Finger Pulley Injuries & Treatment Remedies

by | May 9, 2021 | Outdoor safety, Treating injuries, Wilderness Medicine Case Studies | AWLS

A common injury for rock climbers is to finger flexor pulleys.  Climbers put massive stresses and dynamic loads on their fingers while trying to haul themselves up the wall. This post introduces a new therapy for these injuries.

Breaking News!  There is now a rock climbing emoji!  This is almost as exciting as competitive rock climbing being included in the 2020 Olympics.  Designed by professional climber Sasha Digiulian, it features both male and female versions of a rock climber.  After tweeting her displeasure with the lack of a climbing emoticon to @GetEmoji about 1 year ago, she teamed up Emojipedia and produced the climber emoji, which has been approved and is expected to be available later this year.  Rock climbing has become increasingly popular over the past several years and it was one of the few sports (if any) without a dedicated emoji.  See the related articles from Outside Magazine and Gripped.

On the heels of this revelation, I would like to introduce a new therapy for a specific rock climbing injury.  Rock climbing does have some inherent dangers.  To the uninitiated, it may not be intuitive that the most common injury is finger flexor pulleys.  Climbers put massive stresses and dynamic loads on their fingers while trying to haul themselves up the wall.  These loads can cause pulleys to tear or rupture, with the A2 pulley being one of the most commonly injured.

Finger pulleys.  Picture from Schneeberger paper.

Finger pulley ruptures are frustrating and classically take months to heal.  Single ruptures are usually treated conservatively with good outcomes, but multiple ruptures may be treated surgically.  Conservative options include inelastic tape or a thermoplastic ring.  Schneeberger and Schweizer offer a novel therapeutic approach to finger pulley ruptures with the Pulley Protection Splint (PPS).

The PPS allows splinting so the pulley can heal without compression of vessels or nerves.  In their study of 47 climbers, they found that the PPS reduces tendon-phalanx distance (TPD) compared to conventional treatments, although the functional effects of a reduced TPD are unknown.  The PPS also resulted in a range of motion similar to the contralateral side and return to previous climbing level in a mean of 8.8 months.   Since there was no control group undergoing conventional treatment, it is difficult to do a direct comparison.  However, other than the reduced TPD, these results are similar to other studies that used conventional treatment.

Pulley protection splint.  Picture from Schneeberger paper.

In conclusion, it seems like the PPS works at least as well as conventional treatment so it could be a good option for pulley injuries.  Also, you will probably go through far fewer rolls of tape during recovery.

However, a study directly comparing the PPS to conventional treatment would be ideal.  The PPS reduced the TPD compared to other studies using conventional treatment but we really don’t know what that means in terms of performance or strength. Unfortunately for all you climbers out there, this doesn’t seem to significantly shorten the time to healing: 8-9 months is still a really long time.   You’ll just have to learn how to rest.

Want more wilderness medicine information targeted to the medical professional?  We have you covered.

You can download wilderness med online courses and get CME credit from the comfort of home or as you travel.  Learn more about dealing with hand and wrist injuries in the wilderness. Other online topics include submersion injuries,  our new dive medicine module, ticks, emerging diseases, and more.

Or, if you’re up for a trip, consider taking part in our hands-on Wilderness Medicine courses taking place around the globe.


Alana Hawley, M.D.
Wilderness Medicine Fellowship, University of Utah
PGY-5 Emergency Medicine, McMaster University



Schoffl, V.R. and Schoffl, I.  (2006).  Injuries to the finger flexor pulley system in rock climbers: current concepts.  J Hand Surg Am.  31(4).  Doi: 10.1016/j.jhsa.2006.02.011

Schoffl, V.R., Einwag, F., Strecker, W., Schoffl, I.  (2006).  Strength measurement and clinical outcome after pulley ruptures in climbers.  Med Sci Sports Exerc.  38(4).  Doi: 10.1249/01.mss.0000210199.87328.6a

Schneeberger, M. and Schweizer, A.  (2016).  Pulley ruptures in rock climbers: outcome of conservative treatment with the pulley protection splint – A series of 47 cases.  Wilderness Environ Med.  27(2).  Doi: 10.1016/j.wem.2015.12.017

Cover image: Samantha Sophia via