The thumb A3 pulley is the cruciate pulley of the thumb flexor sheath, located over the IP joint of the thumb. It is variable in its presence and clinical significance.
Provides the IP joint level constraint for the FPL tendon, allowing tendon gliding without bowstringing at the IP joint level. The cruciate design allows collapsing during extreme flexion.
The A3 thumb pulley is variable and may be absent. It is not typically reconstructed when absent. In trigger thumb surgery, careful preservation of at least one annular pulley (A1 preferentially) prevents bowstringing.
Identification of all thumb pulleys (A1, A2, A3) during trigger thumb surgery to ensure at least one annular constraint is preserved after A1 release to prevent FPL bowstringing.
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