Postnatal growth and development of the flexor tendon pulley system.

Abstract

The number, type, position, and size of the pulleys of the flexor tendon sheath of preserved cadaver hands from children ranging in age from newborn to 15 years were studied by dissection, observation, direct measurement, and radiographic evaluation. These studies delineated flexor tendon pulley development and their locations in the developing hand. Pulley positions are relatively constant throughout postnatal development, with the gross anatomic characteristics correlating closely to those of the adult hand. Mild abnormalities in the location of pulleys were identified in three hands classified as growth-retarded on the basis of an inconsistency between skeletal and chronologic ages. The flexor tendon system of the skeletally immature hand progressively develops in concert with adjacent chondro-osseous and soft tissue elements.