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Disruption of the Finger Flexor Pulley System in Elite Rock Climbers

Markus Gabl, MD^*,, Christoph Rangger, MD^*, Martin Lutz, MD^*, Christian Fink, MD^*, Ansgar Rudisch, MD and Sigurd Pechlaner, MD^*

^* University Hospital of Traumatology, Innsbruck, Austria
University Hospital of Radiology, Innsbruck, Austria

Address correspondence and reprint requests to Markus Gabl, MD, Universitäts Klinik für Unfallchirurgie, Anichstrasse 35, A-6020 Innsbruck, Austria

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 patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

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