The C2 pulley is the second cruciate (X-shaped) part of the fibrous flexor sheath of a finger. It lies over the proximal part of the middle phalanx, between the A3 pulley at the PIP joint and the A4 pulley at the middle of the middle phalanx. Like the other cruciate pulleys, it is thin and flexible.
Holds the flexor tendons against the proximal middle phalanx between the A3 and A4 pulleys, and lets the sheath fold up during PIP joint flexion.
The C2 pulley is thin and contributes little to preventing bowstringing compared with the A2 and A4 pulleys. It is often opened to create a window for flexor tendon retrieval and repair in zone II, as long as A2 and A4 are kept intact. It lies near the insertion of flexor digitorum superficialis on the middle phalanx.
The C2 pulley can be opened to reach and repair flexor tendons over the proximal middle phalanx without causing bowstringing, provided the A2 and A4 pulleys are preserved.
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