Finger flexor pulley injury of sport climbers – Literature review
More details
Hide details
Medical Students' Research Association, Medical University of Lublin, Poland
Chair and Department of Rehabilitation, Physiotherapy and Balneotherapy, Medical University of Lublin, Poland
Department of Functional Masticatory Disorders, Medical University of Lublin, Poland
Department of Pathology and Rehabilitation of Speech, Medical University of Lublin, Poland
Submission date: 2015-08-20
Acceptance date: 2016-01-23
Online publication date: 2016-02-28
Publication date: 2020-03-24
Corresponding author
Michał Ginszt   

Nadbystrzycka 14a, 20-618 Lublin, Poland. Tel.: +48 602 533 723.
Pol. Ann. Med. 2016;23(2):191-194
Sport climbing has grown in popularity in recent years. During this activity, the main exercise is made by the upper limbs which carry the largest load. Almost half of climbing injuries concern fingers with most frequent injuries of flexor tendon pulleys.

The aim of this work is to present risk factors, clinical picture, current diagnostic methods and treatment of finger flexor pulley injury of sport climbers.

Material and methods:
The attempt was made to characterize finger flexor pulley injury of sport climbers. Using keywords 'pulley,' climbing,' 'rupture,' injury' we performed a review of relevant articles based on a PubMed search, focusing on last five years.

Results and discussion:
The amount of mechanical load that climbers apply to each finger depends on several hand grips specific to sport climbing. Repetitive loading of the pulleys with high forces can bring on injury and overuse syndromes. The grading system for flexor pulley injuries was proposed by Schöffl et al. to help guide and correlate therapeutic options.

The main causes of pulley injury include the lack of proper warm-up before training, a lack of stretching and cool down the body's muscles after workout, too short time intervals between each workout and repetitive overuse. The diagnosis of pulley disruption is based on the injury history, clinical examination and visualization by ultrasound or a magnetic resonance imaging. Grade 1–3 pulley injuries can be managed conservatively, grade 4 injuries require a surgical repair.

None declared.
Rohrbough JT, Mudge MK, Schilling RC. Overuse injuries in the elite rock climber. Med Sci Sports Exerc. 2000;32(8):1369–1372.
Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers. Wilderness Environ Med. 2003;14(2):94–100.
Doyle JR. Palmar and digital flexor tendon pulleys. Clin Orthop Relat Res. 2001;383:84–96.
Lin GT, Cooney WP, Amadio PC, An KN. Mechanical properties of human pulleys. J Hand Surg Br. 1990;15(4):429–434.
Schöffl VR, Einwag F, Strecker W, Schöffl I. Strength measurement and clinical outcome after pulley ruptures in climbers. Med Sci Sports Exerc. 2006;38(4):637–643.
Schweizer A, Hudek R. Kinetics of crimp and slope grip in rock climbing. J Appl Biomech. 2011;27(2):116–121.
Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217–223.
Morenas Martín J, Del Campo VL, Leyton Román M, Gómez-Valadés Horrillo JM, Gómez Navarrete JS. Description of the finger mechanical load of climbers of different levels during different hand grips in sport climbing. J Sports Sci. 2013;31(15):1713–1721.
Amca AM, Vigouroux L, Aritan S, Berton E. Effect of hold depth and grip technique on maximal finger forces in rock climbing. J Sports Sci. 2012;30(7):669–677.
Mallo GC, Sless Y, Hurst LC, Wilson K. A2 and A4 flexor pulley biomechanical analysis: comparison among gender and digit. Hand (NY). 2008;3(1):13–16.
Logan A, Makwana N, Mason G, Dias J. Acute hand and wrist injuries in experienced rock climbers. Br J Sports Med. 2004;38(5):545–548.
Ginszt M, Goniewicz M, Ginszt A, Goniewicz K. Climbing injuries among children and youth. In: Domżal-Drzewiecka R, Ścibor A, Saracen A, eds. In: Injuries, Accidents Among Children and Youth: Selected Issues. Lublin: Perfekta Info; 2011 :137–145.
Ginszt M, Goniewicz M, Ginszt A. Analysis of causes and consequences of injuries among children and youth in sport climbing. Hygeia Public Health. 2012;47(1):23–27.
Woollings KY, McKay CD, Emery CA. Risk factors for injury in sport climbing and bouldering: a systematic review of the literature. Br J Sports Med. 2015;49(17):1094–1099.
Woollings KY, McKay CD, Kang J, Meeuwisse WH, Emery CA. Incidence, mechanism and risk factors for injury in youth rock climbers. Br J Sports Med. 2015;49(1):44–50.
Bannister P, Foster P. Upper limb injuries associated with rock climbing. Br J Sports Med. 1986;20(2):55.
Schöffl V, Schöffl I. Isolated cruciate pulley injuries in rock climbers. J Hand Surg Eur Vol. 2010;35(3):245–246.
Bollen SR. Soft tissue injury in extreme rock climbers. Br J Sports Med. 1988;22(4):145–147.
Schöffl VR, Schöffl I. Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg Am. 2006;31(4):647–654.
Schweizer A. Sport climbing from a medical point of view. Swiss Med Wkly. 2012;11(142):w13688.
Klauser A, Frauscher F, Bodner G, et al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology. (3):2002;(3):755–761.
Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S. Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med. 1998;26(5):651–655.
Schweizer A. Biomechanical effectiveness of taping the A2 pulley in rock climbers. J Hand Surg Br. 2000;25(1):102–107.
Widstrom CJ, Doyle JR, Johnson G, Manske PR, McGee R. A mechanical study of six digital pulley reconstruction techniques: Part II. Strength of individual reconstructions. J Hand Surg Am. 1989;14(5):826–829.
Mallo GC, Sless Y, Hurst LC, Serra-Hsu F. Minimally invasive A2 flexor tendon pulley and biomechanical comparison with two accepted techniques. Tech Hand Up Extrem Surg. 2008;12(3):170–173.
Journals System - logo
Scroll to top