0:00

So we're in the, we're in the realm of, of the pulley.

0:03

Let's start out with, um, this time the axial projection.

0:08

I, I usually use the SAG

0:10

or the Corona is my most favored nation projection.

0:15

And I'm gonna put up just so we can figure out where we are,

0:17

one long axis image

0:21

and the, the finger is slightly flexed,

0:24

so we're not seeing an inordinate amount of bow stringing.

0:27

And again, for those of you that are, that are new

0:30

to finger imaging, it's very easy to remember the pulley.

0:33

'cause you, you just remember the joints one, three,

0:36

and five, and then two and four are gonna be in between.

0:41

Uh, two is the, is the one

0:42

that most commonly tears in the proximal phalanx.

0:45

So it's not as daunting as it would appear to be.

0:49

And then as we scroll through this one, uh,

0:53

as we sit at the, um, proximal phalanx,

0:58

we've got disruption of the pulley mechanism.

1:01

Let me see, I think I may have a better one here.

1:03

A better picture of it.

1:09

You don't have actually the basket attachments on either

1:12

side that you would normally have at, at a three.

1:16

And, uh, let me take you to another one.

1:18

I, I put a few of them in a row.

1:22

Here we go. Now here's a more typical one

1:26

and just to see where you are again,

1:29

you've got one, three, and five.

1:31

So here you're at, you're at the proximal aspect

1:36

of the proximal phalanx headed towards the mid phalanx.

1:40

And here you've got that floating, um, floating flexor sign.

1:45

Uh, you don't have attachments,

1:47

at least strong attachments on either side.

1:49

They're sagging down.

1:50

So there's a fair amount of,

1:52

of bowing even without the finger inflection.

1:55

And you can see the flexor digitorum superficialis wrapping

1:59

around the profundus allowing it to come through.

2:03

And this decussation right here is known as

2:06

as campers chiasma

2:08

as you get a little bit more, more distally.

2:11

And, um, uh, this patient has an a two pulley mechanism,

2:16

tear or rupture, the most common of, of the three.

2:19

So I showed you one A three and one a two.

2:24

Christine, any comments on this

2:25

before we move on to the next one?

2:28

Nope. Nice examples.

2:29

I mean, and Steven, both of these you showed, um,

2:32

full thickness ruptures through the pulley.

2:33

Just to note that on a few of these a two pulley,

2:35

sometimes they'll be part of the distal extent

2:38

that might still be intact.

2:39

So that's such a long one.

2:41

It takes up about a third of that proximal baling

2:44

so you can get partial tears there as well,

2:47

just to be aware of those.

2:49

Great point. And also you can get tear of a tear

2:52

of one side or the other.

2:53

They don't both have to tear.

2:55

Yeah. And for those, I'll say the radial limb.

2:57

The ulnar limb, you know.

3:01

Great. Let's move on to the next one.