Korean J Sports Med.  2022 Dec;40(4):270-273. 10.5763/kjsm.2022.40.4.270.

Multiple Flexor Tendon Pulleys Injury in Korean Rock Climber

• Park JH
• Hong SW

• KMID: 2536679
• DOI: http://doi.org/10.5763/kjsm.2022.40.4.270

Abstract

Owing to unique biomechanical loading on hand during rock climbing, finger flexor tendon pulleys injury commonly occurred in rock climbers. Although several previous reports showed clinical manifestations and treatment outcomes of flexor tendon pulleys injuries, it has not yet been reported in South Korea. The authors experienced a 29-year-old female patient who sustained digital flexor tendon pulleys injuries while rock climbing. Therefore, we reported this case with a literature review.

Keyword

Rock climbing; Pulley injury; Pulley reconstruction

Figure

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  Fig. 1 Preoperative clinical photographs of the patient’s left ring finger. A 70° of flexion contracture and bowstring phenomenon was observed.

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  Fig. 2 Preoperative anteroposterior (A) and lateral (B) radiographs of the left ring finger of the patient. Definite bony abnormality was not observed.

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  Fig. 3 Preoperative magnetic resonance images of the left ring finger. (A) T1-weighted sagittal, (B) T1-weighted axial, and (C) T2-weighted axial images showed bowstring of flexor tendons but no evidence of tendon injury.

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  Fig. 4 (A) Intraoperative clinical photograph showed full range of motion achievement after adhesiolysis. (B) Intraoperative clinical photograph showing post-pulley reconstructed status. The white arrow indicates the reconstructed A2 pulley and the black arrow indicates the reconstructed A4 pulley. (C) Illustration showing tendon weave technique for reconstruction of A2 pulley using palmaris longus tendon graft.

Reference

1. Zafonte B, Rendulic D, Szabo RM. 2014; Flexor pulley system: anatomy, injury, and management. J Hand Surg Am. 39:2525–32. quiz 2533DOI: 10.1016/j.jhsa.2014.06.005. PMID: 25459958.

2. Marco RA, Sharkey NA, Smith TS, Zissimos AG. 1998; Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. J Bone Joint Surg Am. 80:1012–9. DOI: 10.2106/00004623-199807000-00010. PMID: 9698006.

3. Bollen SR. 1990; Injury to the A2 pulley in rock climbers. J Hand Surg Br. 15:268–70. DOI: 10.1016/0266-7681_90_90135-Q. PMID: 2366027.

4. Tropet Y, Menez D, Balmat P, Pem R, Vichard P. 1990; Closed traumatic rupture of the ring finger flexor tendon pulley. J Hand Surg Am. 15:745–7. DOI: 10.1016/0363-5023(90)90148-K. PMID: 2229971.

5. King EA, Lien JR. 2017; Flexor tendon pulley injuries in rock climbers. Hand Clin. 33:141–8. DOI: 10.1016/j.hcl.2016.08.006. PMID: 27886830.

6. Schneeberger M, Schweizer A. 2016; Pulley ruptures in rock climbers: outcome of conservative treatment with the pulley-protection splint-a series of 47 cases. Wilderness Environ Med. 27:211–8. DOI: 10.1016/j.wem.2015.12.017. PMID: 27067301.

7. Miro PH, vanSonnenberg E, Sabb DM, Schöffl V. 2021; Finger flexor pulley injuries in rock climbers. Wilderness Environ Med. 32:247–58. DOI: 10.1016/j.wem.2021.01.011. PMID: 33966972.

8. Doyle JR. 2001; Palmar and digital flexor tendon pulleys. Clin Orthop Relat Res. (383):84–96. DOI: 10.1097/00003086-200102000-00011. PMID: 11210973.

9. Bowers WH, Kuzma GR, Bynum DK. 1994; Closed traumatic rupture of finger flexor pulleys. J Hand Surg Am. 19:782–7. DOI: 10.1016/0363-5023(94)90183-X. PMID: 7806800.

10. Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. 2003; Pulley injuries in rock climbers. Wilderness Environ Med. 14:94–100. DOI: 10.1580/1080-6032(2003)014[0094:PIIRC]2.0.CO;2.