A2 pulley injury. Now that you have an understanding of the terminology .

A2 pulley injury. They used a pulley protection splint treatment and looked at the bone-tendon distance, which improved from 4. PULLEY SPRAIN REHAB PROTOCOL This protocol is a companion to the online Pulley Sprain Rock Rehab Protocol and the pulley sprain chapter in the book Climb Injury-Free, written by Dr. The pulley system (as a part of the tendon sheath) and flexor tendons form a functional unit so injuries of the tendon sheath are often associated with flexor tendon injuries. The two critical pulleys in the finger are designated the A2 and the A4 pulleys. 16–29 Lin et al 25 showed that the force (load applied uniformly along the length of the pulley and directed volarly) required to rupture the A2 pulley is 432 N and to rupture the A4 pulley is 202 N. 3 Consequently, eccentric flexor tendon loading is generally considered to be one of the greatest risk factors for A2 pulley injury. Schöffl has developed a grading system of pulley injuries: Grade I is a pulley strain, Grade II could be an A-2 partial rupture, Grade III a complete rupture and Grade IV multiple ruptures with muscle and ligament involvement. Jared Vagy DPT. The thumb only has two pulleys that are described as A1 and A2. Five of them are annular; Three of them are cruciate; The flexor digitorum superficialis and flexor digitorum profundus both pass under the A2 pulley Ibrahim D, Finger A2 pulley injury. A1, A3, and A5 pulleys. In climbers, we often see A2 pulley injuries happen while pulling on a full crimp and/or when a foot slips, creating excess force against the pulley. The study population included self-identifying rock climbers with the following inclusion criteria: a minimum of 18 years old; able and willing to participate in rock climbing a minimum of 3 times a week for the duration of the study; and sustained a grade I, II, or III A2 pulley injury based on guidelines set forth by the conservative Sep 4, 2020 · Additionally the SPOrt can be made to fit the A4 pulley whereas the PPS is strictly for A2 pulley injuries. This often happens when a climber slips and their grip tightens to catch themselves. 53347/rID-94227 If the A2 pulley tears, further climbing or strenuous use of the hand will put extra strain on the A3 and A4 pulleys (see arrows on left diagram), putting them at risk for rupture. You may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). See below for Videos as well as anatomy, healing times, tendon glides, Wave Tooling, H-taping, progressive strengthening, and return to climbing progression. A pulley rupture is a complete tear of the ligament, where no part of the tissue remains in contact with the other side. Rupture or injury to the A2 and A4 pulley results in a loss of torque at the DIP and PIP joints, These ruptures can occur when a sudden extension of the digit is preceded May 26, 2012 · The anatomy and biomechanics of the A2 and A4 pulleys have been extensively studied in cadavers (Doyle JR, Blythe WF. In order to understand pulley sprains, we need to understand the anatomy first. Presented at the AAOS Symposium on Tendon Surgery in the Hand). Find out how to prevent, diagnose, and treat A2 pulley injuries with physical therapy, splints, or surgery. The A1, A3, and A5 pulleys are more flexible and attach to the volar plate, a ligament that connects two phalanges together. Consult a sports injury specialist for a comprehensive assessment and personalized treatment plan, which may include anti-inflammatory medications for targeted pain and inflammation You’ve likely only heard of A2 (maybe A3) injuries because they are the most commonly injured. Biomechanical analysis has shown that injury to the A2 pulley likely occurs when the pulley is eccentrically loaded, resulting in high tensile forces between the pulley and tendon. They create a mechanical advantage that allows you finger to move through its full range of motion. A2 pulley injury is the most common injury for climbers. Increasingly severe pulley injuries follow a predictable pattern, with A2 ruptures progressing from partial to complete, and with more severe injuries then involving the A3 pulley and subsequently the Apr 1, 2022 · Climbers most-often injure the A2 pulley in the ring finger. 