Finger Pulley Injuries

What are Pulley Injuries?

Pulley injuries are common among climbers and athletes who rely heavily on hand strength, in particular isolated finger positions. Pulleys are bands of connective tissue that wrap around the tendons in your fingers, helping to keep them close to the bone and facilitating smooth movement. When these pulleys are overstressed due to excessive gripping or pulling motions, it can lead to pain, decreased performance and injury. The A2 and A4 pulleys are most commonly injured.

Causes of Finger Pulley Injuries

• Overuse: Repeated gripping, crimping, or pinching holds without adequate rest can put excessive stress on the pulleys.
• Sudden Trauma: A sudden, forceful pull or jolt, such as catching a fall or yanking on a hold, can strain or tear a pulley.
• Poor Technique: Over-gripping or using inefficient hand positions, such as excessive crimping or poor wrist alignment, can contribute to pulley injuries.
• Lack of Warm-up: Climbing or engaging in other gripping activities without properly warming up the muscles and tendons increases the risk of injury.
• High Loads on Small Holds: Small, sharp holds or pinches in climbing can place disproportionate strain on the finger pulleys, especially if the grip is held for long periods.

Symptoms of Finger Pulley Injuries

• Pain: Pain is often localised to the base or middle of the finger and is particularly felt when pressure is applied to the injured pulley or when the finger is used for gripping.
• Swelling: Swelling around the base or middle of the finger can occur, and sometimes the injury is visible as a bulge or deformity if a pulley has torn.
• Tenderness: Pressing on the area where the pulley is injured (e.g., at the A2 or A4 pulley) may elicit sharp pain.
• Weakness: A decrease in the ability to grip or hold weight may be noticed, especially during activities like climbing or lifting.
• Decreased Range of Motion: Stiffness or limited movement in the injured finger can be an indication of a more severe injury.

Classification of Pulley Injuries

• Grade 1 (Mild):
  • Partial overstretching of the pulley.
  • Pain and tenderness without a tear.
  • Treatment generally involves rest, ice, a period of immobilisation and hand therapy.

• Grade 2 (Moderate):
  • Partial tear of the pulley.
  • Moderate pain, swelling, and some weakness or loss of grip strength.
  • Treatment typically involves rest, splinting, and hand therapy.

• Grade 3 (Severe):
  • Complete rupture of the pulley.
  • Significant pain, swelling, bruising, and loss of function.
  • May require surgical intervention to repair the tear.

Diagnosis

• Physical Examination: A doctor or an Occupational Therapist / Physiotherapist trained in hand therapy may palpate the finger to feel for tenderness or swelling and assess the degree of mobility in the finger.
• Imaging: X-rays may be taken to rule out fractures or other bony injuries, though they are not typically needed for soft tissue injuries like pulley tears. MRI or ultrasound may be used to assess soft tissue damage if the injury is severe or if surgery is being considered.

Treatment for Finger Pulley Injuries

Conservative Treatment (Non-Surgical)

Surgical Treatment (For Severe Injuries)

Surgery may be required if the injury involves a complete rupture of the pulley, especially if there’s a significant loss of grip function or if conservative methods fail.

Rehabilitation after surgery will involve a gradual return to normal activities, with hand therapy focusing on regaining flexibility, strength, and function of the injured finger, as guided by a hand and upper limb surgeon.

Prevention of Finger Pulley Injuries

• Warm-Up Properly: Spend time warming up your fingers before engaging in any gripping activities. This includes light finger stretches, mobility exercises, and gradually building up intensity.
• Strength Training: Strengthening the fingers, hands, and forearms with exercises such as dead hangs, finger curls, and resistance band exercises can help prevent pulley injuries by improving tendon strength and flexibility.
• Use Proper Technique: Avoid over-gripping or using overly aggressive hand positions (e.g., excessive crimping) that increase the strain on your pulleys.
• Gradual Progression: Avoid jumping into intense activity too quickly. Gradually increase the intensity and difficulty of climbing or grip-based exercises to allow your body to adapt.
• Rest and Recovery: Take regular rest days from gripping activities, especially if you’re engaging in high-intensity or high-frequency training. Recovery is essential for preventing overuse injuries.

Prognosis

• Mild Injuries: These typically heal within 2-6 weeks with rest and conservative treatment.
• Moderate Injuries: Healing may take 6-8 weeks depending on the severity. This also requires conservative management from a hand therapist.
• Severe Injuries: Recovery from a complete pulley rupture can take several months, especially if surgery is required. Full function may take up to 6 months or longer to return. Please see a Hand and Upper Limb Specialist for their opinion and management.

Summary

Author: 
Tayla Ogilvie – Occupational Therapist/Hand Therapist- Gold Coast Hand Therapy