What is new in flexor tendon pulleys and the gaps between them in triphalangeal fingers of the hand?

The flexor tendon pulleys in the fingers of the hand are fibrous structures of variable size, shape, and thickness that cover the synovial sheath of these tendons. Despite their clinical relevance, their arrangement and configuration in each of the triphalangeal fingers have been little studied and with small sample sizes. 192 triphalangeal fingers belonging to 48 fresh body donors' hands were dissected. Multivariate analysis was carried out. Twenty-five cases (52%) were left hands, and 26 of the 48 hands belonged to female donors (54.2%). The results were analyzed by fingers for each of the 5 annular pulleys, the 3 cruciform pulleys and the gaps between them. In addition, the most and least frequent configurations of the pulleys in each of the fingers were studied, observing that the classic pattern with all the pulleys appeared only in 3 fingers (1.56%), while the most frequent pattern was A1-A2-C1-A3-A4, which was seen in 35 fingers (18.22%). CONCLUSIONS: The flexor pulleys in the triphalangeal fingers of the hand have shown enormous variability in arrangement and shape, and also rarely appear all in the same finger. This peculiar anatomical arrangement can help the different professionals who perform their clinical work in this region.

The incidence and shape of the digital pulleys: a study of 192 fingers in 48 cadaveric hands.

We dissected 192 fingers in 48 fresh cadaveric hands (23 right and 25 left hands from 26 female and 22 male donors) and analysed the incidence, location, length and structure of the five annular and three cruciform pulleys. No statistically significant differences were found between left and right or between male and female hands. The A1, A2 and A4 pulleys were present in all fingers, while the incidence of other pulleys varied. We found 32 different patterns of pulley combinations. The structure of the pulleys also varied. Most important was the variation of A1, which consisted of one to four separate rings. In 18% there was no gap between the A1 and A2 pulleys. A greater understanding of the anatomical variation of the pulley system is beneficial for hand surgeons performing open or percutaneous trigger finger releases and for radiologists examining the area sonographically.

Choroidal Neovascular Membrane in a Teenage Girl With Chronic Intracranial Hypertension.

The authors describe the case of a 13-year-old girl with choroidal neovascular membrane and a history of benign intracranial hypertension who was successfully treated with a single intravitreal bevacizumab injection administered into the left eye. The visual acuity in the left eye improved to 20/25 at 2 weeks following treatment. The visual acuity was stable (20/20) in the right eye and 20/25 in the left eye with no signs of recurrence over 2 years of follow-up. The current case represents the only one in the literature whereby a teenage girl presented with choroidal neovascular membrane and benign intracranial hypertension. Although this occurrence in males has been previously published, the authors believe that it is important to document the response to treatment because the literature evidence is limited to date. [J Pediatr Ophthalmol. 2020;57:e86-e87.].