Department of Rheumatology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Campus, Barcelona, Spain.
Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain.
Rheumatology (Oxford). 2024 Nov 1;63(11):3050-3055. doi: 10.1093/rheumatology/kead614.
Digital annular pulleys (DAPs) are important anatomical structures for finger function. The anatomy, histology and imaging assessment of DAPs, particularly at the level of their entheses, are still not clearly defined. The advent of high-frequency US transducers opened new perspectives in evaluating submillimetre-scale structures, such as pulleys, paving the way for their global assessment. The study aimed to characterize DAPs from an anatomical, histological and US perspective, focusing on the detection and complete description of pulley entheses.
US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure, including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAPs in 20 healthy controls (HCs) were detected and measured by US. The A1, A2 and A4 DAP entheses were assessed using a new dynamic manoeuvre to better evaluate those structures.
A total of 1200 DAPs (400 cadaveric, 800 HCs) were analysed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAPs (r = 0.96). At the histological level, DAP entheses at the volar plate, sesamoid bones or phalangeal ridges contained fibrous and fibrocartilaginous tissue. US assessment of A1, A2 and A4 DAPs in HCs allowed the identification of 718/720 (99.73%) entheses.
US is an effective tool to detect and study DAPs. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described manoeuvre to optimize DAP enthesis visualization enhances their detection by US.
环形指浅屈肌腱滑车（DAP）是手指功能的重要解剖结构。DAP 的解剖、组织学和影像学评估，尤其是在其附着点水平，仍未得到明确界定。高频超声探头的出现为评估亚毫米级结构（如滑车）开辟了新的视角，为其全面评估铺平了道路。本研究旨在从解剖学、组织学和超声学角度描述 DAP，重点是检测和全面描述滑车附着点。
对 20 只尸体手进行超声评估和大体解剖，以研究 DAP 的厚度和结构，包括附着点的识别。对超声和解剖测量结果进行了相关性分析。通过组织学分析对超声识别的 DAP 附着点进行了特征描述。对 20 名健康对照者（HCs）进行了超声检测和测量。使用新的动态手法评估 A1、A2 和 A4 DAP 附着点，以更好地评估这些结构。
共分析了 1200 个 DAP（400 个尸体，800 个 HCs）。尸体研究表明 DAP 的解剖学和超声测量之间具有很强的相关性（r=0.96）。在组织学水平上，滑车在掌板、籽骨或指骨嵴处的附着点包含纤维和纤维软骨组织。HCs 中 A1、A2 和 A4 DAP 的超声评估可识别 718/720（99.73%）的附着点。
超声是检测和研究 DAP 的有效工具。DAP 附着点具有纤维和纤维软骨的特征。新描述的优化 DAP 附着点可视化的手法增强了超声检测的效果。
