Histopathology of the A1 pulley in adult trigger fingers

The histopathology of the central parts of 40 Al pulleys from adult patients with primary trigger fingers was studied using light and transmission electron microscopes and the findings were compared with those in a control series of 10 normal Al pulleys. The evaluation of the normal Al pulley revealed a bi-laminar structure. The deepest layer was composed of dense normal connective tissue. The outermost layer was formed by loose connective tissue. In trigger digits, it was possible to identify a tri-laminar structure. The deepest layer was composed of irregular connective tissue, formed by small collagen fibres and abundant extracellular matrix. A considerable amount of chondroid-metaplasia was present in this layer. The middle layer contained dense, normal connective tissue with some fibrocytes. The outermost layer was formed of loose connective tissue. In conclusion, there was an additional layer in the Al pulley in pathological cases which was not present in normal pulleys.