Morphological and Biomechanical Study of the Pulley System of the Thumb

The purpose of this study was to define more precisely the anatomy of the thumb flexor pulley system and to determine the relative contribution of each of the pulleys to the biomechanics of thumb motion at the metacarpophalangeal (MP) and interphalangeal (IP) joints. For this, 22 hands from 11 cadavers were used and randomly assigned to two groups. In the first group, the first annular (A1) pulley was cut first followed by the variable annular (Av) pulley and then the oblique pulley. In the second group, the oblique pulley was cut first followed by the, pulley and then the Av pulley. In 7 of 22 hands, it was a transverse structure parallel to the, pulley with a gap between the A1 and Av pulleys, referred to here as type I. In 9 hands, the A1 and Av pulleys were connected without any gap (type II). In 6 hands, the space between the A1 and Av pulleys were triangular in shape with fibers of the Av pulley converging toward the radial side (type III). In biomechanical study of both first and second experiments, there was no significant difference in MCP joint flexion between the all intact, A1 section, A1/Av section, A2 intact (A1/Av/oblique section), and no pulley configuration (p>.05). In occurring displacements less than 10 mm, there was no significant difference in IP joint flexion (p>.05). However, there was a significant decrease in IP joint flexion occurred in both 15 mm and 20 mm excursion (p<.05), when the oblique pulley was resected additionally after cutting the A1 and Av pulleys in first experiment, and when the A1 pulley was resected additionally after cutting the oblique pulley. According to the results, the injury of only the oblique pulley does not decrease thumb motion significantly. The oblique pulley injury with both the A1 and Av pulleys laceration decreased thumb motion significantly. The additional laceration of the A2 pulley does not decrease thumb motion.