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These are images on a 35 year old rock climbing individual

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who sustain an injury while performing his favorite sport, not mine.

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And you can see on axi images T two weighted non-fat

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Saturn, uh,

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the flexor tendon and the flexor pully system at the level of the

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proximal filling. So we are talking about the A two pulley here,

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which is starts in the proximal chaff of the proximal fillings

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and extends to the junction of the proximal two thirds and dista third of

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the fillings. In this patient, we have a partial injury,

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so there is only involvement of the ulnar sided aspect of a two.

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Uh, the radial component is completely normal and we see

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fluid signal intensity that is extending through the region of the focal here

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and forming a smooth synovial cyst in that location or synovial

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pseudo cyst due to the disruption of the A to pulley narly.

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Now a key element on sagittal images is the presence

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of voice stringing of the flexor tendon.

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So we have the proximal feelings, the p i p joint, uh,

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this patient wasm image inflection, he was having quite severe pain.

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Uh, there's some motion artifact too,

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but the image help us see a key element in the

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diagnosis of a to pully injuries,

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which is both stringing of the flexor tendon. Uh,

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flexor digit profundus is move away from the bone.

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And then we see fluid like signal intensity,

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interpose between the phalanx and the, uh, flexor tendon,

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making the diagnosis of a two really injury.