The pulley is inspected arthroscopically in evaluation of PIP joint injuries.
A3 pulley damage in volar plate avulsion fractures at the PIP joint, managed as part of the overall PIP joint reconstruction without specific concern for bowstringing given its small size.
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