Strength measurement and clinical outcome after pulley ruptures in climbers

Ruptures of the finger flexor pulleys are the most frequent injuries in rock climbers. Whereas multiple pulley injuries demand a surgical reconstruction, single ruptures are mainly treated conservatively. Nevertheless, the question of the clinical outcome or a persisting finger strength deficit after conservative therapy arises.

Twenty-one rock climbers (age 34 +/- 9 yr) with a grade 2-4 pulley injury were reevaluated 3.46 (range: 0.25-18) yr after injury. The clinical evaluation followed a standard questionnaire in combination with an ultrasound examination in extension and forced flexion. In order to determine the finger strengths, the subjects hung with the respective finger in various postures on a ledge attached above a door frame, while standing on a force platform, which measured the relative release.

The 21 subjects had old (3.46 yr, range: 0.25-18) pulley injuries in 27 fingers (10 A2, 1 A3, 11 A4, 3 A2/3, 2 A3/4). The clinical outcome was excellent (Buck-Gramcko score of 3) in all cases; the subjects regained their climbing level within a year. There was no difference between the initial ultrasound examination and the follow-up during the study. For 17 finger pairs, data for the relative strength of the injured and the respective healthy finger could be gathered. The finger strength was not significantly different for the injured and the healthy finger in either the hanging or the crimping finger position.

Nonsurgical treatment of single pulley ruptures is recommended. The clinical outcome was good to excellent, and no long-term strength deficit for the injured finger could be observed.