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not under warranty

For those wanting pretty pictures of what I was talking about in my MRI post, here is a diagram of the inside of your average finger, borrowed from Radiology (obligatory warning for the squeamish – there are pictures of opened up cadaver fingers on that site):

a2pulley

That big ol’ A2 segment is what I apparently completely ruptured, to the point where it is just hanging out inside my finger. No word on the cruciform pulleys (C1), but I cannot imagine they are happy, and I assume no news about the A3 is good news.

Since this question has come up in comments, no, this will not heal on its own. In fact, the way the doctor presented it is that this is pretty much a permanent "thing" I am just going to have to live with; those pulleys are actually ligaments, which largely do not heal on their own due to the lack of appreciable blood flow in/around them. Sure, sprained/stretched ligaments will fix themselves over time, and partially torn ones might go back and knit up some of the damage, but when you go and split the thing end-to-end like I apparently did, you are functionally sierra-oscar-lima.

So why not just fix it? Because it involves stuff like this (squeamish warning), and I am not sure I want to go down that road yet.

And that is where the ring / tape / compression come in – taking the place of the missing pulley. Some studies indicate taping might not be as effective as people hope/think, but the general premise is to use an external band to take the place of the internal one, with some folks even offering dedicated rings (though I feel certain I can find something more interesting if I tried).

Unfortunately, the ring is only a valid option after my finger stops looking like this:

IMAG0016

That was at the end of a bad day, after the swelling had come down a touch. Really bad days meant you could not make out the wrinkles on the top of my first joint. It is really the swelling that is decreasing my range of motion and ratcheting up the pain at the moment, and, unfortunately, it is the swelling that keeps me from being able to do anything to support the blown ligament, since a hard band would either be too large or too small, depending on the level of the edema that day. We are working on the swelling with Coban (which is pretty nifty stuff… I can see all kinds of applications even outside of medical uses), ice, and specific exercises (with the pulley being constantly supported), so I guess time will tell.

After the MRI, the only real question remaining is, "How the hell did I manage to do that, and, better, how did I manage to forget?"

In other news, your body has pulleys, and a lot of them. Who knew?

2 comments to not under warranty

  • Justin

    Fascinating! I’ve never really thought about the anatomy of the fingers that much. The diagram in your post then the surgical picture are amazing. Thanks for taking the time and effort to explain this.

  • Kind of impressive how our bodies work, is it not? I had never thought about how our flexor tendons avoid bowstringing in our fingers, but the “pulleys” answer that question.

    Here is to finding useful graphics on the web :).