The pulley system, present on the flexor surface of each finger, has been described as consisting of five annular, four cruciate and one palmar aponeurosis pulley. The function of the pulley system is to prevent bowstringing of the tendons on finger flexion. Many studies have looked at which combination of pulleys are required for mechanically efficient finger flexion and their results have guided hand surgeons in pulley preservation and reconstruction. In this article we review the anatomy of the flexor pulley system and its clinical relevance.
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