Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley- Protection Splint—A Series of 47 Cases Micha Schneeberger, BS, Andreas.

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Presentation transcript:

Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley- Protection Splint—A Series of 47 Cases Micha Schneeberger, BS, Andreas Schweizer, MD Wilderness & Environmental Medicine Volume 27, Issue 2, Pages 211-218 (June 2016) DOI: 10.1016/j.wem.2015.12.017 Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 1 The finger flexor tendons glide in a sheath reinforced by annular (A1–A5) and cruciform (C1–C3) pulleys. The tendons are kept close to the phalanges also during finger flexion. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 2 A, Pulley-protection splint with padding on the contact zones to provide a comfortable fit. B, The splint’s lateral convexities prevent compression of blood vessels and nerves running along both sides of the finger. FDP, flexor digitorum profundus tendon; FDS, flexor digitorum superficialis tendon. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 3 The pulley-protection splint forces the flexor tendons back into their usual position close to the phalanges. The most effective bowstringing reduction is achieved when the splint is placed right next to the proximal interphalangeal joint, here in case of an A2 pulley rupture. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 4 Shaping a customized pulley-protection splint using a template. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 5 Explanatory picture from the questionnaire showing how to record the outline of the back of the finger on a piece of paper for later analysis of range of motion, here for the middle finger in maximal flexion. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 6 Effect of treatment with the pulley-protection splint on tendon-phalanx distance (TPD). Tendon-phalanx distance was reduced in all 39 climbers who were followed up with ultrasound. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 7 Tendon-phalanx distance in an A2 pulley rupture before (top) and after (bottom) treatment with a pulley-protection splint. FDP, flexor digitorum profundus tendon; FDS, flexor digitorum superficialis tendon; PIP, proximal interphalangeal. Wilderness & Environmental Medicine 2016 27, 211-218DOI: (10.1016/j.wem.2015.12.017) Copyright © 2016 Wilderness Medical Society Terms and Conditions