title: Pulley injuries in rock climbers.
abstract: OBJECTIVE
  The closed traumatic rupture of finger flexor tendon pulleys in rock climbers appeared as a new complex finger trauma in the mid 1980s. The objectives of this study are to characterize this injury and to describe diagnostic and therapeutic guidelines. A grading system for the severity of pulley injuries was developed and used to set therapeutic pathways.
  
  
  METHODS
  Six hundred four injured rock climbers were prospectively evaluated from January 1998 to December 2001 with a questionnaire and standard examination protocol. Diagnostic ultrasound was performed in all rock climbers with finger injuries; if necessary, an additional magnetic resonance imaging was done. All pulley injuries were graded according to an introduced pulley-injury score (grade 1-4).
  
  
  RESULTS
  Three of four of the most frequent injuries were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%. One hundred twenty-two (20.2%) rock climbers presented an injury of the flexor tendon pulley system, 48 had pulley strains, and 74 had ruptures (a single rupture in 90.5% and multiple pulley ruptures in 9.5%). According to the pulley-injury score, 39% were grade 1, 25% were grade 2, 30% were grade 3, and 6% were grade 4 injuries.
  
  
  CONCLUSIONS
  Pulley injuries were the most frequent injuries in rock climbers. Whereas grade 1-3 injuries respond well to conservative treatment, grade 4 injuries require surgical repair. We recommend the "loop and a half" technique of Widstrom and colleagues and, alternatively, the Weilby repair. We also recommend postoperative initial immobilization and early functional treatment under external pulley protection.
authors.affiliation: Department of Trauma Surgery, Teaching Hospital of University Erlangen-Nürnberg, Klinikum Bamberg, Germany. volker.schoeffl@t-online.de
authors.forename: Volker
authors.initials: V
authors.lastname: Schöffl
authors.forename: Thomas
authors.initials: T
authors.lastname: Hochholzer
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Winkelmann
authors.forename: Wolf
authors.initials: W
authors.lastname: Strecker
mesh_terms: D000293:Adolescent; D000328:Adult; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000293:injuries*; D011446:Prospective Studies; D012421:Rupture; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology