Download PDF
Semin Musculoskelet Radiol 2021; 25(02): 203-215
DOI: 10.1055/s-0041-1727196
Review Article

Pulley, Flexor, and Extensor Tendon Injuries of the Hand

Andrea B. Rosskopf
1   Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
2   Department of Radiology, ARISTRA, Zurich, Switzerland
,
Mihra S. Taljanovic
3   Department of Medical Imaging, University of Arizona, Business, SimonMed Imaging, Scottsdale, Arizona
,
Luca M. Sconfienza
4   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
5   Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
,
Salvatore Gitto
5   Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
,
Carlo Martinoli
6   Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
,
Riccardo Picasso
6   Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
,
Andrea Klauser
7   Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Innsbruck, Austria
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Tendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.

Keywords

tendon - injury - hand - pulley

Supplementary Material



Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 De Jong JP, Nguyen JT, Sonnema AJ, Nguyen EC, Amadio PC, Moran SL. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clin Orthop Surg 2014; 6 (02) 196-202
    CrossrefPubMedGoogle Scholar
  • 2 Schöffl V, Heid A, Küpper T. Tendon injuries of the hand. World J Orthop 2012; 3 (06) 62-69
    CrossrefPubMedGoogle Scholar
  • 3 Klauser A, Frauscher F, Bodner G. et al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology 2002; 222 (03) 755-761
    CrossrefPubMedGoogle Scholar
  • 4 Clavero JA, Alomar X, Monill JM. et al. MR imaging of ligament and tendon injuries of the fingers. Radiographics 2002; 22 (02) 237-256
    CrossrefPubMedGoogle Scholar
  • 5 Vassa R, Garg A, Omar IM. Magnetic resonance imaging of the wrist and hand. Pol J Radiol 2020; 85: e461-e488
    CrossrefPubMedGoogle Scholar
  • 6 Petchprapa CN, Vaswani D. MRI of the fingers: an update. AJR Am J Roentgenol 2019; 213 (03) 534-548
    CrossrefPubMedGoogle Scholar
  • 7 Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 1983; 8 (5 Pt 2): 794-798
    CrossrefPubMedGoogle Scholar
  • 8 Alla SR, Deal ND, Dempsey IJ. Current concepts: mallet finger. Hand (N Y) 2014; 9 (02) 138-144
    CrossrefPubMedGoogle Scholar
  • 9 Wang T, Qi H, Teng J, Wang Z, Zhao B. The role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. Sci Rep 2017; 7 (01) 11049
    CrossrefPubMedGoogle Scholar
  • 10 Schweitzer TP, Rayan GM. The terminal tendon of the digital extensor mechanism: Part II, kinematic study. J Hand Surg Am 2004; 29 (05) 903-908
    CrossrefPubMedGoogle Scholar
  • 11 Ferlic DC. Boutonniere deformities in rheumatoid arthritis. Hand Clin 1989; 5 (02) 215-222
    CrossrefPubMedGoogle Scholar
  • 12 Westerheide E, Failla JM, van Holsbeeck M, Ceulemans R. Ultrasound visualization of central slip injuries of the finger extensor mechanism. J Hand Surg Am 2003; 28 (06) 1009-1013
    CrossrefPubMedGoogle Scholar
  • 13 Rothwell AG. The pseudo-boutonniere deformity. N Z Med J 1979; 89 (628) 51-54
    PubMedGoogle Scholar
  • 14 Rayan GM, Murray D. Classification and treatment of closed sagittal band injuries. J Hand Surg Am 1994; 19 (04) 590-594
    CrossrefPubMedGoogle Scholar
  • 15 Willekens I, Kichouh M, Boulet C, De Maeseneer M, Clarys JP, de Mey J. Ultrasound follow-up of posttraumatic injuries of the sagittal band of the dorsal hood treated by a conservative approach. Eur J Radiol 2015; 84 (02) 278-283
    CrossrefPubMedGoogle Scholar
  • 16 Meraj S, Gyftopoulos S, Nellans K, Walz D, Brown MS. MRI of the extensor tendons of the wrist. AJR Am J Roentgenol 2017; 209 (05) 1093-1102
    CrossrefPubMedGoogle Scholar
  • 17 Bencardino JT. MR imaging of tendon lesions of the hand and wrist. Magn Reson Imaging Clin N Am 2004; 12 (02) 333-347 vii vii
    CrossrefPubMedGoogle Scholar
