Injury to the A2 pulley in rock climbers

Bollen, Steve

doi:10.1016/0266-7681(90)90135-q

Cited by 122 publications

(95 citation statements)

References 4 publications

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“…During rock climbing, the A2 pulley and the A4 pulley are stressed in a way that injuries and overuse are very common (Bollen, 1990;Cartier et al, 1985;Gabl et al, 1998;Tropet et al, 1990). Foremost the so-called crimp grip position where the PIP joint is flexed 901 or more and the DIP joint is hyperextended results in a distinct bowstringing (Schweizer, 2001) and stresses the distal edge of the A2 pulley mostly.…”

Section: Injury Mechanism Of the A2 Pulley In Rock Climbersmentioning

confidence: 99%

“…The presence of friction would explain also why rock climbers can resist immense forces by the finger flexors during the grip of very small holds although they do not show proportionally greater concentric muscular force compared to non-climbing subjects (Watts et al, 1996). Furthermore, friction would explain the mechanism of injury to the A2 pulleys in rock climbers more exactly (Bollen, 1990;Gabl et al, 1998), (A2 pulley: annular like ligament, part of the flexor tendon sheath, at the volar side of the proximal phalanx, prevents flexor tendons from bowstringing). Until now there is only evidence that friction between flexor tendons and pulleys may be apparent in a few in vitro measurements (Uchiyama et al, , 1997.…”

Section: Introductionmentioning

confidence: 99%

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Friction between human finger flexor tendons and pulleys at high loads

Schweizer

Frank

Ochsner

et al. 2003

Journal of Biomechanics

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A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads. r

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Section: Injury Mechanism Of the A2 Pulley In Rock Climbersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Friction between human finger flexor tendons and pulleys at high loads

Schweizer

Frank

Ochsner

et al. 2003

Journal of Biomechanics

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“…distribution of overuse injuries in this population (2)(3)(4)(5)9). Most of these studies have focused on hand injuries (4)(5)(6).…”

mentioning

confidence: 99%

Injuries Associated with Rock Climbing

Maitland

1992

J Orthop Sports Phys Ther

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“…Two papers were studies of diagnostic accuracy (18,19). The remainder of the articles included seven reviews (10,13,(15)(16)(17)24,34), two case studies (8,9), eight comparative studies (12,14,22,23,27,28,30,31), and 10 noncomparative studies (2,3,11,20,21,25,26,29,32,33), of varying quality. The findings are presented below in three sections corresponding to the three research questions.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis of finger flexor pulley injury in rock climbers: A systematic review

Sheikh¹,

Wong²

2006

CAN J PLAST SURG

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BACKGROUND: Closed injury to the finger flexor pulley system is found frequently in rock climbers. There are no evidence-based published guidelines on the diagnosis and treatment of these injuries. OBJECTIVES: The present systematic review was undertaken to answer the following questions: what are the most commonly recommended diagnostic criteria for finger flexor pulley injury in rock climbers; and, based on the available evidence, what is the best diagnostic test for these injuries? METHODS: Four electronic databases were searched using specific key terms, with limits set for language and date. Two reviewers independently identified potentially relevant titles based on inclusion criteria. Inter-reviewer variability was assessed using the Kappa statistic. The scientific quality of articles was assessed using validated scales. RESULTS: Of the 93 articles identified, 29 were included in the present analysis. The inter-rater agreement for selection of potentially relevant titles was 88% (kappa=0.74). The most commonly cited diagnostic criterion for closed finger pulley injury was clinical bowstringing of the flexor tendons over the volar aspect of the proximal interphalangeal joint. However, the best study of diagnostic accuracy for these injuries supports the use of dynamic ultrasound. CONCLUSIONS: Dynamic ultrasound is recommended for the diagnosis of closed finger pulley injuries in rock climbers. The prevailing notion that these injuries can be diagnosed by testing for clinical bowstringing is not supported by evidence.

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Injury to the A2 pulley in rock climbers

Abstract: Injury to the A2 pulley of the flexor sheath, resulting in bow-stringing of the flexor tendons, would appear to be fairly common in rock climbers performing at the present limits of difficulty. A typical case is described.

Cited by 122 publications

References 4 publications

Friction between human finger flexor tendons and pulleys at high loads

Friction between human finger flexor tendons and pulleys at high loads

Injuries Associated with Rock Climbing

Diagnosis of finger flexor pulley injury in rock climbers: A systematic review

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