Tendon injuries of the hand

Figure 1 The pulley system of the long fingers (modified according to Schmidt and Lanz[8]).

Figure 2 Complete pulley system during a stress test in the biomechanical laboratory. (Figure with permission of Schöffl V, MD, PhD, Institute of Anatomy, University of Erlangen-Nuremberg, Germany[9]).

Figure 3 A2-pulley rupture during a stress test in the biomechanical laboratory. Note the increased distance between the flexor tendons and the bone. The A3-pulley is unharmed. (Figure with permission of Schöffl V, MD, PhD, Institute of Anatomy, University of Erlangen-Nuremberg, Germany[9]).

Figure 4 Closed flexor tendon rupture of the flexor digitorum profundus at the level of the middle phalanx (rock climber)[9].

Figure 5 Lumbrical tendon rupture (note the edema and the dislocated lumbrical tendon from the flexor tendon).

Figure 6 Degenerative flexor tendon rupture in a long term rock climber with chronic tendinosis.

Figure 7 Degenerative flexor tendon rupture in a long term rock climber with chronic tendinosis. The histology showed a mucoid degeneration with numerous blood vessel proliferations and a siderosis as a sign of an older bleed[9].

Figure 8 Ruptured A3 pulley (the tendon sheath with chronic inflammation is already removed).

Figure 9 Algorithm for pulley injuries[3]. MRI: Magnetic resonance imaging.