The Flexor Tendon Pulley System and Rock Climbing

 

PDF Download Buy Article Permissions and Reprints

Abstract

Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed.

• References

• 1 Schöffl V, Hochholzer T. Pulley injuries in rock climbers. Wild Environ Med 2003; 14 ((2)) 94-100
  CrossrefPubMedGoogle Scholar
• 2 Schöffl V et al Strength measurements and clinical outcome after pulley ruptures in climbers. Med Sci Sports Exerc 2006; 38 ((4)) 637-643
  CrossrefPubMedGoogle Scholar
• 3 Doyle JR. Palmar and digital flexor tendon pulleys. Clin Orthop Relat Res 2001; 383: 84-96
  CrossrefPubMedGoogle Scholar
• 4 Moutet F. Flexor tendon pulley system: anatomy, pathology, treatment. Chir Main 2003; 22: 1-12
  CrossrefPubMedGoogle Scholar
• 5 Lin G, Cooney P, An K. Mechanical properties of human pulleys. J Hand Surg 1990; 15(B): 429-434
  CrossrefPubMedGoogle Scholar
• 6 Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech 2001; 34: 217-223
  CrossrefPubMedGoogle Scholar
• 7 Bollen SR. Upper limb injuries in elite rock climbers. J R Coll Surg Edinb 1990; 35: 18-20
  PubMedGoogle Scholar
• 8 Bollen SR. Injury to the A2 pulley in rock climbers. J Hand Surg 1990; 15(B): 268-270
  CrossrefPubMedGoogle Scholar
• 9 Bollen SR. Soft tissue injuries in extreme rock climbers. Br J Sports Med 1988; 22: 145-147
  CrossrefPubMedGoogle Scholar
• 10 Bollen SR, Gunson CK. Hand injuries in competition climbers. Br J Sports Med 1990; 24: 16-18
  CrossrefPubMedGoogle Scholar
• 11 Tropet Y et al Closed traumatic rupture of the ring finger flexor tendon pulley. J Hand Surg 1990; 15(A): 745-747
  CrossrefPubMedGoogle Scholar
• 12 Schöffl I et al The influence of concentric and eccentric loading on the finger pulley system. J Biomech 2009; 42 ((13)) 2124-2128
  CrossrefPubMedGoogle Scholar
• 13 Moor BK, Nagy L, Snedeker JG, Schweizer A. Friction between finger flexor tendons and the pulley system in the crimp grip position. Clin Biomech 2009; 24 ((1)) 20-25
  CrossrefPubMedGoogle Scholar
• 14 Schöffl I et al The influence of the crimp and slope grip position on the finger pulley system. J Biomech 2000; 42 ((13)) 2183-2187
  PubMedGoogle Scholar
• 15 Schweizer A, Hudek R. Kinetics of crimp and slope grip in rock climbing. J Appl Biomech 2011; 27 ((2)) 116-121
  PubMedGoogle Scholar
• 16 Bannister P, Foster P. Upper limb injuries associated with rock climbing. Br J Sports Med 1986; 20: 20-55
  PubMedGoogle Scholar
• 17 Shea KG, Shea OF, Meals RA. Manual demands and consequences of rock climbing. J Hand Surg 1992; 17(A): 200-205
  CrossrefPubMedGoogle Scholar
• 18 Holtzhausen LM, Noakes TD. Elbow, forearm, wrist and hand injuries among sport rock climbers. Clin J Sports Med 1996; 6: 196-203
  CrossrefPubMedGoogle Scholar
• 19 Schöffl V, Schöffl I. Isolated cruciate pulley injuires in rock climbers. J Hand Surg Eur Vol 2010; 35 ((3)) 245-246
  PubMedGoogle Scholar
• 20 Schöffl V, Jűngart J. Closed flexor pulley injuries in nonclimbing activities. J Hand Surg 2006; 31 ((5)) 806-810
  CrossrefPubMedGoogle Scholar
• 21 Lourie GM et al Annular flexor pulley injuries in professional basball pitchers: a case series. Am J Sports Med 2011; 39 ((2)) 421-424
