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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 tearing of one or more pulleys along the finger.

Symptoms of Flexor Tendon Pulley System Injury

Pain and swelling usually occurs after the injury.  This can make bending the finger difficult.  Even after time passes and the initial discomfort may decrease, bending the finger can remain difficult because of the altered joint mechanics due to the pulley damage.  Most patients with pulley injuries recall hearing or feeling a “pop” right before the pain started.

Common Causes of Flexor Tendon Pulley System Injury

Flexor Tendon Pulley System Injury

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

For this reason, the 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.

Diagnosis of Flexor Tendon Pulley System Injury

Speaking with you to learn about recreational activities and what was felt at the time of injury are helpful to arrive at the correct diagnosis.  A careful physical exam is always essential.  Imaging studies are also useful.  An x-ray is obtained to evaluate for possible associated fracture or joint irregularity.  To visualize the flexor tendons and the overlying pulleys, an ultrasound or MRI can be performed as part of the diagnostic workup.

Treatment Options for Flexor Tendon Pulley System Injury

Promptly diagnosed injuries without extensive injury can be treated with immobilization, ring splints, occupational therapy, and cortisone injection.  Severe cases with flexor tendon dysfunction may demand surgical intervention to repair or reconstruct torn pulleys and improve finger function.


Pulleys, though small, allow the powerful finger flexor tendons to do their job. Call New York City Hand Surgeons Dr. Mark Pruzansky and Dr. Jason Pruzansky at 212-249-8700 to schedule an appointment and return proper flexion back to your finger.

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