Tendon Repair Question!

[anonymous-user]

Does anyone know what a4 pulley divided means, in relation to a finger tendon injury please?
Anyone have any experience of this?

[The_Doc]

Finger anatomy very complicated

You often have to open (or divide) the A4 pulley to repair a tendon in zone 2

They prevent bowstringing of the tendon. I wouldn't worry

[anonymous-user]

Thanks. Will see what the surgeon says in a few days..
I really shouldn't have tried to decipher the hospital letter !

[drfrank]

No disrespect to The Doc but the A2 and A4 pulleys are the most important pulleys and should be preserved at all costs !
If you have ruptured the A4 pulley then it may limit the amount of flexion you have at the finger tip. The pulley system of the flexor sheath is very important and effectively shortens the excursion of the tendon to produce maximum movement, without the pulley system the tendons would need to move much greater distances to move the fingers.

I would suggest that you see a hand surgeon (Plastic or Orthopaedic) who operates on hands regularly, your hands are amazing structures that are extremely delicate and need to be looked after.

[The_Doc]

I think he's post-op and reading the discharge summary or op note. You're right of course, if the pulleys are opened for a repair, you try and reconstruct them afterwards to preserve function. That's what I was taught to do, we would use a bit of FDS to make a new pulley.

I only do big tendons now