  CrossrefPubMedGoogle Scholar
• 22 Gabl M. et al Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med 1998; 26: 651-655
  CrossrefPubMedGoogle Scholar
• 23 Bodner G et al Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI. Ultraschall Med 1999; 20: 131-136
  Article in Thieme ConnectPubMedGoogle Scholar
• 24 Gabl M. et al Rupture or stress injury of the flexor tendon pulleys? Early diagnosis with MRI. Handchir Mikrochir Plast Chir 1996; 28: 317-321
  PubMedGoogle Scholar
• 25 Kaluser A. et al Diagnosis of climbing related overuse injuries. Radiologe 2002; 42: 788-798
  CrossrefPubMedGoogle Scholar
• 26 Klauser A. et al Value of high resolution ultrasound in the evaluation of finger injuries in extreme sport climbers. Ultraschall Med 2000; 21: 73-78
  Article in Thieme ConnectPubMedGoogle Scholar
• 27 McGeorge DD, McGeorge S. Diagnostic medical ultrasound in the management of hand injuries. J Hand Surg 1990; 15(B): 256-261
  CrossrefPubMedGoogle Scholar
• 28 Logan A.J et al Acute hand and wrist injuries in experienced rock climbers. Br J Sports Med 2004; 38: 545-548
  CrossrefPubMedGoogle Scholar
• 29 Schweizer A. Biomechanical effectiveness of taping the A2 pulley in rock climbers. J Hand Surg 2000; 25(B): 102-107
  CrossrefPubMedGoogle Scholar
• 30 Straub G. Musculoskeletal problems in rock climbing—a review. Wein Med Wochenschr 2000; 150: 186-190
  PubMedGoogle Scholar
• 31 Warme WJ, Brooks D. The effect of circumfrential taping on flexor tendon pulley failure in rock climbers. Am J Sports Med 2000; 28 ((5)) 674-678
  CrossrefPubMedGoogle Scholar
• 32 Schöffl I et al The impact of taping after finger flexor tendon pulley ruptures in rock climbing. J Appl Biomech 2007; 23 ((1)) 52-62
  CrossrefPubMedGoogle Scholar
• 33 Gabl M, Reinhart M, Lutz M. The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger. J Hand Surg 2000; 25(B): 98-101
  CrossrefPubMedGoogle Scholar
• 34 Lin G.T. et al Functional anatomy of the human digital flexor pulley system. J Hand Surg 1989; 14(A): 949-956
  CrossrefPubMedGoogle Scholar
• 35 Lin G.T. et al Biomechanical analysis of finger flexor pulley reconstruction. J Hand Surg 1989; 14(B): 278-282
  CrossrefPubMedGoogle Scholar
• 36 Widstom C.J. et al A mechanical study of six digital pulley reconstruction techniques: part I. Mechanical effectiveness. J Hand Surg 1989; 14(A): 821-825
  CrossrefPubMedGoogle Scholar
• 37 Widstrom C.J. et al. A mechanical study of six digital pulley reconstruction techniques: part II. Strength of individual reconstructions. J Hand Surg 1989; 14(A): 826-829
  CrossrefPubMedGoogle Scholar
• 38 Schöffl V, Schöffl I. Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg 2006; 31 (A): 647-654
  CrossrefPubMedGoogle Scholar
• 39 Voulliaume D. et al Surgical repair in flexor tendon pulley rupture in high level rock climbing. Chir Main 2004; 23: 243-248
  CrossrefPubMedGoogle Scholar
• 40 Arora R. et al Reconstructon of the digital flexor pulley system: a retrospective comparison of two methods of treatment. J Hand Surg Eur Vol 2007; 32 ((1)) 60-66
  CrossrefPubMedGoogle Scholar