Dynamic ultrasound in forced flexion detects finger pulley injuries with 98% sensitivity and 100% specificity; a tendon-to-bone distance above 1.0 mm counts as positive
Key Findings
Ultrasound depicted finger pulley injuries with a sensitivity of 98% and a specificity of 100% in 64 extreme rock climbers (75 symptomatic and 181 asymptomatic fingers).
The distance between the flexor tendon and the phalanx was measured in extension and forced flexion at the A2 and A4 pulleys; a distance greater than 1.0 mm was read as a pulley injury.
All 16 complete A2 ruptures, all 9 complete A4 ruptures, 6 of 7 combined A2 and A3 ruptures and all 15 incomplete A2 ruptures were depicted.
Practical Application
The right first test for a suspected pulley injury is dynamic ultrasound by someone who examines climbers' hands; ask for it by name.
How the finger feels or looks cannot tell a strain from a rupture — the measurement that separates them is a millimetre on a screen.
Limitations
Reference standard was MRI, with surgery in only seven cases; elite climbers at one centre. Abstract only was read.