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The A1 Pulley in Rheumatoid Flexor Tenosynovectomy

To retain or divide?

From Princess Alice Orthopaedic Hospital and the University of Cape Town, South Africa

Correspondence: Dr L.T. de Jager, Department of Orthopaedic Surgery, University of Cape Town, Observatory 1925, South Africa.

We report a detailed comparative evaluation of flexor tenosynovectomy in 55 fingers in which the A1 pulley was divided and 45 fingers in which the A1 pulley was retained. The metacarpophalangeal joint subluxed volarly in 49% when the A1 pulley was divided, compared to 11% when the pulley was preserved. Bowstringing occurred in 7% and only when the A1 pulley was divided. Ulnar deviation was 7° worse when the pulley was divided. Active range of movement was limited in both groups. It was 11° less when the A1 pulley was divided.

Journal of Hand Surgery (British and European Volume), Vol. 19, No. 2, 202-204 (1994)
DOI: 10.1016/0266-7681(94)90166-X


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