High-Frequency Ultrasonographic Examination of the Finger Pulley System

Abstract

The purpose of this study was to determine the ability of high-frequency ultrasonography to provide for direct evaluation of the annular and cruciform finger pulley system. In the first part of the work, a cadaveric study was performed to outline the normal anatomy of the annular and cruciform finger pulley system. Eighteen cadaveric hands were cut (n = 10) or dissected (n = 8). Two musculoskeletal radiologists retrospectively reviewed in consensus the photographs of anatomic sections and dissections. This cadaveric study gave the 2 readers the opportunity to learn the normal anatomy of the finger pulley system. In the second part of the work, the annular and cruciform finger pulley system of 20 hands of volunteers was evaluated by ultrasonography with a 17-MHz linear transducer. Images were retrospectively analyzed by means of consensus of the 2 radiologists with respect to the visibility of each finger pulley. For annular (A) pulleys, high frequency ultrasonography showed A1, A2, A3, and A4 in 100%, 100%, 65%, and 100% of cases, respectively. For cruciform (C) pulleys, high-frequency ultrasonography showed only C1 in 45% of cases. Direct visualization of A5, C2, and C3 was not possible. High-frequency ultrasonography allows excellent depiction of finger pulleys except for annular pulley A5 and cruciform pulleys C2 and C3.