4 millimeters to 2. The most common injury in climbers is the A2 pulley sprain or rupture and is caused by overloading the tissue. Learn about the A2 pulley, a ligament that connects your flexor tendons to your finger bones, and how it can be damaged by overuse or trauma. Mar 28, 2024 · There are five flexor tendon pulleys in the fingers that are named A1-A5. The A2 and A4 are the major pulleys of the system (inserting directly to the bone) and are most prone to injury. org (Accessed on 17 Jun 2025) https://doi. Other pulleys are susceptible to excessive forces as well with the middle finger being the next most-commonly injured digit; The A2 pulley is located at the base of your finger near the junction with your palm. Pulley injuries to the fingers were the most common diagnoses, accounting for 30% of finger injuries and 12% of total Dec 9, 2022 · For A2 pulley injuries, the most common pulley injury for climbers, the pain usually arises at the base of the finger and is noticeable when trying to straighten or bend the finger. For A2–A4 ruptures, there may be bowstringing—bulging at the base of the finger—which can be detected by resisting finger bending at the fingertip. Mar 21, 2024 · Most commonly, either the middle or index digit is the injured finger. Author Volker Schöffl found that 37 (13 per cent) of 284 climbers surveyed experienced pulley injuries. Now that you have an understanding of the terminology When this happens, the pulley will stretch, tear, or rupture, causing the tendon to partially (or completely, in the case of rupture) pull away from the bone. Healing from a pulley injury is best explored in stages. 3 millimeters after an A2 pulley rupture and also from 2. attach to the volar plate. The A2 pulley can be partially or completely torn. A2 and A4 First up let’s describe the injury: A2 and A4 pulley sprains/tears Over the course of my climbing career I have had my fair share of pulley sprains in different A2 and A4 pulleys in different fingers. The most commonly affected pulley is the A2 pulley, located in the proximal phalanx. overlie the palmar aspect of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints respectively. org/10. A sprain/strain describes a stretch or partial tear of a ligament (“strain” is usually reserved for injuries to a muscle or tendon, but some of the literature mentions a strain of the pulley). Pulley Injury - Complete Rehabilitation Program for Climbers PT Jeff’s comprehensive rehabilitation program for finger pulley injuries. He distinguished grade 1 with pulley strain, grade 2 with a complete rupture of A4 or partial rupture of A2, grade 3 with complete rupture A2 or A3, grade 4 with multiple ruptures (as A2/A3, A2/A3/A4) or single rupture (as A2 or A3) combined with lumbricalis muscle or collateral ligament trauma. A2 Pulley Strain The A2 pulley is the structure that holds the flexor tendon close to the first finger segment (proximal phalanx). When the first finger joint is flexed past 90 degrees (seen below), there is 3–4 times more stress on the A2 pulley than at the fingertip. rarely torn. A2 and A4 Finger pulley injuries are the most common injury with rock climbers. 2 When the A-2, A-3 and A-4 pulleys rupture at the same time, the patient’s hand will show marked bowstringing and The A2 pulley is the strongest, but also the most frequently injured pulley, and the pulley most frequently identified as abnormal on MR images. On the grading scale these were clearly grades 1 and 2 (minor and major sprain), and I have never had a grade 3 (full tear accompanied by awful Mar 28, 2024 · There are five flexor tendon pulleys in the fingers that are named A1-A5. A4 pulley tears will in turn put extra strain on the A3 and A2 pulleys (see arrows on right diagram). Designed for climbers. Case study, Radiopaedia. 3 A2 pulley injuries have been Jun 7, 2021 · The annular pulleys (A1, A2, A3, A4, A5) hold your flexor tendons close to the bone and act as pulleys. Nov 22, 2024 · Type III - triangular/oblique Av pulley with fibers converging to radial side A2 pulley (5-10mm) contributes least to arc of motion of thumb if A2 is intact, cutting A1 or oblique pulley will not result in bowstringing Jan 26, 2018 · The A2 and A4 are the major pulleys of the system (inserting directly to the bone) and are most prone to injury. In the beginning stages following injury we want to unload the pulley from finger forces, prevent the formation of scar tissue, control . Learn about the pathophysiology, anatomy, grading system, imaging, and surgical options for this condition. 1 millimeters after an A4 pulley rupture. How to Rehab a Pulley Injury Acute Phase. The step-by-step protocol will take a climber through a four-phase system to unload, gain full mobility, improve strength and eventually return to Nov 15, 2023 · Professional medical intervention is essential for severe flexor tendon pulley injuries, including partial pulley ruptures and complete A2 pulley ruptures. A-2 pulley rupture is a tendon injury that affects the flexor digitorum profundus or superficialis of the second or fourth digit. A2 and A4 Pulleys are ligaments. 9 millimeters to 2. Jun 3, 2020 · A2 pulley rehab, education on injury, anatomy, prevention, and more. So, let’s discuss the pulleys in the fingers. Apr 9, 2024 · What is a Finger Pulley Injury? A finger pulley injury involves the tearing or rupture of one or more of the pulley systems in the fingers. sptwm ydsz zsdvvcm mzu jnrq xxrhftm rrs aaop gmfgw ttkusf