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Publication
Palmar Ridges of the Fingers: Radiographic and CT Findings, Correlation with Age, and Histologic Investigation
Journal Contribution - Journal Article
Purpose: Bony spurs can be seen at the palmar aspect of the proximal and middle phalanges of the fingers. Our purpose was to address the following questions (1) is there a difference of the prominence of the ridges between the different fingers, (2) is there a correlation with age ?, (3) and, which structures precisely insert onto the ridges and what is the histological appearance of the insertion site ?
Materials and methods: In this IRB approved study, 2 observers retrospectively evaluated 113 radiographs (82 men, 31 women, mean age 39 years), 33 CT scans (22 men, 11 women, mean age 46 years), and 10 dry bone specimens of the hand. The ridges were graded using a 4-point scale. A cadaveric hand was dissected to study the soft tissue structures inserting onto the ridges. Two hands were sectioned and the ridges were examined histologically. A chi-square test was used to compare the different fingers (p<0.05). Linear regression analysis was used to study the prominence of the ridges in relation to age (p<0.05).
Results: There was a statistically significant difference for the ridges at the proximal phalanx of the third and fourth fingers compared to the other fingers on radiography. For all fingers and for both proximal and middle phalanx there was a statistically significant correlation between the prominence of the ridges and age. Anatomic-histologic investigation showed that the A2 pulley inserted on the ridges of the proximal phalanx, and the flexor superficialis and A4 pulley on the middle phalanx.
Conclusion: The bony ridges are enthesophytes. At the proximal phalanx they correspond to the insertion site of the A2 pulley, and at the middle phalanx to the insertion site of the flexor superficialis tendon and A4 pulley. The ridges become more prominent with age, and they are more prominent at the level of the 3th and 4th finger. Further studies could address whether the ridges show imaging abnormalities in diseases affecting the enthesis.
Materials and methods: In this IRB approved study, 2 observers retrospectively evaluated 113 radiographs (82 men, 31 women, mean age 39 years), 33 CT scans (22 men, 11 women, mean age 46 years), and 10 dry bone specimens of the hand. The ridges were graded using a 4-point scale. A cadaveric hand was dissected to study the soft tissue structures inserting onto the ridges. Two hands were sectioned and the ridges were examined histologically. A chi-square test was used to compare the different fingers (p<0.05). Linear regression analysis was used to study the prominence of the ridges in relation to age (p<0.05).
Results: There was a statistically significant difference for the ridges at the proximal phalanx of the third and fourth fingers compared to the other fingers on radiography. For all fingers and for both proximal and middle phalanx there was a statistically significant correlation between the prominence of the ridges and age. Anatomic-histologic investigation showed that the A2 pulley inserted on the ridges of the proximal phalanx, and the flexor superficialis and A4 pulley on the middle phalanx.
Conclusion: The bony ridges are enthesophytes. At the proximal phalanx they correspond to the insertion site of the A2 pulley, and at the middle phalanx to the insertion site of the flexor superficialis tendon and A4 pulley. The ridges become more prominent with age, and they are more prominent at the level of the 3th and 4th finger. Further studies could address whether the ridges show imaging abnormalities in diseases affecting the enthesis.
Journal: Surgical & Radiologic Anatomy [=SRA]
ISSN: 0930-1038
Issue: 6
Volume: 36
Pages: 587-593
Publication year:2014
Keywords:Hand-Radiography, CT, Hand- Enthesophytes, Finger Pulley, Flexor Superficialis Tendon