Pulley injuries were 20% of 604 climbing injuries; nine in ten ruptures were a single pulley, and grades 1–3 responded to conservative treatment while grade 4 needed surgery
Key Findings
122 of 604 injured climbers (20.2%) had an injury of the flexor tendon pulley system: 48 strains and 74 ruptures; 90.5% of ruptures were a single pulley, 9.5% multiple.
By grade: 39% grade 1, 25% grade 2, 30% grade 3, 6% grade 4.
Grade 1–3 injuries responded well to conservative treatment; grade 4 injuries required surgical repair.
Ultrasound was performed in all climbers with finger injuries, with MRI added when necessary.
Practical Application
A sudden finger pain on a crimp — often with a pop — is most likely a pulley injury, and the grade decides everything. The grade is given by a hand clinician with ultrasound, not by the athlete and not by the assistant.
Until it is assessed: no finger-loading sessions (crimps, campus, hangboard, hard bouldering); other training continues.
Most cases are single-pulley and treated without surgery — that is the reassuring part, said only after the referral.