https://www.wemjournal.org/article/S1080-6032(03)70539-0/pdf

Pulley Injuries in Rock Climbers

Basic science and clinical investigation have advanced significantly the treatment and the outcome following intrasynovial flexor tendon repair and rehabilitation and reconstruction over the past 30 years. The application of modern multistrand suture repair techniques as well as postoperative rehabilitation protocols emphasizing the application of intrasynovial repair site excursion has led to a protocol for treatment of intrasynovial flexor tendon lacerations emphasizing a strong initial repair followed by the application of postoperative passive motion rehabilitation. Protocols for the reconstruction of failed initial treatment have likewise undergone modification given new findings on the biologic and clinical behavior of flexor tendon grafts. Currently accepted treatment protocols following flexor tendon repair and reconstruction are based on current clinical and scientific data.

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Flexor tendon repair and rehabilitation: state of the art in 2002.

Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. This article analyzes this type of injury and the current diagnostic and therapeutic criteria. Ultrasound and magnetic resonance imaging are used to differentiate between a pulley strain, partial rupture, complete rupture, or multiple ruptures. Grade I to III injuries (strains, partial rupture, single ruptures) are treated conservatively with initial immobilization and early functional therapy under pulley protection. Grade IV injuries (multiple ruptures) require surgical repair.

Injuries to the finger flexor pulley system in rock climbers: current concepts

Biomechanical model for the determination of the forces acting on the finger pulley system

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bowstringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6° (range, 0° to 10°) in group A and 4° (range, 0° to 10°) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four pati...

Disruption of the finger flexor pulley system in elite rock climbers.

A laboratory study on fresh-frozen human cadaver limbs compared six types of flexor tendon pulley reconstruction in the fingers. The reconstructions used were those described by (1) Bunnell, (2) Karev, (3) Weilby, and (4) Lister, and two types developed by us that have not been previously described. The pulleys were studied in specific configurations to determine their effectiveness in transforming tendon excursion into finger flexion. In each finger, comparison was made between the amount of tendon excursion required for full flexion with an intact pulley system versus the various types of reconstructed pulleys. The ratio of these two values was defined as the mechanical effectiveness of the pulley reconstruction. The Karev reconstruction was most effective at 108.2%, which was significantly different from the other five reconstructions ( p

Glenn Johnson

Papers

A mechanical study of six digital pulley reconstruction techniques: Part I. Mechanical effectiveness.