Sports Medicine
Pulley ligament injuries in climbing
Pulley ligament injuries are a common injury among climbers. These ligaments play a key role in the functionality of the fingers and are essential for safe grip and pulling on the rock or in the gym.
Anatomy and function of the pulley ligaments
The annular ligament system comprises several ligaments that hold the flexor tendons of the fingers close to the bone and act as pulleys. They consist of the annular ligaments A1 to A5 and the cruciate ligaments C1 to C3. These ligaments form a tunnel through which the flexor tendons run and are crucial for the stability and power transmission of the fingers.
- A1 Pulley: Located at the base of the finger and secures the tendon during flexion.
- A2 Pulley: One of the most important ligaments, located at the proximal phalanx of the finger and capable of withstanding high levels of stress.
- A3 Pulley: Located at the middle phalanx of the finger.
- A4 Pulley: Another critical ligament located at the middle section of the finger.
- A5 Pulley: Located at the distal phalanx of the finger.
- C1 to C3: These cruciate ligaments complement the stability of the finger.
Injury Mechanisms
Pull ligament injuries usually occur due to sudden, high loads or continuous overuse. Typical injury mechanisms in climbing include:
- Sudden load changes: When a climber slips on a hold or a heavy object suddenly falls from their hand, extreme forces can act on the pulley ligaments, especially the A2 pulley ligament.
- Continuous overload: Repetitive loading without sufficient recovery time can lead to microtrauma and ultimately tears, with the A4 pulley ligament frequently affected.
Diagnosis
The diagnosis of pulley ligament injuries occurs in several steps:
- Clinical Examination: A complete rupture is often indicated by the bowstring phenomenon, in which the tendon visibly and palpably separates from the bone under the skin.
- Imaging Techniques: Ultrasound is the method of choice for diagnosing partial ruptures, as it precisely depicts the distance between the tendon and the bone in the area of the torn annular ligament. In unclear cases, an MRI scan can provide additional information.
Therapy
The treatment of pulley ligament injuries depends on the extent of the damage:
- Conservative Treatment: Minor ruptures or those with a dehiscence (distance from the bone) of less than 2 mm can often be treated conservatively. This involves wearing a tape bandage or a thermoplastic ring for several weeks.
- Surgical Treatment: Larger ruptures or multiple injuries often require surgical reconstruction of the pulley ligaments. A tendon graft can be used, which is woven into the remnants of the original ligament.
Conclusion
Pull ligament injuries are serious and particularly common in climbing. Careful diagnosis and appropriate treatment are crucial to avoid long-term functional impairment. If such an injury is suspected, climbers should consult a specialist promptly.