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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).

View larger version (30K): [in a new window]   Figure 1a. Schematic drawings of the US examination. (a) Normal annular pulley system (A1-A5) and flexor tendons. US was performed with the finger at rest. Transducer is positioned on the volar side of the finger (longitudinal scan). (b) Complete A2 pulley rupture. US with active forced flexion pressing the fingertip against the resistance (large arrow) of the radiologist’s finger demonstrates an increased TP distance at the level of the A2 pulley (between crosshairs). A1-A5 = annular pulleys, a = distal interphalangeal joint, b = proximal interphalangeal joint, c = metacarpophalangeal joint, FT = flexor tendon, G = gel pad, T = transducer.

View larger version (30K): [in a new window]   Figure 1b. Schematic drawings of the US examination. (a) Normal annular pulley system (A1-A5) and flexor tendons. US was performed with the finger at rest. Transducer is positioned on the volar side of the finger (longitudinal scan). (b) Complete A2 pulley rupture. US with active forced flexion pressing the fingertip against the resistance (large arrow) of the radiologist’s finger demonstrates an increased TP distance at the level of the A2 pulley (between crosshairs). A1-A5 = annular pulleys, a = distal interphalangeal joint, b = proximal interphalangeal joint, c = metacarpophalangeal joint, FT = flexor tendon, G = gel pad, T = transducer.

View larger version (82K): [in a new window]   Figure 2a. Complete A2 pulley rupture in a 32-year-old climber, demonstrated at US and MR imaging. (a) Longitudinal US scan demonstrates a TP distance of A2 of 3.1 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the proximal phalanx (short solid arrow) measured 21.5 mm from the base of the proximal phalanx (arrowhead). (b) Sagittal T1-weighted spin-echo (528/20) MR image demonstrates an anterior tendon (open arrows) displacement (long solid arrows) in the area of the A2 pulley. Short solid arrows = proximal phalanx.

View larger version (78K): [in a new window]   Figure 2b. Complete A2 pulley rupture in a 32-year-old climber, demonstrated at US and MR imaging. (a) Longitudinal US scan demonstrates a TP distance of A2 of 3.1 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the proximal phalanx (short solid arrow) measured 21.5 mm from the base of the proximal phalanx (arrowhead). (b) Sagittal T1-weighted spin-echo (528/20) MR image demonstrates an anterior tendon (open arrows) displacement (long solid arrows) in the area of the A2 pulley. Short solid arrows = proximal phalanx.

View larger version (97K): [in a new window]   Figure 3a. Complete A4 pulley rupture in a 25-year-old climber, demonstrated at US and MR imaging. (a) Longitudinal US scan demonstrates a TP distance of A2 of 3.7 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the intermediate phalanx (short solid arrows) (small black arrow = cursor). (b) Sagittal T2-weighted fast spin-echo (2,000/86) MR image demonstrates an anterior tendon (open arrows) displacement in the area of the A4 pulley (long solid arrows) at the level of the intermediate phalanx (short solid arrows).

View larger version (106K): [in a new window]   Figure 3b. Complete A4 pulley rupture in a 25-year-old climber, demonstrated at US and MR imaging. (a) Longitudinal US scan demonstrates a TP distance of A2 of 3.7 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the intermediate phalanx (short solid arrows) (small black arrow = cursor). (b) Sagittal T2-weighted fast spin-echo (2,000/86) MR image demonstrates an anterior tendon (open arrows) displacement in the area of the A4 pulley (long solid arrows) at the level of the intermediate phalanx (short solid arrows).

View larger version (92K): [in a new window]   Figure 4a. Complete combined A2 and A3 pulley rupture in a 29-year-old climber. (a) Longitudinal US scan demonstrates a TP distance A2 of 6.4 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the proximal phalanx (short solid arrows). (b) Sagittal T1-weighted spin-echo (528/20) MR image demonstrates an anterior tendon displacement (open arrows) in the area of the A2 and A3 pulley at the level of the proximal phalanx (solid arrows) and PIP joint. (c) Surgical photograph shows complete combined A2 and A3 pulley rupture (short arrows) and flexor tendons (long arrows).

View larger version (88K): [in a new window]   Figure 4b. Complete combined A2 and A3 pulley rupture in a 29-year-old climber. (a) Longitudinal US scan demonstrates a TP distance A2 of 6.4 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the proximal phalanx (short solid arrows). (b) Sagittal T1-weighted spin-echo (528/20) MR image demonstrates an anterior tendon displacement (open arrows) in the area of the A2 and A3 pulley at the level of the proximal phalanx (solid arrows) and PIP joint. (c) Surgical photograph shows complete combined A2 and A3 pulley rupture (short arrows) and flexor tendons (long arrows).

View larger version (133K): [in a new window]   Figure 4c. Complete combined A2 and A3 pulley rupture in a 29-year-old climber. (a) Longitudinal US scan demonstrates a TP distance A2 of 6.4 mm (long solid arrows mark crosshairs), with forced flexion measured between the flexor tendons (open arrows) and the proximal phalanx (short solid arrows). (b) Sagittal T1-weighted spin-echo (528/20) MR image demonstrates an anterior tendon displacement (open arrows) in the area of the A2 and A3 pulley at the level of the proximal phalanx (solid arrows) and PIP joint. (c) Surgical photograph shows complete combined A2 and A3 pulley rupture (short arrows) and flexor tendons (long arrows).

View larger version (87K): [in a new window]   Figure 5. Joint fluid collection in a 29-year-old climber. Longitudinal US scan demonstrates a hypoechoic area in the PIP joint representing fluid collection (arrow).