Ron Hazani1, Josh Elston, Bradon J Wilhelmi. 1. Division of Plastic Surgery, University of Louisville School of Medicine, 550 S. Jackson St. ACB 2nd Floor, Louisville, KY 40292 USA.
Abstract
BACKGROUND: Triggering of the thumb is a common entity resulting in pain and disability. Operative management requires accurate knowledge of the pulley system for proper release of the A1 pulley. The purpose of this study was to predict the location of the A1 pulley with surface anatomic landmarks while avoiding injury to the neurovascular bundles and the critical oblique pulley. METHODS: Thirteen fresh cadaveric thumbs were dissected while the volar digital creases of the thumb served as our potential anatomic landmarks for the A1 pulley. These included the distal crease and the two identifiable proximal creases. Measurements from the proximal edge of the A1 pulley to the surface landmarks were obtained. The pulley system was also inspected for variability, and the length of the A1 pulley was measured. RESULTS: Of the three volar creases in the thumb, the proximal-proximal crease (PPC) corresponded anatomically to the A1 pulley and demonstrated minimal variability compared to the other landmarks. It measured 0.10 ± 0.15 cm distal to the proximal edge of the A1 pulley. The average length of the thumb A1 pulley measured 0.61 ± 0.17 cm. Therefore, the distal edge of the A1 pulley is predicted to be located 0.51 cm distal to the PPC. CONCLUSIONS: Hand surface landmarks can be used reliably to predict the location of the thumb A1 pulley, thus avoiding injury to adjacent structures such as the critical oblique pulley.
BACKGROUND: Triggering of the thumb is a common entity resulting in pain and disability. Operative management requires accurate knowledge of the pulley system for proper release of the A1 pulley. The purpose of this study was to predict the location of the A1 pulley with surface anatomic landmarks while avoiding injury to the neurovascular bundles and the critical oblique pulley. METHODS: Thirteen fresh cadaveric thumbs were dissected while the volar digital creases of the thumb served as our potential anatomic landmarks for the A1 pulley. These included the distal crease and the two identifiable proximal creases. Measurements from the proximal edge of the A1 pulley to the surface landmarks were obtained. The pulley system was also inspected for variability, and the length of the A1 pulley was measured. RESULTS: Of the three volar creases in the thumb, the proximal-proximal crease (PPC) corresponded anatomically to the A1 pulley and demonstrated minimal variability compared to the other landmarks. It measured 0.10 ± 0.15 cm distal to the proximal edge of the A1 pulley. The average length of the thumb A1 pulley measured 0.61 ± 0.17 cm. Therefore, the distal edge of the A1 pulley is predicted to be located 0.51 cm distal to the PPC. CONCLUSIONS: Hand surface landmarks can be used reliably to predict the location of the thumb A1 pulley, thus avoiding injury to adjacent structures such as the critical oblique pulley.
Entities:
Keywords:
A1 pulley; Anatomic landmarks; Bowstring; Open release; Percutaneous release; Trigger thumb
Authors: Bradon J Wilhelmi; Arian Mowlavi; Michael W Neumeister; Reuben Bueno; W P Andrew Lee Journal: Plast Reconstr Surg Date: 2003-09-15 Impact factor: 4.730
Authors: Angelika Maria Schwarz; Georg Lipnik; Ulrike Maria Schwarz; Marco Johannes Maier; Andreas Heinrich Weiglein; Gloria Maria Hohenberger Journal: Indian J Orthop Date: 2021-03-30 Impact factor: 1.251