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Finger pulley injury

Finger injuries are common in climbers, due to the high level of workload and stress placed upon fingers during manoeuvring as well as holding high percentages of your body weight through your fingers.

A typically common finger injury seen in climbers is a ‘Pulley injury’.

Pulleys are structures that hold the tendons against the bones of the fingers. Tendons are structures that connect muscles to bones: When a muscle contracts, it pulls the tendon, which in turn pulls the bone. When a person ruptures a pulley, they may sustain a variety of injury patterns, ranging from a simple strain of the pulley to ruptures of multiple pulleys in a single digit.


Signs and Symptoms

The most common signs of finger pulley injuries include:

  • Pain on the palm side of the finger and tenderness with pressure
  • Swelling of the finger
  • Difficulty forming a fist
  • Hearing a ‘pop’ at the time of the injury.

It is important to have suspected digital pulley injuries examined by a specialist sometime soon (within several days to a week) after the injury. While emergency treatment is generally not needed, delayed treatment (weeks or months later) can lead to less successful results. The most important aspect of the clinical evaluation is to determine if there is any bowstringing of the tendons as a result of the pulley injury. If not, treatment is usually just simple protection, modified activity and strengthening until swelling and pain have subsided.



If there is bowstringing of the tendons, then more careful management of the injury needs to occur. This does not always mean surgery is necessary, but there are specialised splints and therapy techniques that can allow the pulleys to heal properly. Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.

As far as returning to activity, this varies significantly with the severity of the injury. With mild pulley strains, the full activity can be resumed as soon as swelling and pain have subsided. For full ruptures that are being treated non-surgically, duration of treatment is typically between one and three months. For people who require surgical reconstruction of a pulley injury, there may be restrictions for up to a year from the time of surgery.


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