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The Journal of Bone and Joint Surgery 78:1753-4 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

The Palmar Aponeurosis Pulley as a Cause of Trigger Finger. A Report of Two Cases*

PAMELA J. SHERMAN, M.D.{dagger}, NEW YORK CITY and LEWIS B. LANE, M.D.{ddagger}, MANHASSET, NEW YORK

Investigation performed at The Hospital for Special Surgery, New York City, and North Shore University Hospital, Manhasset


   Introduction
 
Five annular and three cruciate pulleys make up the retinacular structures of the digital flexor tendon sheath1. The transverse fibers of the palmar fascial aponeurosis, which are anchored on each side of the synovial sheath of the flexor tendons in the palm, have been identified as constituting an additional flexor tendon pulley2,3. To our knowledge, the palmar aponeurosis pulley has not been reported as a cause of trigger finger. We describe two patients in whom persistent triggering of the flexor tendons was found, after operative release of the first annular pulley, to be occurring at the palmar aponeurosis pulley.


   Case Reports
 
CASE 1. A twenty-five-year-old right-hand-dominant woman who had insulin-dependent diabetes mellitus was seen because of a ten-month history of painful triggering of the right thumb and of the right and left ring fingers. On physical examination, there was marked tenderness over the first annular pulley of both of these . . . [Full Text of this Article]


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