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Review
. 2022 Sep 9:34:246-249.
doi: 10.1016/j.jor.2022.09.002. eCollection 2022 Nov-Dec.

Closed flexor pulley injuries: A literature review and current practice

Francesco Bosco  1 , Fortunato Giustra  1 , Alessandro Lusso  1 , Carlotta Faccenda  1 , Stefano Artiaco  1 , Alessandro Massè  1
Affiliations
Review

Closed flexor pulley injuries: A literature review and current practice

Francesco Bosco et al. J Orthop. .

Abstract

Background: Closed flexor pulley injuries are a clinical entity of great interest in hand surgery, and these lesions could be observed mainly in rock-climbing athletes.

Objective: An extensive literature search of PubMed, SCOPUS, Cochrane Library, and Web of Sciences databases on closed finger pulley rupture, related treatments, and outcomes were performed. All relevant information was used in this literature review.

Conclusions: Many athletes are potentially exposed to these uncommon injuries. Therefore, these lesions require careful examination and a high index of suspicion to confirm the diagnosis and identify the degree of soft tissue injury, particularly in patients not involved in sporting activities. The data summarized in this literature review demonstrated that according to Schöffl's classification, conservative treatment should be indicated for low-grade injuries (grade 1 or 2), whereas surgical treatment should be performed in patients with more severe acute injuries (grade 4). Grade 3 flexor pulley injuries lie in a grey area where conservative and surgical treatment may give good clinical and return-to-sport patient results.

Keywords: Bowstringing; Finger injury; Flexor tendon; Pulley injury; Pulley rupture; Rock climbing.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
The digital pulley system of the fingers.
Fig. 2
Fig. 2
Clinical photograph of a patient with an acute A2-pulley rupture, middle finger, left hand. Fig. 2-A with the hand (A) open. Fig. 2-B with the hand (B) closed. Note the swelling and the active flexion deficit in the proximal interphalangeal joint one week after the trauma.
Fig. 3
Fig. 3
Ultrasound image of A2-pulley rupture. The distance between point A and point B represent the tendon-bone distance.
See this image and copyright information in PMC

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