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What is Flexor Tendon Pulley System Injury?

The flexor tendons travel through a tunnel in each finger called a sheath. Pulleys are the thickened parts of the sheath, which help to hold the tendon in place against the bones of the finger. This allows for proper bending of the finger. Injury to the Flexor Tendon Pulley System can involve partial or complete tear of one or more pulleys along the finger.

Signs and Symptoms of Flexor Tendon Pulley System Injury

Many people who sustain a pulley injury report hearing a “pop” sound at the time of injury. However, some patients do not report hearing this sound.

Other indications of this injury may be localized pain at the site of the pulley, including tenderness to touch, painful weak grasp, and bowstringing of tendons evidenced by palmar swelling.

The most common injury symptoms include:

  • Most commonly occurs over the A2 pulley
  • Tenderness to touch along the pulley
  • Swelling and inflammation at the base of the finger
  • Stiffness, weakness and/or pain with bending the fingers
  • Painful to actively crimp and grip

Causes of Flexor Tendon Pulley System Injury

Soft tissue only has so much strength and can only tolerate so much load. Past that point, athletes may rupture ligaments, pulleys, or tendons.

Placing large amounts of weight or force through a bent finger risks rupture of the pulley system.

Injuries Associated with Flexor Tendon Pulley System Injury

Flexor Tendon Pulley System Injury is most often experienced by rock climbers, who spend much of their activity tightly gripping rock faces and supporting a large part of their body weight on one or a few fingers. Baseball pitchers may also sustain these types of injuries. Competitive grip strength athletes are at risk.

Treatment Options for Flexor Tendon Pulley System Injury

Promptly diagnosed injuries without extensive injury can be treated with ring splints, limited use, and occupational therapy.

Severe cases with flexor tendon dysfunction may demand surgical intervention to repair or reconstruct torn pulleys to optimize finger function.

Conservative Treatments

Rest, anti-inflammatory medication, and physician-supervised physical therapy are most often recommended for mild cases. More serious injuries may benefit from repair or reconstruction.

A prompt diagnosis has the potential to improve a patient’s prognosis and reduces the likelihood that surgical intervention will be needed.

Surgical Treatments

Severe cases with flexor tendon dysfunction may demand surgical intervention to repair or reconstruct torn pulleys and restore finger function. Patients may require splinting or casting to immobilize the finger until it is cleared for movement.

Physical therapy is often recommended following surgery to help restore mobility and range of motion.

Prognosis for Flexor Tendon Pulley System Injury

Because this injury is often sustained while climbing, patients are recommended to cease climbing activity temporarily. Patients benefit medical supervision during the healing process to develop a rehabilitation process appropriate for the injury that will allow them to return to sports activity in due time.

If You Believe You Have Flexor Tendon Pulley System Injury Contact HandSport Surgery Institute

Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing Flexor Tendon Pulley System Injury ought to be evaluated to try and prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment, obtain an accurate diagnosis, and start to maximize your function.  

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