The Double Sheath System and Tendon Gliding in Zone 2C

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Abstract
Anatomical structures, the morphology of gliding tunnel, the gliding amplitude of tendons and the range of finger motion after sheath incision in zone 2C were studied in 40 fingers of ten preserved cadaver hands. The tendon of FDS in zone 2C courses around that of FDP, and FDS serves functionally as a second sheath for FDP. This “double sheath” system in zone 2C accounts for the poor results of tendon repair in zone 2C. The tendon repairs in zone 2C glide into zone 2D during finger flexion. Therefore, the condition of the gliding tunnel of zone 2D is also important to the function of tendon repairs in zone 2C. The range of motion was shown to be insignificantly influenced by partial incision of the A2 pulley, and this did not decrease the total strength of the sheath markedly. These suggest that partial incision or enlargement of the A2 pulley can be carried out for tendon repairs in zone 2C without causing mechanical problems of function.

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