Artikel
Diagnosis of the A3 pulley injury using ultrasound
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Autoren
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Volker Schöffl
- Sportorthopädie, Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Johannes Deeg
- Department of Radiology, University Innsbruck, Innsbruck, Austria
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Christoph Lutter
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Thomas Bayer
- Institute of Radiology, FAU Erlangen-Nuremberg, Erlangen, Germany
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Isabelle Schöffl
- Department of Pediatrics, Klinikum Bamberg, Bamberg, Germany
| Veröffentlicht: | 6. November 2018 |
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Gliederung
Text
Objectives: The pulley rupture is the most common injury in sport climbing. Ruptures of the A2 and A4 pulleys have been studied extensively, and ultrasound has proven to be a highly sensitive and specific tool for their diagnosis. As the correct diagnosis of A3 pulley rupture remains a challenge we investigated a novel approach to this pathology.
Methods: Eighteen fingers from nine different cadavers were examined using high resolution, dynamic ultrasound before and after inflicting different combinations of singular and multiple pulley ruptures in a standardized fashion. Special attention was paid to the behaviour of the volar plate (VP) with respect to the proximal interphalangeal joint (PIP) and the flexor tendons before and after pulley rupture.
Results: Injuries to the A2 and A4 pulleys were diagnosed via ultrasound with sensitivities of 90% and 94%, and specificities of 100% and 97% respectively. A direct visualization of the A3 pulley was achieved in 61% of the fingers. The VP became significantly thicker and shorter with a flexing of the finger as well as after A3 pulley rupture. The distance between tendon and VP became significantly more pronounced after A3 pulley rupture. For distances, greater than 0.9 mm between VP and tendon, a sensitivity of 76% and a specificity of 94% were achieved for determining A3 pulley ruptures.
Conclusion: The distance measurement between VP and tendon was found to be a valid indirect method for A3 pulley rupture diagnosis. This approach represents the first ultrasound method for accurately diagnosing A3 pulley ruptures.
