Rotator cuff tear 2010 found no solid evidence that rotator-cuff surgery benefited people more than nonoperative management. Those with pain but reasonably maintained function are suitable for nonoperative management. This includes oral medications that provide pain relief such as anti-inflammatory agents, topical pain relievers such as cold packs, and if warranted, subacromial corticosteroid/local anesthetic injection. An alternative to injection is iontophoresis, a battery-powered patch which "drives" the medication to the target tissue. A sling may be offered for short-term comfort, with the understanding that undesirable shoulder stiffness can develop with prolonged immobilization. Early physical therapy may afford pain relief with modalities (e.g. iontophoresis)
Annular ligaments of fingers Annular ligaments of fingers In human anatomy, the annular ligaments of the fingers, often referred to as A pulleys, are the annular part of the fibrous sheathes of the fingers. Four or five such annular pulleys, together with three cruciate pulleys, form a fibro-osseous tunnel on the palmar aspect of the hand through which passes the deep and superficial flexor tendons. The annular and cruciate ligaments serve to govern the flexor mechanism of the hand and wrist, providing critical constraints to the flexor tendons to prevent bowstringing upon contraction and excursion of extrinsic flexor musculo-tendinous units. The first annular pulley