  • 18 Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain's tenosynovitis. Ann Rheum Dis 2002; 61 (11) 1034-1035
    CrossrefPubMedGoogle Scholar
  • 19 Goel R, Abzug JM. De Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y) 2015; 10 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 20 Montechiarello S, Miozzi F, D'Ambrosio I, Giovagnorio F. The intersection syndrome: ultrasound findings and their diagnostic value. J Ultrasound 2010; 13 (02) 70-73
    CrossrefPubMedGoogle Scholar
  • 21 Draghi F, Bortolotto C. Intersection syndrome: ultrasound imaging. Skeletal Radiol 2014; 43 (03) 283-287
    CrossrefPubMedGoogle Scholar
  • 22 Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol 2009; 38 (02) 157-163
    CrossrefPubMedGoogle Scholar
  • 23 Mattox R, Battaglia PJ, Scali F, Ottolini K, Kettner NW. Distal intersection syndrome progressing to extensor pollicis longus tendon rupture: a case report with sonographic findings. J Ultrasound 2016; 20 (03) 237-241
    CrossrefPubMedGoogle Scholar
  • 24 Draghi F, Bortolotto C, Draghi AG, Gregoli B. Musculoskeletal sonography for evaluation of anatomic variations of extensor tendon synovial sheaths in the wrist. J Ultrasound Med 2015; 34 (08) 1445-1452
    CrossrefPubMedGoogle Scholar
  • 25 Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius—a clinical and microangiographic study. Hand 1979; 11 (01) 76-86
    CrossrefPubMedGoogle Scholar
  • 26 Bonatz E, Kramer TD, Masear VR. Rupture of the extensor pollicis longus tendon. Am J Orthop 1996; 25 (02) 118-122
    PubMedGoogle Scholar
  • 27 Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR Imaging and US of the wrist tendons. Radiographics 2016; 36 (06) 1688-1700
    CrossrefPubMedGoogle Scholar
  • 28 Tanaka T, Kamada H, Ochiai N. Extensor tendon rupture in ring and little fingers with DRUJ osteoarthritis without perforating the DRUJ capsule. J Orthop Sci 2006; 11 (02) 221-223
    CrossrefPubMedGoogle Scholar
  • 29 Ghatan AC, Puri SG, Morse KW, Hearns KA, von Althann C, Carlson MG. Relative contribution of the subsheath to extensor carpi ulnaris tendon stability: implications for surgical reconstruction and rehabilitation. J Hand Surg Am 2016; 41 (02) 225-232
    CrossrefPubMedGoogle Scholar
  • 30 Conroy CRD, Vitale MA. Extensor carpi ulnaris instability in athletes - diagnosis and treatment. Oper Tech Sports Med 2016; 24 (02) 139-147
    CrossrefPubMedGoogle Scholar
  • 31 MacLennan AJ, Nemechek NM, Waitayawinyu T, Trumble TE. Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation. J Hand Surg Am 2008; 33 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 32 Ali S, Cunningham R, Amin M, Popoff SN, Mohamed F, Barbe MF. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI. Skeletal Radiol 2015; 44 (12) 1735-1743
    CrossrefPubMedGoogle Scholar
  • 33 Patel DB, Emmanuel NB, Stevanovic MV. et al. Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options. Radiographics 2014; 34 (07) 1968-1986
    CrossrefPubMedGoogle Scholar
  • 34 Gupta P, Lenchik L, Wuertzer SD, Pacholke DA. High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries. AJR Am J Roentgenol 2015; 204 (03) W314-23
    CrossrefPubMedGoogle Scholar
  • 35 Shapiro LM, Kamal RN. Evaluation and treatment of flexor tendon and pulley injuries in athletes. Clin Sports Med 2020; 39 (02) 279-297
    CrossrefPubMedGoogle Scholar
  • 36 Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg 2011; 19 (03) 152-162
    CrossrefPubMedGoogle Scholar
  • 37 Schöffl VR, Schöffl I. Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg Am 2006; 31 (04) 647-654
    CrossrefPubMedGoogle Scholar
  • 38 Jones G, Johnson MI. A critical review of the incidence and risk factors for finger injuries in rock climbing. Curr Sports Med Rep 2016; 15 (06) 400-409
    CrossrefPubMedGoogle Scholar
  • 39 Klauser A, Bodner G, Frauscher F, Gabl M, Zur Nedden D. Finger injuries in extreme rock climbers. Assessment of high-resolution ultrasonography. Am J Sports Med 1999; 27 (06) 733-737
