University of Arizona College of Medicine, Phoenix, AZ.
University of Arizona College of Medicine, Phoenix, AZ.
Wilderness Environ Med. 2021 Jun;32(2):247-258. doi: 10.1016/j.wem.2021.01.011. Epub 2021 May 6.
Finger flexor pulley system injuries are the most common overuse injury in rock climbers. These injuries occur rarely outside of rock climbing, owing to the sport's unique biomechanical demands on the finger. As rock climbing continues to grow and earn recognition as a mainstream sport, an understanding of how to diagnose and treat these injuries also has become important. Our purpose is to describe current concepts in anatomy, biomechanics, clinical evaluation, imaging, prevention, and treatment strategies relating to finger flexor pulley system injuries. Our literature search was performed on PubMed with MeSH terms and keywords as subject headings to meet the objectives of this review. The "crimp grip" used in rock climbing is the mechanism for these injuries. The A2, A3, and A4 pulleys are at the highest risk of injury, especially when loaded eccentrically. Physical examination may reveal clinical "bowstringing," defined as the volar displacement of the flexor tendons from the phalanges; however, imaging is required for characterization of the underlying injury. Ultrasound is highly sensitive and specific for diagnosis and is recommended as the initial imaging technique of choice. Magnetic resonance imaging is recommended as an additional imaging study if ultrasound is inconclusive. Properly warming up increases the amount of physiologic bowstringing and is thought to prevent injury from occurring. Pulley injuries may be classified as grade I through IV. Conservative treatment, including immobilization, the H-tape method, and the use of a protective pulley splint, is recommended for grade I to III injuries. Surgical repair is reserved for grade IV injuries that are not amenable to conservative treatment.
手指屈肌滑车系统损伤是攀岩者最常见的过度使用损伤。由于该运动对手指的独特生物力学要求，这些损伤在攀岩以外的情况下很少发生。随着攀岩运动的不断发展，并被公认为一项主流运动，了解如何诊断和治疗这些损伤也变得尤为重要。我们的目的是描述与手指屈肌滑车系统损伤相关的解剖学、生物力学、临床评估、影像学、预防和治疗策略的当前概念。我们的文献检索是在 PubMed 上进行的，使用了 MeSH 术语和关键词作为主题词，以满足本综述的目标。攀岩中使用的“握力”是造成这些损伤的原因。A2、A3 和 A4 滑车最容易受伤，尤其是在偏心加载时。体格检查可能会发现临床“弓弦征”，定义为屈肌腱从指骨向掌侧的移位；然而，需要影像学来确定潜在的损伤。超声检查对诊断具有高度的敏感性和特异性，建议作为首选的初始影像学检查方法。如果超声检查不确定，则建议进行磁共振成像（MRI）检查。适当热身可增加生理性弓弦征的程度，被认为可预防损伤的发生。滑车损伤可分为 I 级至 IV 级。对于 I 级至 III 级损伤，建议采用保守治疗，包括固定、H 带法和使用保护性滑车夹板。对于无法通过保守治疗的 IV 级损伤，建议进行手术修复。
