The annular pulley system is the fibro-osseous tunnel maintaining the flexor tendons against the phalanges. The A2 and A4 pulleys are biomechanically critical — their loss produces bowstringing and loss of flexion efficiency. Trigger finger occurs when a nodular flexor tendon catches at the A1 pulley, producing painful locking of the finger. The annular pulleys are reconstructed using palmaris longus or extensor retinaculum strips when damaged during Zone II tendon repair.
The pulley system converts the linear FDS/FDP muscle contraction into efficient finger flexion — without the pulleys the tendons would bowstring across the palm
A2 pulley rupture from rock climbing (crimping — forced finger flexion against resistance) produces the classic bowstring deformity with increased tendon-to-bone distance on ultrasound. Multiple pulley ruptures require reconstruction. A1 pulley release for trigger finger is the most common hand surgical procedure worldwide — it can be performed with a needle (percutaneous release) or open.
Rock climbing crimp injury to the A2 pulley producing bowstringing managed with conservative treatment for single pulley and reconstruction for multiple pulley injuries.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
