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What is a Pulley?

As I’m sure you can appreciate, hands are complicated. There are 27 individual muscles that operate the wrist and hand. These muscles act to flex (bend) and extend (straighten) the wrist and fingers, move them side to side, rotate the wrist and multiple different movements at the thumb. Pulleys are made of similar tissue to the ligaments throughout your body, however they act slightly differently. They act to keep the tendons, that run down your hand and fingers, close to the bones. The muscles that flex the fingers (and many other muscles that operate the wrist and hand), originate in the forearms. Without pulleys, when we flex our fingers, we would have bow-string effect, where the tendon of the finger flexors would bow out from the finger, under the skin. While this would actually make us stronger, it would also make the fingers far more difficult to use.

What caused my Pulley Injury?

Pulley injuries occur when excessive stress is placed on them. More often than not, this occurs when the stress placed on them is rapid and sudden, but it may also result as an overuse injury, due to repeated trauma. The most commonly injured pulley is known as the A2 pulley. A common mechanism of injury is a rock climber performing a “crimp”, and slipping off the hold, thereby placing a rapid overload of tension on the tendons, and by association, the pulley. Pulley injuries, like any other ligament injury, can be graded by levels of severity, with a grade I tear affecting up to 25% of the pulley fibres, a grade II tear affecting from 25-90% of the pulley fibres, and a grade III tear affecting from 90-100% of the pulley fibres. This may also be referred to as a “Pulley Rupture”.

How can you help me with my Pulley Injury?

Your physiotherapist will perform a through and detailed assessment in order to fully understand your pulley injury and how it is affecting your life. From this assessment of your finger and hand, as well as the surrounding muscles, nerves and joints, your physiotherapist will be able to provide you with an individualised treatment plan to get you back to full function. Typically, you program will include treatment techniques designed to improve pain levels and restore your finger mobility back to normal levels. You will then start on a rehabilitation program designed to return to your optimum level. In some cases, immobilising your finger with a splint, or in some grade 3 tears surgery may even be required. In these cases, physiotherapy is recommended following this stage in order to ensure you get the best results.

What should I do to avoid aggravating my Pulley Injury?

  • AVOID activities that aggravate your pain, until you have seen a Musculoskeletal Physiotherapy Australia Clinician.
  • AVOID generic upper-limb strengthening activities such as bicep curls and wrist curls, until you have seen a physiotherapist.
  • REMAIN ACTIVE, while avoiding aggravating activities or activities that require a strong grip
  • For RELIEF, try applying heat to the affected area.
  • For RELIEF, applying ice to the area may help to reduce some pain and inflammation.
  • RECEIVE physiotherapy care to get your joints, ligaments and muscles performing to their optimum level

Keep good care of your body and your physiotherapist will continue to monitor your condition. Once your Pulley Injury has resolved you will be able to resume your full activities without worrying about future flare-ups.

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