The C1 cruciate pulley of the finger flexor sheath is the first of the three cruciate pulleys, located over the proximal interphalangeal joint, forming an X-shaped fibrous crossing that allows the sheath to collapse during flexion.
Allows the finger flexor sheath to fold during PIP joint flexion without bunching, maintains FDS and FDP tendon position at the PIP level, and contributes to the overall flexor sheath integrity.
The C1 pulley is encountered during flexor tendon repair in zone II — it may require partial resection for tendon retrieval but must be preserved when possible to maintain the pulley system. In Dupuytren's contracture, the C1 pulley contributes to the spiral cord that can displace the neurovascular bundle.
The cruciate C1 pulley at the PIP joint may require incision for tendon retrieval during zone II repair, but preservation of the A2 and A4 annular pulleys is the priority.
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