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Pulley rupture

poulisam-s The pulley, that is the pulley of the finger flexor tendons, is a fibrous structure the role of which it is to maintain the tendon at its place along the bone..... 

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Francis HELIAS
Jocelyn-William LOUBRIAT

Definition

The pulley, that is the pulley of the finger flexor tendons, is a fibrous structure the role of which it is to maintain the tendon at its place along the bone.
We call it a partial or complete pulley rupture when one or more of these structures give way to excessive stress.

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Fig 1: Anatomy of the pulley digits
Fig 2: Damaged pulley

The rupture can occur brutally, with a sharp crack audible several meters away, but it can also rupture more progressively. It is often – but not always – accompanied by pain and an oedema.

The diagnosis can be made by an experienced medical practitioner or, in case of doubt, by use of CT scan or magnetic resonance imaging (MRI).


Mechanism of the lesion

Crimp holds leads the tendons to presenting a significant angle. The resultant of the forces exerted on the pulleys can reach their rupture point (around 200N – between 137N and 147N for A2, between 193N and 210N for A4), especially if the stretching manoeuvre is brutal as when landing after a dyno.

Fig.3 : Forces exerted on the pulleys 
(source: Photos S. GNECCHI, schemes inspired by the work of L. VIGOUROUX
Excerpts from the article of F. MOUTET and S. GNECCHI)



It is crucial to realize that the repetition of similar efforts or of the same movement (training of a specific move) may weaken the tissues. Most pulley ruptures occur after too much training and after having neglected the warnings (pain in the fingers, swelling).

Prevention

Technique correction:
Learn to grab the holds open handed and use crimp holds only if you have no other choice.

Correction of the planning:
Take a rest of one or two days between 2 intensive sessions for the fingers.
Respect the alternation load/unload and intensity/volume.

Correction of the physical preparation:
Training the finger muscles should only be done when they are stretched (unless that you decide voluntarily to pull on your pulleys, but then you yourself are responsible). Be aware of plyometrics on the Pan Güllich: load + inertia = DANGER.

Warm ups help to reduce friction and strain on the pulleys. Stretching favours recovery.


Treatment

Put ice on it as soon as possible

It is strictly forbidden to climb and you must see a hand specialist.

The injured finger should be immobilized by taping or as shown here if you can not get any thermoforming material. .
Once the diagnosis is made by the specialist, you must plan to undergo surgery if the rupture is complete, which involves stopping any climbing activity for at least 3 months.

In case of partial rupture, it is strictly forbidden to climb for at least 45 days; an appropriate physical therapy is also necessary.

References :

MOUTET F. et Al : Pathologies de la main du grimpeur, Kinésithérapie Scientifique, Ed. SPEK 2010; (511): 5-14

THOMAS D. et Al : Rééducation des lésion des poulies digitales chez le grimpeur, Kinésithérapie Scientifique, Ed. SPEK 2010; (511): 15-21

GNECCHI S. et Al : Les traumatismes des doigts en escalade chez le grimpeur "anciennement lésé", Kinésithérapie Scientifique, Ed. SPEK 2010; (515): 23-33

VIGOUROUX et Al : Estimation of finger muscle tensions during specific sport-climbing grip techniques. Journal of biomechanics 2006:2583-92

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