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Climbing Injuries

A common climbing injury is a flexor tendon pulley system injury: What is a flexor tendon pulley system injury?

Tendons are bands that connect muscles to bones. The flexor tendons in the hand help control the bending of the fingers. There are multiple flexor tendons that are located in a tunnel called a sheath. The thickened parts of the sheath work like a pulley to allow for the flexing of the fingers. Any injury to these systems usually involves a partial or complete tear to the pulleys from the tendon pulling through the sheath. There are 5 annular pulleys and 3 cruciate pulleys in each finger. The second annular pulley (A2) is the thickest and strongest pulley, but often the most frequently injured after climbing injuries. 

The most common flexor tendon pulley system injuries are gripping injuries. Placing increased pressure or weight on a bent finger can cause a tear in the pulley system. These are frequently seen in rock climbers or sports including grip strength. 

What are the symptoms of a flexor tendon pulley system injury?

Pain with gripping or bending the fingers

Stiffness with flexing the fingers

Weakness of the fingers



When does a flexor tendon pulley system injury require surgery?

Conservative treatments for flexor tendon pulley system injuries include RICE (rest, ice, compression, elevation) therapy, non-steroidal anti-inflammatory medications, and physical therapy. While this can help with minor cases, surgery is usually required to repair the torn pulley and in some cases reconstruct the pulley system. 

How is a flexor tendon pulley system surgery per

Dr. Azouz will visualize the flexor tendon and affected pulley of the finger. He will repair the pulley system along with any nearby tendons, ligaments, or fractures. If there is significant damage, he can reconstruct the pulley and use flexor tendon grafts to restore the function of the finger.

What is the anesthesia for a flexor tendon pulley system surgery?

For flexor tendon pulley system surgery, Dr. Azouz will use sedation with an axillary block. Patients are given sedative medications to help them relax in a deep sleep. Dr. Azouz then injects a numbing medication for pain which can last up to 24 hours.

What is the recovery for flexor tendon pulley system surgery?

After the procedure, Dr. Azouz will place a splint over the finger and hand. The splint is worn for a few weeks to allow the finger to recover well. During routine follow-up visits, Dr. Azouz will evaluate the healing and may recommend therapy to regain strength and movement. 


What is the cost of flexor tendon pulley system surgery?

Surgery costs differ extensively depending on the type of injury. Dr. Azouz will obtain a medical history and perform a physical exam to assess the injury. With work-related injuries, workers’ compensation carriers typically cover medical costs.