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Finger Pulley Injuries in Extreme Rock Climbers: Depiction with Dynamic US¹

¹ From the Departments of Radiology (A.K., G.B., M.F.S., P.S., W.J., D.z.N.) and Traumatology (M.G.), University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; and the Department of Radiology, Division of Diagnostic Ultrasound (F.F., E.J.H.), Thomas Jefferson University, Philadelphia, Pa. Received April 8, 2001; revision requested May 11; revision received July 30; accepted September 14. Address correspondence to A.K. (e-mail: andrea.klauser@uibk.ac.at).

PURPOSE: To determine the ability of dynamic ultrasonography (US) to depict finger pulley injuries in extreme rock climbers.

MATERIALS AND METHODS: Sixty-four extreme rock climbers (climbing levels 8–11 on a scale ranging from 1 to 11; Union Internationale des Associations d’Alpinisme) with finger injuries (75 symptomatic and 181 asymptomatic fingers) were examined by using US, with the transducer operating at 12 MHz. The distance between the flexor tendon and phalanx was evaluated in extension and forced flexion at the level of the A2 and A4 annular pulleys as an indicator of tendon bowstringing. A distance between the flexor tendon and phalanx greater than 1.0 mm was interpreted as positive for a pulley injury. US findings were compared with those of magnetic resonance imaging. Surgical correlation was available in seven cases. Statistical analysis was performed by using analysis of variance, the Student t test, and the Bonferroni method.

RESULTS: US depicted 16 (100%) of 16 complete A2 pulley ruptures, nine (100%) of nine complete A4 pulley ruptures, six (86%) of seven surgically proved complete combined A2 and A3 pulley ruptures, and 15 (100%) of 15 incomplete A2 pulley ruptures. Measurement of distance between the flexor tendon and phalanx was significantly different among patient subsets without pulley ruptures and those with incomplete, complete, or complete combined pulley ruptures (P < .001). The sensitivity of US for depiction of finger pulley injuries was 98%, and specificity was 100%.

CONCLUSION: Dynamic US allows excellent depiction of finger pulley injuries in extreme rock climbers.

Index terms: Fingers and toes, injuries, 43.489 • Hand, injuries, 43.489 • Hand, US, 43.1298

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