All About Finger Pulley Injury And Its Treatment

Finger injuries are very common, especially in the case of rock climbing which has uneven surfaces. The injuries that may occur may be a bit different from that of typical injuries. It is not just the usual sprains or the dislocation of the joints. One of the most unusual injuries is usually seen among rock climbers, finger pulley, or rupture. 

The injury results from the mechanics in the finger pulley and the joints and the particular position where the fingers are usually held at the time of rock climbing. 

Finger Pulley

Everyone has structures in their fingers which are usually called digital pulleys. The digital pulley is usually a specialized structure that does the task of holding the tendons against the bones of the fingers. In the case of the non-presence of these pulleys, there can be a problem that may occur, which is called bowstringing of the tendons.

Tendons are those structures that connect muscles with the bones. With the contracting of the muscles, the tendon is being pulled, which pulls the bone. In the upper extremity, the muscles in the forearm get contracted, which leads to the pulling of the flexor tendons of the fingers, which causes the fingers to contract into a fist. In case of the absence of the pulley for holding the tendons against the bone, the tendons would get pulled tightly across the palm, which would disrupt it to function normally. 

Each finger in the hand consists of eight pulleys, but only two would have critical importance for preventing the brown stringing of the finger tendons. When a person ruptures a pulley, they may get sustained to various injury patterns, from a simple strain of the pulley to the ruptures of the multiple pulleys. 

When the tendons are bowstringing in most severe cases, the tendons may get lifted away from the finger. 

Signs And Symptoms

Some of the most common symptoms of the finger pulley may include the following:

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

It is essential to properly examine and diagnose a suspected injury in the finger pulley. A certified physical therapist for finger pulley injury or others can be beneficial in adequately diagnosing it after the injury. Delay in the treatment can make it less successful. The most important aspect of the clinical evaluation is determining if there is any bowstringing of the tendons due to the injury in the pulley. The treatment may be simple protection if it is not the same until the pain and swelling have subsided. 

It is seen that the middle and index fingers get injured most of the time. The two critical pulleys that are designated in the finger are known as the A2 and A4 pulleys. The rock climbers usually hurt one or both of their pulleys. In the baseball pitchers, the injury is isolated to the A4 pulley. The medical practitioner may also perform special imaging tests to help the diagnosis process and the plan for the treatment. 

Diagnostic Procedures

A fresh injury in the pulley results from local swelling, tenderness and pain in the affected areas. The main indicator for the identification of whether a total rupture or a pulley has occurred is the appearance of the clinical bowstringing. Some of the diagnostic procedures include the following:

• Plain Radiograph – It does not have any major role in the process of diagnosis. However, it may be requested in the case of acute setting in a finger injury. 
• Ultrasound – Ultrasound allows for dynamic testing with flexion stress on the affected dight. The process is usually considered to be 100 per cent accurate for the detection of the pulley injury. 

According to a study it was found that ultrasound is the most effective and better diagnostic tool than MRI or others for the treatment of finger pulley injury.

Treatment 

In case of injury, you must first visit a medical practitioner or a doctor who can adequately assess the damage by ultrasound or MRI tests. It would be beneficial in the determination of the level of the injury. Now let’s look at the grading scale of the finger injury and the rehab solutions:

• Grade 1: Pulley Strain – It refers to a partial tear of a single pulley. Immobilization is not needed for treating this. It would help if you began with some gentle range of motion exercise. Firstly bend the finger till it feels tight and hold on to the same position for about two to three seconds. Repeat the same about ten times at various times in a day. 
• Grade 2: Complete A4 or partial tearing or rupture of A2 or A3 – It means that either A4 is fully torn or A2 and A3 are torn partially. The treatment requires one or two weeks of immobilization using a finger-immobilization splint or a pulley-protection splint.

• Complete tearing or rupture of A2 or A3 – In this situation, A2 and A3 pulleys are entirely torn. It also requires one or two weeks of immobilization or using a finger-immobilization splint. 
• Annular Pulley Ruptures – It refers to single or multiple ruptures along with the possible lumbricalis muscle or collateral ligament trauma. It usually requires surgery because of the greater risk of fixed flexion contractures which is the inability to straighten the finger fully.  

Conclusion

In the case of bowstringing of the tendons, it is essential to ensure careful management of the injury. A certified physical therapist can prove to be very helpful for treating the symptoms and the cause of the pain to make it stronger and reduce the additional risk of injury.