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Questions and Answers
What is the role of annular pulleys in preventing tendon bowstringing?
What is the role of annular pulleys in preventing tendon bowstringing?
- Facilitating tendon gliding
- Increasing mechanical efficiency of tendon excursion (correct)
- Maintaining tendon nutrition
- Enhancing tendon vascularity
Which pulley is the largest and plays a critical role in preventing bowstringing?
Which pulley is the largest and plays a critical role in preventing bowstringing?
- Volar plate pulley
- A2 pulley (correct)
- Oblique pulley
- A4 pulley
Where do annular pulleys originate from in relation to the MCP and IP joints?
Where do annular pulleys originate from in relation to the MCP and IP joints?
- Volar plate (correct)
- Radial side
- Dorsal plate
- Distal phalanx
What structures supply tendons with nutrition?
What structures supply tendons with nutrition?
Which structure assists with extensor digitorum communis (EDC) stabilization?
Which structure assists with extensor digitorum communis (EDC) stabilization?
What is the primary function of interconnections between the EDC of digits II to V?
What is the primary function of interconnections between the EDC of digits II to V?
When MCPJ flexion is limited, what should be performed with the IPJ's in extension to isolate the intrinsic muscles?
When MCPJ flexion is limited, what should be performed with the IPJ's in extension to isolate the intrinsic muscles?
What is the primary purpose of blocking exercises for DIPJ and PIPJ?
What is the primary purpose of blocking exercises for DIPJ and PIPJ?
For independent isolated superficialis gliding exercises, how should each digit be positioned?
For independent isolated superficialis gliding exercises, how should each digit be positioned?
What is the main focus of tendon gliding exercises?
What is the main focus of tendon gliding exercises?
Why are resistance exercises recommended after immobilization?
Why are resistance exercises recommended after immobilization?
What is the rationale behind performing active motion with blocking exercises?
What is the rationale behind performing active motion with blocking exercises?
Which supporting structure prevents dorsal bowstringing and limits EDC excursion?
Which supporting structure prevents dorsal bowstringing and limits EDC excursion?
Attenuation of the Transverse Retinacular Ligament (TRL) leads to which deformity?
Attenuation of the Transverse Retinacular Ligament (TRL) leads to which deformity?
Which supporting structure originates from the edge of the flexor sheath and prevents excessive dorsal migration of lateral bands during flexion?
Which supporting structure originates from the edge of the flexor sheath and prevents excessive dorsal migration of lateral bands during flexion?
Which structure optimizes tendinous forces and maintains lateral bands closer to the joint axis?
Which structure optimizes tendinous forces and maintains lateral bands closer to the joint axis?
Which supporting structure prevents excessive volar migration of lateral bands and can lead to a boutonniere deformity if attenuated?
Which supporting structure prevents excessive volar migration of lateral bands and can lead to a boutonniere deformity if attenuated?
Which supporting structure is maximally taut when the PIP joint is passively held in full extension with the DIP joint flexed?
Which supporting structure is maximally taut when the PIP joint is passively held in full extension with the DIP joint flexed?
What is a primary reason for joint stiffness and limited tendon gliding after trauma and immobilization?
What is a primary reason for joint stiffness and limited tendon gliding after trauma and immobilization?
Which exercise technique is necessary to regain motion in hand therapy and restore mobility and function?
Which exercise technique is necessary to regain motion in hand therapy and restore mobility and function?
What should be avoided to prevent stiffness in the hand following an injury, according to the text?
What should be avoided to prevent stiffness in the hand following an injury, according to the text?
At what length should the PIP joint be held to make the Oblique Retinacular Ligament maximally taut according to the text?
At what length should the PIP joint be held to make the Oblique Retinacular Ligament maximally taut according to the text?
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Study Notes
Pulleys
- Annular pulleys prevent tendon bowstringing, increasing mechanical efficiency of tendon excursion
- A2 pulley is the largest, measuring 1.5-1.7 cm in length
- A4 pulley is the second largest, measuring 0.5 cm in length
- Preservation of A2 and A4 pulleys is critical to prevent bowstringing
Pulley System of the Thumb
- Thumb pulleys are distinct from the digits
- Annular pulleys arise from the volar plate of the MCP and IP joints
- Oblique pulley is located over the proximal phalanx and is the most important pulley
Tendon Vascularity and Nutrition
- Tendons receive nutrition from both vascular supply and synovial diffusion
- Viniculi are small arteries that supply the tendon with nutrition
- The volar surface of the tendon is avascular
- Repairs should avoid the dorsa surface to prevent disruption of dorsal blood supply
Extensor Compartments
- 1st compartment: APL, EPB
- 2nd compartment: ECRL, ECRB
- 3rd compartment: EPL
- 4th compartment: EIP, EDC
- 5th compartment: EDQ
- 6th compartment: ECU
Extrinsic Extensors
- EDC: sagittal bands, terminal tendon
- Lumbricals: orientation of interosseous, intrinsic, and extrinsic relationship
Juncturae Tendinum
- Assists with EDC stabilization
- Interconnection between EDC II to V
- Maintains and retains divergent angle of tendons
- Decreases load on sagittal bands
- Prevents secondary stiffness with preventative active ROM to the shoulder and elbow
Tendon Supporting Structures
- Sagittal band: stabilizes extensor tendon at midline, prevents dorsal bowstringing, and limits EDC excursion
- Transverse retinacular ligament: prevents excessive dorsal migration of lateral bands during flexion
- Triangular ligament: prevents excessive volar migration of lateral bands
- Oblique retinacular ligament: maximally taut when PIP is passively held in full extension with DIP flexed
Active Motion Exercises
- Blocking exercises: DIPJ blocking, PIPJ blocking
- Intrinsic stretching: active MCPJ flexion with IPJ extension
- Tendon gliding exercises: maximum differential glide between FDS and FDP, maximum profundus gliding, maximum FDS gliding
- Independent isolated superficialis gliding: flexing one digit at a time at the PIP joint with the uninvolved hand keeping the other fingers in extension
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