Pulley injuries in rock climbers

Wilderness Environ Med. Summer 2003;14(2):94-100. doi: 10.1580/1080-6032(2003)014[0094:piirc]2.0.co;2.


Objective: The closed traumatic rupture of finger flexor tendon pulleys in rock climbers appeared as a new complex finger trauma in the mid 1980s. The objectives of this study are to characterize this injury and to describe diagnostic and therapeutic guidelines. A grading system for the severity of pulley injuries was developed and used to set therapeutic pathways.

Methods: Six hundred four injured rock climbers were prospectively evaluated from January 1998 to December 2001 with a questionnaire and standard examination protocol. Diagnostic ultrasound was performed in all rock climbers with finger injuries; if necessary, an additional magnetic resonance imaging was done. All pulley injuries were graded according to an introduced pulley-injury score (grade 1-4).

Results: Three of four of the most frequent injuries were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%. One hundred twenty-two (20.2%) rock climbers presented an injury of the flexor tendon pulley system, 48 had pulley strains, and 74 had ruptures (a single rupture in 90.5% and multiple pulley ruptures in 9.5%). According to the pulley-injury score, 39% were grade 1, 25% were grade 2, 30% were grade 3, and 6% were grade 4 injuries.

Conclusion: Pulley injuries were the most frequent injuries in rock climbers. Whereas grade 1-3 injuries respond well to conservative treatment, grade 4 injuries require surgical repair. We recommend the "loop and a half" technique of Widstrom and colleagues and, alternatively, the Weilby repair. We also recommend postoperative initial immobilization and early functional treatment under external pulley protection.

MeSH terms

  • Adolescent
  • Adult
  • Cumulative Trauma Disorders / diagnosis
  • Cumulative Trauma Disorders / diagnostic imaging
  • Cumulative Trauma Disorders / epidemiology*
  • Cumulative Trauma Disorders / etiology
  • Cumulative Trauma Disorders / pathology
  • Cumulative Trauma Disorders / therapy
  • Europe / epidemiology
  • Female
  • Finger Injuries / diagnosis
  • Finger Injuries / diagnostic imaging
  • Finger Injuries / epidemiology*
  • Finger Injuries / etiology
  • Finger Injuries / pathology
  • Finger Injuries / therapy
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Mountaineering / injuries*
  • Prospective Studies
  • Rupture
  • Surveys and Questionnaires
  • Tendon Injuries / diagnosis
  • Tendon Injuries / diagnostic imaging
  • Tendon Injuries / epidemiology*
  • Tendon Injuries / etiology
  • Tendon Injuries / pathology
  • Tendon Injuries / therapy
  • Ultrasonography
  • United States / epidemiology