The A5 pulley is the smallest annular pulley, located at the DIP joint level. It is frequently absent as a discrete structure. Its sacrifice or damage does not cause significant functional deficit. It is the pulley most commonly involved in Jersey finger (FDP avulsion) injuries where the avulsed tendon may be trapped beneath A5 during retraction.
The most distal annular pulley at the DIP joint; allows final FDP glide to the distal phalanx; can be sacrificed without significant bowstringing.
A5 pulley significance in Jersey finger (FDP avulsion from distal phalanx) lies in its role as a potential trap point — the retracted FDP tendon can lodge under A5, A4, or A3 depending on the extent of retraction. Jersey finger classified by Leddy-Packer system: type 1 (tendon retracts to palm), type 2 (arrested at PIP level), type 3 (bone fragment caught at A4). Type 1 requires repair within days to prevent muscle contracture.
FDP avulsion from the distal phalanx with the tendon retracting and becoming caught at the A5 pulley level (type 2 or 3 Leddy-Packer), requiring early operative retrieval and reattachment to the distal phalanx.
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