Flexor pulley system: Anatomy, injury, and management

Brian Zafonte, Dora Rendulic, Robert M Szabo

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the onceheld dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function.

Original languageEnglish (US)
Pages (from-to)2525-2532
Number of pages8
JournalJournal of Hand Surgery
Issue number12
StatePublished - 2014


  • Annular pulley
  • Flexor pulley
  • Pulley reconstruction
  • Pulley rupture
  • Rock climbing

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery


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