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

Abstract

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.

Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock Climbing Injuries

“…A recent review article on the diagnosis of climbing-related finger injuries suggested that dynamic ultrasound was highly accurate for the diagnosis of finger pulley injuries. 22 Another review article on the imaging of climbing injuries also emphasized that ultrasound had distinct advantages for imaging finger injuries, including high spatial resolution and dynamic capabilities. 23 These features make ultrasound an important tool for imaging tendons, ligaments, nerves, and other soft tissues.…”

Sonography of Non‐neoplastic Disorders of the Hand and Wrist Tendons

“…Acute tears of annular pulleys are frequently related to sport activities, specifically rock climbing, and mostly involve the middle and ring fingers . Patients present with pain and swelling over the affected pulley and may have a “pop” at the time of injury .…”

Review article: Best practice management of closed hand and wrist injuries in the emergency department (part 5 of the musculoskeletal injuries rapid review series)

“…). At full text, 23 primary articles, 26 SR articles and six guidelines were included in the review.…”