Ultrasound features of a pulley strain in a sport climber: a discussion based on a case report

Ruptures of the annular pulleys of the finger flexor tendons are not common in the general population. In sport climbing, these structures can be abnormally stressed, mainly because of the so-called crimped position, an extreme flexion of the proximal interphalangeal joint, levering an abnormal tension by flexor tendons. Complete pulley tears manifest with explicit pain and an inability, but strains or minor tears might only be perceived by individuals like professional climbers, since they can bring total disability to crucial grip positions. Complete tears of one or more pulleys have already been characterized by ultrasound and magnetic resonance, but no imaging features were described for strains or smaller partial tears. We describe the case of a climber with symptoms of an A2-pulley injury, in whom ultrasound imaging revealed reversible features of fusiform thickening and hypoechogenicity, which resemble the strains that we find in similar structures like tendons and other ligaments.