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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 Sheath¹

¹ From the Department of Radiology, University of California, San Diego, Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161 (O.H., C.B.C., N.L., D.T., R.D.B., D.R.), and the Division of Orthopaedic Surgery, Scripps Clinic and Research Foundation, La Jolla, Calif (M.J.B.). From the 1999 RSNA scientific assembly. Received August 25, 1999; revision requested September 29; revision received January 5, 2000; accepted January 17. Supported by Veterans Affairs grant SA-360. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu).

PURPOSE: To describe the normal anatomy of the finger flexor tendon pulley system, with anatomic correlation, and to define criteria to diagnose pulley abnormalities with different imaging modalities.

MATERIALS AND METHODS: Three groups of cadaveric fingers underwent computed tomography (CT), magnetic resonance (MR) imaging, and ultrasonography (US). The normal anatomy of the pulley system was studied at extension and flexion without and with MR tenography. Pulley lengths were measured, and anatomic correlation was performed. Pulley lesions were created and studied at flexion, extension, and forced flexion. Two radiologists reviewed the studies in blinded fashion.

RESULTS: MR imaging demonstrated A2 (proximal phalanx) and A4 (middle phalanx) pulleys in 12 (100%) of 12 cases, without and with tenography. MR tenography showed the A3 (proximal interphalangeal) and A5 (distal interphalangeal) pulleys in 10 (83%) and nine (75%) cases, respectively. US showed the A2 pulley in all cases and the A4 pulley in eight (67%). CT did not allow direct pulley visualization. No significant differences in pulley lengths were measured at MR, US, or pathologic examination (P = .512). Direct lesion diagnosis was possible with MR imaging and US in 79%–100% of cases, depending on lesion type. Indirect diagnosis was successful with all methods with forced flexion.

CONCLUSION: MR imaging and US provide means of direct finger pulley system evaluation.

Index terms: Computed tomography (CT), comparative studies, 43.12111, 43.12112, 43.12115 • Fingers and toes, injuries, 43.489 • Hand, CT, 43.1211 • Hand, MR, 43.121411, 43.121412, 43.121413, 43.121415 • Hand, US, 43.1298 • Ultrasound (US), tissue characterization, 43.1298, 43.12988

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