Flexor Tendon Anatomy: Multimedia

References

1. Moore KL. The upper extremity. In: Moore KL. Clinically Oriented Anatomy. 3rd ed. Baltimore, Md: Williams & Wilkins;1992:553-606.

2. Verdan CE. Primary repair of flexor tendons. J Bone Joint Surg Am. Jun 1960;42-A:647-57. [Medline].

3. Doyle JR. Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg [Am]. Jul 1988;13(4):473-84. [Medline].

4. Doyle JR. Anatomy of the flexor tendon sheath and pulley system: a current review. J Hand Surg [Am]. Mar 1989;14(2 Pt 2):349-51. [Medline].

5. Doyle JR. Anatomy and function of the palmar aponeurosis pulley. J Hand Surg [Am]. Jan 1990;15(1):78-82. [Medline].

6. Doyle JR, Blythe WF. Anatomy of the flexor tendon sheath and pulleys of the thumb. J Hand Surg [Am]. Mar 1977;2(2):149-51. [Medline].

7. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet. 1918;26:103-10.

8. Strauch B, de Moura W. Digital flexor tendon sheath: an anatomic study. J Hand Surg [Am]. Nov 1985;10(6 Pt 1):785-9. [Medline].

9. Manske PR, Lesker PA. Palmar aponeurosis pulley. J Hand Surg [Am]. May 1983;8(3):259-63. [Medline].

10. Cohen MJ, Kaplan L. Histology and ultrastructure of the human flexor tendon sheath. J Hand Surg [Am]. Jan 1987;12(1):25-9. [Medline].

11. Stewart DA, Smitham PJ, Gianoutsos MP, Walsh WR. Biomechanical influence of the vincula tendinum on digital motion after isolated flexor tendon injury: a cadaveric study. J Hand Surg [Am]. Oct 2007;32(8):1190-4. [Medline].

12. Azar CA, Culver JE, Fleegler EJ. Blood supply of the flexor pollicis longus tendon. J Hand Surg [Am]. Jul 1983;8(4):471-5. [Medline].

13. Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clin. Feb 1985;1(1):13-24. [Medline].

14. Bojsen-Moller F, Schmidt L. The palmar aponeurosis and the central spaces of the hand. J Anat. Feb 1974;117(Pt 1):55-68. [Medline]. [Full Text].

15. Canuto HC, Oliveira ML, Fishbein KW, Spencer RG. Tendon and neurovascular bundle displacement in the palm with hand flexion and extension: an MRI and gross anatomy correlative study. J Magn Reson Imaging. May 2006;23(5):742-6. [Medline].

16. Fahrer M. The proximal end of the palmar aponeurosis. Hand. Feb 1980;12(1):33-8. [Medline].

17. Idler RS. Anatomy and biomechanics of the digital flexor tendons. Hand Clin. Feb 1985;1(1):3-11. [Medline].

18. Mester S, Schmidt B, Szabo G. Biomechanics of the membranous flexor tendon sheath: the role of Grayson's ligaments. Plast Reconstr Surg. Feb 2006;117(2):497-506. [Medline].

19. Barton NJ. Experimental study of optimal location of flexor tendon pulleys. Plast Reconstr Surg. Feb 1969;43(2):125-9. [Medline].

20. Hunter JM, Cook JF, Ochiai N. The pulley system. Proceedings of the American Society for Surgery of the Hand. Orthop Trans. 1980;4:4.

21. Li ZM, Tang J, Chakan M, Kaz R. Complex, multidimensional thumb movements generated by individual extrinsic muscles. J Orthop Res. Sep 2008;26(9):1289-95. [Medline].

22. Nimbarte AD, Kaz R, Li ZM. Finger joint motion generated by individual extrinsic muscles: A cadaveric study. J Orthop Surg. Jul 11 2008;3:27. [Medline].

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24. Chin KF, Khalid M, Gogi N, Fussey J, Shanahan D, Deshmukh S. The mend of the bend-flexor pollicis longus tendon has an additional pulley distal to its point of angulation. Clin Anat. Jul 2008;21(5):427-32. [Medline].

25. Dona E, Walsh WR. Flexor tendon pulley V-Y plasty: an alternative to pulley venting or resection. J Hand Surg [Br]. Apr 2006;31(2):133-7. [Medline].

26. Hazani R, Engineer NJ, Zeineh LL, Wilhelmi BJ. Assessment of the distal extent of the A1 pulley release: a new technique. Eplasty. Aug 22 2008;8:e44. [Medline].

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29. Strickland JW. Flexor tendon injuries. Part 1. Anatomy, physiology, biomechanics, healing, and adhesion formation around a repaired tendon. Orthop Rev. Oct 1986;15(10):632-45. [Medline].

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31. Verdan C. Reparative surgery of flexor tendons in the digits. In: Verdan C, Boyes JH, eds. Tendon Surgery of the Hand. New York, NY: Churchill Livingstone;1979:57-66.

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33. Zidel P. Zidel P: Tendon healing and flexor tendon surgery. In: Aston SJ, Beasley RW, Thorne CHM, Grabb WC, Smith JW, eds. Grabb and Smith's Plastic Surgery. 5th ed. Baltimore, Md: Williams & Wilkins;1996:875-82.

34. Leddy JP. Flexor tendon acute injuries. In: Green DP, Hotchkiss RN, eds. Operative Hand Surgery. 3rd ed. New York, NY: Churchill Livingstone;1993:1823-45.

35. Schoffl VR, Schoffl I. Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg [Am]. Apr 2006;31(4):647-54. [Medline].

Further Reading

Clinical guidelines and studies:

ACR Appropriateness Criteria® acute hand and wrist trauma. American College of Radiology - Medical Specialty Society.  1998 (revised 2005).  8 pages.  NGC:004607

Collagenase in the Treatment of Zone II Flexor Tendon Adhesions in the Hand

The Role of Splinting in Fingertip Injuries

Keywords

flexor tendon, flexor tendon anatomy, flexor tendon system, flexor pulley system, flexor sheath, retinacular sheath, trigger finger, stenosing tenosynovitis

Contributor Information and Disclosures

Author

Steven J Bates, MD, Staff Physician, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
Steven J Bates, MD is a member of the following medical societies: Alpha Omega Alpha
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Coauthor(s)

Cato T Laurencin, MD, PhD, Van Dusen Chair Professor of Academic Medicine, Distinguished Professor of Orthopaedic Surgery, and Chemical, Materials, and Biomolecular Engineering, University of Connecticut
Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
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James Chang, MD, Assistant Professor of Plastic Surgery and Orthopedic Surgery, Program Director, Department of Plastic Surgery, Stanford University Medical Center
James Chang, MD is a member of the following medical societies: American Society of Plastic Surgeons
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Medical Editor

Peter M Murray, MD, Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital
Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons
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Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
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Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
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