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Hand Pulley Injuries

The hand pulleys are thickened areas of the tendon sheath that provide support to movements of the hand such as flexion and extension, and provide tensile strength in activities such as bouldering and weightlifting. Each finger contains 5 annular pulleys (A1-5) and 3 cruciate pulleys (C1-5), and the thumb has one 2 annular pulleys. The pulleys allow forces to be used in the fingers in different angles, especially in gripping, and also allow for smoother gliding in the fingers.

Injuries to the hand pulleys can be quite debilitating, and are commonly caused by excessive tension to the finger in activities like martial arts and rock climbing. This occurs more often to the A2 pulley of the finger, on the ring finger of the hand, and in excessively flexed finger gripping. There may be an audible pop in the finger, followed by pain and bruising around the base of the finger. When an injury to the hand pulley occurs, it is often associated with great pain, difficulty to move the finger, and inflammation around the area. If the pulleys are ruptured, bowstringing will occur and the finger will be unable to move or use force due to the loss of ability to flex the fingers or grip due to the loss of support from the pulley.

Treatment to hand pulley injuries involves stopping the activity immediately, and to use ice and gentle exercises to reduce the swelling in the affected finger. As one recovers, they may prepare to return to the sport through strengthening finger flexion and improving finger mobility. Returning to the activity may involve taping the finger to act as a splint and provide support to the joint. More severe injuries may require surgical repair, taking much longer to recover and return to the activity.

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