A Realistic Look at A2 Pulley Injuries in Climbers
A2 pulley injuries are very common in climbers.
In adult climbers, this is the most common type of finger injury, whether it be a rupture or some form of sprain. (Though in adolescent climbers, this is incredibly uncommon. It is more common for kids to get fractures of the growth plate across the joint.)
but it doesn’t have to sound so scary.
One of the reasons I am posting this is to bring up the idea that sometimes images can be more scary than is necessary.
Even the language we use can be stressful (“tear” and “rupture” specifically).
One thing I suggest to my clients is to step back and take a look at the big picture. In the big picture, one pulley of one finger is quite a small percentage of the connective tissues of the hands. If we put all of our emotional and physical attention on that one structure, we tend to over value it’s importance.
our bodies are adaptable and can train through these injuries.
There are many ways to train an athlete through these types of injuries. If we discontinue loading— or under-load— the specific injury, it tends to increase the time it takes to get back to full sports participation.
Our bodies are much more resilient and adaptable than most injured athletes would assume. Just think of all of the stress you’ve placed on those tissues prior to having pain.
pulley rupture ultrasound:
In this ultrasound, the bright white line that is concave upwards is the proximal phalange. As the image moves to the left you can see the joint on the right side where that bone ends and there is a space.
The tissue that is more granular in its appearance above the bone is the finger flexor tendons. Notice how the tendon has a space underneath it from the bone. When I have the athlete flex their finger that space increases. That is not a physiologic space. That is a pathologic space brought on by an injury of the A2 pulley which is now allowing the tendon to displace away from the bone.
Key takeaways:
Finger ruptures don’t have to be as scary as we make them sound.
The athlete in the ultrasound video is still able to load on a fingerboard and climb with modifications.
Don’t sit around wait for these to heal on their own. Mechanical loading is still a good stress.