Table of ContentsView AllTable of ContentsWhat Is a Finger Pulley?Signs of an InjuryDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What Is a Finger Pulley?
Signs of an Injury
Diagnosis
Treatment
Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers.This makes sense given the stress this activity places on the digits when maneuvering along uneven surfaces while supporting the weight of the entire body. Pulley injuries result from the mechanics of the finger tendons and joints and the particular position the fingers are held in while rock climbing.
These unique digital injuries, distinct fromsprains of the finger or dislocations, are becoming increasingly common as rock climbing grows in popularity.
Hermann Erber / LOOK-foto / Getty Images
The only other sport this injury has been described in is baseball, in elite pitchers. The forces acting on the finger are very different in these two activities, but they both place high stress on the finger pulleys.
This article explains what finger pulleys are, where they are located in the hand, the symptoms of an injury, and treatment options.
Everyone has structures in their fingers called digital pulleys (doctors often use the words “digit” and “finger” interchangeably). These digital pulleys hold thetendons(structures that connect muscles to bones) against the bones of the fingers. Each finger has eight pulleys, but only two are generally felt to be of critical importance to prevent the problem of bowstringing of the finger tendons.
Bowstringing occurs when one pulley gives out or ruptures. This can result in a variety of injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur.
In the most severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.
Signs of a Finger Pulley Injury
The most common signs of finger pulley injuries include:
Most commonly, either the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and the A4 pulleys.You may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4).
In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.
Degloving Injuries From Accidents
Special imaging tests may be performed to both help with the diagnosis and to plan for treatment. An ultrasound is recommended as the initial imaging technique.Magnetic resonance imaging (MRI)may be advised if an ultrasound is inconclusive. Sometimes an MRI will be performed with the finger held straight, and then bent, to see if there is bowstringing of the tendons.
An X-ray can also be helpful to exclude other causes of finger pain includingsprains and fractures of the finger.
If there is no bowstringing of the tendons due to a pulley injury, treatment is usually to protect the injured finger until any swelling and pain have subsided. If there is bowstringing of the tendons, then more careful management of the injury is needed.
If you suspect a pulley injury, rest or splint the finger and usenonsteroidal anti-inflammatory drugs (NSAIDs)as necessary for pain until you can get a medical evaluation.
For most pulley injuries, physical therapy is recommended alongside immobilization, the H-tape method, and the use of a protective pulley splint.Specialized splints and therapy techniques can allow the pulleys to heal properly. Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.
As far as returning to activity, this varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. For full ruptures that are being treated non-surgically, the duration of treatment is typically between one and three months.
For people requiring surgical reconstruction of a pulley injury, there may be restrictions up to a year from the time of surgery.
How to Buddy Tape a Finger
Summary
Finger pulleys are structures that hold tendons against the bones of the fingers. Pulley injuries are most often seen in rock climbers and occasionally in baseball pitchers. Injury symptoms include pain, swelling, and a “popping” sound heard at the time of the injury.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miro PH, vanSonnenberg E, Sabb DM, Schöffl V.Finger Flexor Pulley Injuries in Rock Climbers.Wilderness Environ Med. 2021;32(2):247-258. doi:10.1016/j.wem.2021.01.011Carruthers KH, Skie M, Jain M.Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience.Sports Health. 2016;8(5):469-478. doi:10.1177/1941738116658643
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miro PH, vanSonnenberg E, Sabb DM, Schöffl V.Finger Flexor Pulley Injuries in Rock Climbers.Wilderness Environ Med. 2021;32(2):247-258. doi:10.1016/j.wem.2021.01.011Carruthers KH, Skie M, Jain M.Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience.Sports Health. 2016;8(5):469-478. doi:10.1177/1941738116658643
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Miro PH, vanSonnenberg E, Sabb DM, Schöffl V.Finger Flexor Pulley Injuries in Rock Climbers.Wilderness Environ Med. 2021;32(2):247-258. doi:10.1016/j.wem.2021.01.011Carruthers KH, Skie M, Jain M.Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience.Sports Health. 2016;8(5):469-478. doi:10.1177/1941738116658643
Miro PH, vanSonnenberg E, Sabb DM, Schöffl V.Finger Flexor Pulley Injuries in Rock Climbers.Wilderness Environ Med. 2021;32(2):247-258. doi:10.1016/j.wem.2021.01.011
Carruthers KH, Skie M, Jain M.Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience.Sports Health. 2016;8(5):469-478. doi:10.1177/1941738116658643
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