Importance of proximal A2 and A4 pulleys to maintaining kinematics in the hand: a biomechanical study

The A2 and A4 pulleys have been shown to be important in finger flexor tendon function. Other authors have suggested either reconstruction or venting of portions of these pulleys in an attempt to preserve finger function in certain clinical situations. This study examines the effects of partial incision of these pulleys on finger flexion kinematics and biomechanics.

The index and ring fingers of 16 cadaveric hands were studied. The flexor digitorum profundus tendon was isolated and attached to a computer driven servo-motor. Micro-potentiometers measured flexion angles of the metacarpophalangeal, proximal inter-phalangeal and distal inter-phalangeal joints. Joint inertial torques were calculated making use of this experimental kinematic data.

Proximal 50 % incisions of either the A2 or the A4 pulleys resulted in a statistically significant decrease in overall finger motion. This effect was greatest in the proximal inter-phalangeal joint, with a decrease in joint motion, as well as an earlier time to initiation of motion. These changes in finger motion were more pronounced with A2 pulley incision than they were with A4 pulley incision, but the changes were statistically significant in either case. No significant changes in joint inertial torques were shown.

Our data provides evidence to the importance of the proximal portions of the A2 and A4 pulleys, and may support partial distal incision of these pulleys in certain clinical situations.