PULLEY AVULSION Bonefix（滑轮崩裂Bonefix）.pdfVIP

PULLEY AVULSION Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. It can be iatrogenic as in trigger finger release caused by excessive loss of the proximal pulleys. As the flexor tendon moves away from the center of rotation of the metacarpophalangeal joint, the flexion moment arm is increased. Thus the flexors gain an increased mechanical advantage over the extensors resulting in limited digital extension. Rock climbing In climbing movements, the fingers produce tension on a hold to support a proportion of the body mass while the elbow and shoulder joints flex to pull the body upward. The isometric contraction of the finger flexors is interrupted when reaching towards the next hold. Finger flexor strength has been shown to be a determinant of performance in rock climbing. Bollen identified one style in particular, known as “crimping” which is of particular relevance to injury patterns among climbers. It is thought that over 90% of climbers use this grip style regularly. Crimping involves placing the fingertips on the hold with the distal interphalangeal joint (DIP) held extended while the proximal interphalangeal joint (PIP) and the metacarpophalangeal joint are held flexed. Prevalence 67 world-class climbers at the first ever rock climbing: 26% of the climbers, mainly affecting the ring finger. It was noted that the climbers considered firm taping with non- stretch zinc oxide tape around the affected part of the finger allowed continued training in the presence of injury and made the injury “feel better”. Evidence of A2 pulley injury was present in 50% of the climbers. 26% of these showed evidence of bowstringing. Relevant Anatomy Flexor Tendon Pulleys A1 pulley: - Arises from volar plate of MP