Pulley Ruptures Explained to Rock Climbers
Quick Primer on Climber's Finger
Climbers have a tendency to injure the A2 and A4 pulleys in their fingers, most commonly in the ring finger, but the injury can also occur in the middle, index or small fingers. It doesn’t happen in the thumb.
The pulleys hold the flexor tendons close to the bones, (MC: metacarpal; PP: proximal phalanx; MP: middle phalanx; DP: distal phalanx), like guides on a fishing pole hold the line close to the pole. The A2 pulley is the strongest and most important pulley, but sadly the most frequently injured; (A4 is the #2 most injured).
Injuries happen most commonly when using the crimp grip, like one would use on a small hold. The finger joint at the first knuckle, (proximal interphalangeal joint), is flexed more than 90 degrees. This puts lots of stress on the A2, A3 and A4 pulleys, and if a foot slips or a foot hold breaks, or the climber dynamically loads the finger, the pulleys get “shock loaded” and can rupture or tear. If this happens the flexor tendons pull away from the bone increasing the tendon-phalanx distance, (TPD), as indicated by the *’s below.
If the A2 pulley tears, further climbing or strenuous use of the hand will put extra strain on the A3 and A4 pulleys, (see arrows on left diagram), putting them at risk for rupture. A4 pulley tears will in turn put extra strain on the A3 and A2 pulleys, (see arrows on right diagram). Untreated, the torn pulley will heal in a stretched-out condition and will not work ideally.
Climbing after a pulley injury that is (or was) not optimally treated can be associated with finger soreness as the tendons are not in an ideal position and are more prone to inflammation and recurrent tendonitis. In the acute setting the SPOrt™ supports the pulley as it heals in close to a normal size. In chronically stretched-out pulleys, the SPOrt™ will not change the shape of the healed pulley, but its support decreases finger soreness and keeps climbers climbing.
"The SPOrt has found its way into my daily first aid kit. Hats off Dr. Warme for a great tool in the recovery arsenal.
- Adam Hoke