Objective: Closed traumatic ruptures of finger flexor tendon pulleys are frequent in rock climbing. The objectives of this study were to characterise this injury and to formulate diagnostic and therapeutic guidelines. An algorithm and a grading system are analysed for validation.
Methods: 122 pulley injuries were prospectively evaluated. After standard radiographs, a dynamic ultrasound examination was performed in all climbers. In ten cases an additional MRI was necessary. All patients were classified according to the pulley injury score. Grade I-III injuries received conservative and grade IV injuries received operative therapy. 88 patients were re-evaluated, including all grade IV patients.
Results: 48 climbers had pulley strains, and 74 had ruptures (a single rupture in 90.5 % of the cases and multiple ruptures in 9.5 %). According to the pulley-injury-score, 39 % were grade I, 25 % were grade II, 30 % were grade III and 6 % were grade IV injuries. 115 patients underwent conservative therapy, of which 81 were re-evaluated. 8/81 complained three months after the injury about consistent pain, mostly caused by tendinitis. All grade IV injuries underwent surgical reconstruction, in two cases through Weilby's repair, in three cases through the "loop and a half" technique and in two further cases with a combination of the two. According to the Buck-Gramcko Score we had four excellent, two good and one fair result. The functional result was excellent in one, good in five and fair in one case.
Conclusions: The use of the diagnostic-therapeutic algorithm as well as the grading system proved to be highly suitable. The good results achieved with the conservative treatment in grade I - III injuries justify this approach.