title: [Therapy of injuries of the pulley system in sport climbers].
abstract: OBJECTIVE
  Closed traumatic ruptures of finger flexor tendon pulleys are frequent in rock climbing. The objectives of this study were to characterise this injury and to formulate diagnostic and therapeutic guidelines. An algorithm and a grading system are analysed for validation.
  
  
  METHODS
  122 pulley injuries were prospectively evaluated. After standard radiographs, a dynamic ultrasound examination was performed in all climbers. In ten cases an additional MRI was necessary. All patients were classified according to the pulley injury score. Grade I-III injuries received conservative and grade IV injuries received operative therapy. 88 patients were re-evaluated, including all grade IV patients.
  
  
  RESULTS
  48 climbers had pulley strains, and 74 had ruptures (a single rupture in 90.5 % of the cases and multiple ruptures in 9.5 %). According to the pulley-injury-score, 39 % were grade I, 25 % were grade II, 30 % were grade III and 6 % were grade IV injuries. 115 patients underwent conservative therapy, of which 81 were re-evaluated. 8/81 complained three months after the injury about consistent pain, mostly caused by tendinitis. All grade IV injuries underwent surgical reconstruction, in two cases through Weilby's repair, in three cases through the "loop and a half" technique and in two further cases with a combination of the two. According to the Buck-Gramcko Score we had four excellent, two good and one fair result. The functional result was excellent in one, good in five and fair in one case.
  
  
  CONCLUSIONS
  The use of the diagnostic-therapeutic algorithm as well as the grading system proved to be highly suitable. The good results achieved with the conservative treatment in grade I - III injuries justify this approach.
authors.affiliation: II. Chirurgische Klinik, Klinikum Bamberg. volker.schoeffl@t-online.de
authors.forename: V
authors.initials: V
authors.lastname: Schöffl
authors.forename: T
authors.initials: T
authors.lastname: Hochholzer
authors.forename: H-P
authors.initials: HP
authors.lastname: Winkelmann
authors.forename: W
authors.initials: W
authors.lastname: Strecker
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000293:injuries*; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D012421:Rupture; D052256:Tendinopathy / Q000209:etiology; D013708:Tendon Injuries / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
vernacular_title: Zur Therapie von Ringbandverletzungen bei Sportkletterern.