    CrossrefPubMedGoogle Scholar
  • 40 Bayer T, Adler W, Schweizer A, Schöffl I, Uder M, Janka R. Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol 2015; 44 (09) 1279-1285
    CrossrefPubMedGoogle Scholar
  • 41 Klauser A, Frauscher F, Bodner G. et al. Value of high-resolution ultrasound in the evaluation of finger injuries in extreme sport climbers. [in German]. Ultraschall Med 2000; 21 (02) 73-78
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Schellhammer F, Vantorre A. Semi-dynamic MRI of climbing-associated injuries of the finger. Skeletal Radiol 2019; 48 (09) 1435-1437
    CrossrefPubMedGoogle Scholar
  • 43 Hauger O, Chung CB, Lektrakul N. et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 2000; 217 (01) 201-212
    CrossrefPubMedGoogle Scholar
  • 44 Bodner G, Rudisch A, Gabl M, Judmaier W, Springer P, Klauser A. Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI. Ultraschall Med 1999; 20 (04) 131-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Leeflang S, Coert JH. The role of proximal pulleys in preventing tendon bowstringing: pulley rupture and tendon bowstringing. J Plast Reconstr Aesthet Surg 2014; 67 (06) 822-827
    CrossrefPubMedGoogle Scholar
  • 46 Hoff MN, Greenberg TD. MRI sport-specific pulley imaging. Skeletal Radiol 2018; 47 (07) 989-992
    CrossrefPubMedGoogle Scholar
  • 47 Lapegue F, Andre A, Brun C. et al. Traumatic flexor tendon injuries. Diagn Interv Imaging 2015; 96 (12) 1279-1292
    CrossrefPubMedGoogle Scholar
  • 48 Bianchi S, Martinoli C, de Gautard R, Gaignot C. Ultrasound of the digital flexor system: normal and pathological findings. J Ultrasound 2007; 10 (02) 85-92
    CrossrefPubMedGoogle Scholar
  • 49 Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol 2007; 17 (09) 2237-2247
    CrossrefPubMedGoogle Scholar
  • 50 Gitto S, Draghi F. Normal sonographic anatomy of the wrist with emphasis on assessment of tendons, nerves, and ligaments. J Ultrasound Med 2016; 35 (05) 1081-1094
    CrossrefPubMedGoogle Scholar
  • 51 Taljanovic MS, Melville DM, Gimber LH. et al. High-resolution US of rheumatologic diseases. Radiographics 2015; 35 (07) 2026-2048
    CrossrefPubMedGoogle Scholar
  • 52 Sconfienza LM, Adriaensen M, Albano D. et al; Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR). Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—Part II, elbow and wrist. Eur Radiol 2020; 30 (04) 2220-2230
    CrossrefPubMedGoogle Scholar
  • 53 Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper limb interventions. Radiol Clin North Am 2019; 57 (05) 1073-1082
    CrossrefPubMedGoogle Scholar
  • 54 Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol 2005; 60 (02) 149-159
    CrossrefPubMedGoogle Scholar
  • 55 Gitto S, Draghi AG, Draghi F. Sonography of non-neoplastic disorders of the hand and wrist tendons. J Ultrasound Med 2018; 37 (01) 51-68
    CrossrefPubMedGoogle Scholar
  • 56 Chau CL, Griffith JF, Chan PT, Lui TH, Yu KS, Ngai WK. Rice-body formation in atypical mycobacterial tenosynovitis and bursitis: findings on sonography and MR imaging. AJR Am J Roentgenol 2003; 180 (05) 1455-1459
    CrossrefPubMedGoogle Scholar
  • 57 Turecki MB, Taljanovic MS, Stubbs AY. et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010; 39 (10) 957-971
    CrossrefPubMedGoogle Scholar
  • 58 Orlandi D, Gitto S, Perugin Bernardi S. et al. Advanced power Doppler technique increases synovial vascularity detection in patients with rheumatoid arthritis. Ultrasound Med Biol 2017; 43 (09) 1880-1887
    CrossrefPubMedGoogle Scholar
  • 59 Wick MC, Weiss RJ, Arora R. et al. Enthesiopathy of the flexor carpi ulnaris at the pisiform: findings of high-frequency sonography. Eur J Radiol 2011; 77 (02) 240-244
    CrossrefPubMedGoogle Scholar
  • 60 Guillin R, Bianchi S. Sonographic assessment of orthopedic hardware impingement on soft tissues of the limbs. J Ultrasound 2012; 15 (01) 50-55
    CrossrefPubMedGoogle Scholar