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Re: [cracklover] A2 pulley: ruptured or torn?:
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drrock
Mar 13, 2007, 4:01 PM
Views: 17424
Registered: Oct 18, 2003
Posts: 610
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cracklover wrote: FYI, the standard therapy for a fully ruptured A2 pulley is more aggressive than what drrock is suggesting. Yes, you can leave it alone, and the muscle will eventually take up most of the tension lost from the lack of mechanical advantage from the missing A2 pulley, but if you go this route, you'll probably never gain full strength or mobility, and this will also put more strain on the other pulleys in that finger. There is a standard surgery that's usually done, where they create a new pulley out of a piece of one of your other tendons. This, apparently (I've only read about it) is pretty successful. Again, this is only for a fully ruptured A2 pulley (that's the pulley right at the base of your finger, just before it enters your hand). GO
You may be right. I suppose what you suggest about increased tension on the other pulleys in that finger makes sense. I don't know about the lack of regained strength, but mobility is a *tiny* bit impaired. I never notice it either climbing or in daily life. I have heard that the mechanical advantage is greater in the fingers actually without the pulleys, so theoretically strength should be improved. I wouldn't suggest deliberately rupturing your pulleys though for this purpose. Not sure if this is actually true, as I slept through most of physics class.
There was a somewhat recent article in Wilderness and Sports Medicine in 2003 by Volker Schoffl and colleagues who suggest based on their prospective research of 600 climbers, 74 of whom had pulley ruptures during the study period (single or multiple). They graded them, and the bottom line is that they found that grade 1-3 responded well to conservative, non-surgical measures where grade 4 basically required surgery for function. Their grading scheme was:
Grade 1: Strain
Grade 2: Complete A4 or partial A2 or A3
Grade 3: Complete A2 or A3
Grade 4: Multiple ruptures *or* a single rupture combined with lumbricalis muscle or collateral ligament damage
You can argue with their treatment schema and how they came up with the design of the study, but the bottom line is that they did not do surgery on Grade 1-3 and those people had very little pain or functional impairment after 3 months. They did have those folks off of climbing for 6-8 weeks, I think, with early finger therapy for mobility.
I did not have this data when I was making my decision. The surgeon wanted to operate on the finger and do the repair you mention with the palmaris longus tendon, but mentioned that I would be out of climbing completely for 4-6 months, no exceptions. I was not willing to concede to that and figured I would probably be better by 4-6 months anyway, and I was right, for better or worse. Everything I had read up to that point lead me to believe that while surgery was an option, it was certainly not necessary. This all happened right around the time this article came out, and it's not like this is a huge hand surgery journal that this guy would have been reading in any case.
Anyway, good discussion about a common problem. If it were me, with a complete single A2 rupture without any other associated damage, I would absolutely not allow any surgeon to operate and I would recommend the same for anyone else.
Edited for clarity and spelling, duh.
(This post was edited by drrock on Mar 13, 2007, 4:12 PM)
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Post edited by drrock
() on Mar 13, 2007, 4:10 PM
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Post edited by drrock
() on Mar 13, 2007, 4:12 PM
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