Pulleys

[Diane]

Hi Steve,
I scanned a young male with a small lump on the palmar ring finger PIPJ at the level of the middle phalanx base. It looked like a ganglion cyst but when I flexed the finger, it didn’t seem to move with the tendon. I was wondering then, do cysts that form from the pulleys stay still when the flexor is moving because the pulley is fixed?

Also, do toes have pulleys as well? I saw this recently https://link.springer.com/article/10.1007/s00256-014-2019-y/figures/1 and realise it doesn’t receive much mention as the finger pulleys nor do I remember learning about them at Uni… ?

Thanks!

[Stephen Bird]

Hi Diane,

What you saw was a ganglion arising from the A3 pulley.
The pulley is part of the tendon sheath apparatus rather than the tendons themselves,

So the ganglion will NOT move with the flexor tendons.

The sheath stays stationary during flexion and extension and the flexor tendons slide within the stationary sheath. So the ganglion will not move.

Indeed toes have a pulley system but as we don’t load our toes like we do our fingers that are rarely pathological and nobody really comes complaining of trigger toe.

It is true the pulley system is very similar to the hands, it looks like the design of the toes were cut and paste from whoever designed the hand.

I have seen a few cases of thickened toe pulleys with patients complaining of toe movement stiffness.

Nice one,

Steve

[Author]

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