Finger Pulley Injuries

Rock Climbing Flexor Pulley Injury

What is a finger pulley?

Each of the fingers has multiple pulleys.  Pulleys act like a system of tunnels holding the tendons that flex the fingers in place.  Without a functional pulley system, the flexor tendon would bowstring away from its proper position.  Picture a fishing pole with one of the eyelets missing. The missing eyelet causes the fishing line to bowstring away from the pole.
 

Why does it occur?

Pulley injuries often occur after extreme force is placed on the flexor tendons of the fingers. Flexor tendon injuries are therefore commonly seen in baseball pitchers and rock climbers.

Symptoms

Patients most commonly experience pain on the palm side of the affected finger(s).  This pain may be accompanied by swelling and difficulty flexing the finger.  Patients may also notice decreased grip strength.

 

Diagnostic testing:

An x-ray may be performed to rule out a fracture or avulsion injury. An ultrasound and/or MRI can often be helpful to confirm the diagnosis.
 

Treatment Options:

The majority of pulley injuries can be treated nonoperatively.  Like many diagnoses, it is imperative that the treatment is initiated ASAP to maximize results.  Most patients will be placed into a pulley protection splint or pulley ring that supports the pulley while it heals, and will remain in this splint for approximately 6 weeks.  
 

Surgical Treatment:

Surgery to repair or reconstruct the pulley may be recommended should a patient continue to experience significant pain, instability or bowstring despite nonoperative treatment.

 

Learn more about scheduling surgery.

 

Recovery Expectations:

Patients will be placed into a custom pulley protection splint or pulley ring at their first postoperative visit.  Patients will usually remain in either the splint or pulley ring for 6 weeks, after which therapy is usually started.  Patients usually return to normal activities at 3 months post-op.
 

Immediate Post-Operative Instructions

Please refer to the following pages for more information:

*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.

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