Does ruptured A2 pulley ever actually heal?

Ruptured my A2 pulley on Saturday (left hand ring finger).  Finally got into a hand specialist/surgeon Wednesday.  Surgeon said I ruptured the A2 pulley, surgery is not recommended, and that the pulley will never actually heal.  I get a different impression from what I have read.  Is it true that a ruptured A2 pulley will never heal and that when I return to climbing I will be relying on the A1 and A3 to do the work the A2 use to do?

I have had partial tears of my ring-finger A2 pulley in the past and I have fully recovered every time.

By the way, here is an interesting article about finger tendon pulley injuries: http://nicros.com/training/training-articles/finger-tendon-pulley-injury/

I had complete rupture of my A2 on left hand ring finger in 2005.  Surgeon recommended surgery to repair it (which I declined).  

I don't think that a pulley can regrow or heal with a complete rupture, but you should regain full function and range of motion - without the pulley.  A partial tear might behave differently - you want to rest to prevent further tearing I suppose (like the article says).  I didn't stop climbing at all, just kept climbing easier stuff and ignoring the pain.  

Was yours a complete rupture or a partial tear?

Trust the surgeon, or get a second opinion. I think plenty of us have thrown a pulley on our ring fingers and are still climbing. By any chance are you O blood type? 

No, it will not heal since the pulley is made of tendon material. I had my A2 surgically repaired about 15yrs ago. The MRI showed that it was partially torn but I made the decision to have surgery, and once the surgeon opened up my finger, it was completely blown.

Yes, you will be relying on the A1 and A3 pulleys, but the bigger issue is that over time, your finger will develop a permanent bend and will not be able to straighten the finger completely.

If you haven't already, I would seek a second opinion about having surgery. The recovery period isn't that long as long as you don't try to do too much with PT. I returned to climbing about eight weeks post surgery.

Hope that helps.

Chris 

Thanks for the insights.

The meeting with the surgeon was real fast (less than 10 minutes for sure).  No imaging so it is not certain whether it was a complete rupture or a bad tear.  He suspects a complete rupture.  There was an audible pop when it went (could hear it 15 feet away).   His logic seems to be that surgery is over the top for a single pulley rupture or tear.   And that it is not going to heal regardless of treatment.    Just wait a month and then ease back into climbing.  

I am o negative blood type.  Why do you ask?

The crazy thing is I was not even doing a super hard move.  I was climbing below max grade.  I was stiff and it was the first move of the day so I was less than graceful and I had to try it twice.  I was surprised when I heard the pop but knew what it was when I heard it.  

Just a hunch. 
Or maybe more.

I had a pulley blow earlier this year. A2 ring finger after the hard crimp while holding a sloper in late May. Just like you it was very loud, my belayer thought i pulled a rock off. I'm back to climbing although not a full strength quite yet.

After that I did a fair amount of reading on the topic. The journal of hand surgery article from 2006 that seems to be the go to for pulley injuries indicates surgery only if there is a complete rupture and other partially torn pulleys. It is impossible to say without imaging what your pulley looks like. As others have indicated if you have a complete rupture it will never heal on its own, but your body will compensate. My wife had a severe pulley blow about 7 years ago now, she never got it checked out. She couldn't use her ring finger at all for over a year. She can now hold crimps better than me with no surgery. That said she couldn't climb for about 3 years.

Overall though i would echo others, get a second opinion. If you get imaging done, which you should, get an ultrasound. It works better because you can move your finger during the imaging. And even if you have a complete rupture it will heal without surgery, if you want to avoid it.

Floyd Eggers wrote: Just a hunch. 
Or maybe more.

Solid reference to the Hungarian journal of traumatology, ca. 1990. 

Brian Shaffer wrote:

Solid reference to the Hungarian journal of traumatology, ca. 1990. 

Thanks. You might be surprised that other countries do studies too. *gasp*

Make sure you don't float off into space. Issac Newton was English, so gravity might not be relevant here.

clemay wrote: No, it will not heal since the pulley is made of tendon material. I had my A2 surgically repaired about 15yrs ago. The MRI showed that it was partially torn but I made the decision to have surgery, and once the surgeon opened up my finger, it was completely blown.

Yes, you will be relying on the A1 and A3 pulleys, but the bigger issue is that over time, your finger will develop a permanent bend and will not be able to straighten the finger completely.

If you haven't already, I would seek a second opinion about having surgery. The recovery period isn't that long as long as you don't try to do too much with PT. I returned to climbing about eight weeks post surgery.

Hope that helps.

Chris 

Regarding your 2nd paragraph, that was not the case for me. I would never know anything happened to my finger. Works completely normally, as it did prior to the rupture. YMMV

Go to a surgeon that understands what climbers do and how important our hands are to us. It may be overkill for a non climber to have it repaired but not for us. I vote you get a second opinion. It may be the same but at least you won’t be second guessing. 

Floyd Eggers wrote: Just a hunch. 
Or maybe more.

These links discuss the achilles tendon, which is more prone to breaking if you have O blood. The A2 pulley is a ligament, not a tendon - ligaments connect bone to bone, while tendons connect muscle to bone. In another study ( ncbi.nlm.nih.gov/pubmed/157…), they show the same trend with achilles tendon injuries, but for a host of other injuries (including ACL rupture, which IS a ligament) there was no difference between blood types. 

I ruptured my rt ring finger A2. A surgeon discouraged surgery because he said that for the risks (surgery always carries a risk of infection, poor healing, weak spot) and that fact that that finger isn't quality-of-life critical, it was better to be conservative, take time off, and do therapy. Well, fives months later I started back at it and I'm not all too unpleased with how I'm doing. Of course I always tape it now.

Frankly with climbing and non-climbing related health problems, I just accept that my body is an amazing POS sometimes. And other times it isn't so bad. Maybe it's the O- blood type, maybe it was too many Funyuns as a kid, who knows. But I'm gonna keep trying until I absolutely can't climb anymore

FYI:

I only scramble, highpoint, and backpack, but I do have some expertise in martial arts - this is where I completely ruptured my left ring finger A2 & A4 in one event. Additionally, the next door fingers were also severely hyper-extended, but were only inflamed and sore. I am right-handed. Like all of you: my hands are extremely important to my daily activities and the associated mental health.

MRI MINIMALLY required.

As mentioned, and mirrored by my THREE [independent] surgeons, surgery was strongly suggested unless I would accept a curled up finger in a few months, and then, potentially,  the rest of my life. I live in an area with a great selection of excellent surgeons, and pro-sports physicians... outside of Chicago. I am healthy, and fit. I opted for surgery.

Briefly: reconstructed A2 & A4 using a sacrificial palmaris longus from my left arm. Wow: they waaayyy underestimated the effect of removing that allegedly "unused" tendon. My hands are VERY strong, and just that area took more time to regain strength than the hand & finger. Months of diligent non-minimall therapy still led to contracture. However, I did regain full flexion strength - just really bad Range of Motion. Second opinion after that said leave it alone. I wanted my hand fully restored. I opted for Contracture Release (PIP) surgery. I was ecstatic post-op, full ROM... ahhh but it was short-lived. Again, even with diligent first-rate P.T., just six months later the PIP was contracting again. I gave it 9 months therapy, and a full year until I sought the advice from the hand-man for the Bulls and White Sox. Ulimately: leave it alone... the A2 & A4 repair had failed.

I should say that the two sports specialists actually used the word "destroyed" when describing the severity of my injury. The sheaths were shredded throughout the immediate area - which lead to much more scaring. As of today, 2.5 years post-injury and 1.5 years post-2ndOp i have full flexion strength, but an unpleasant 75 degree PIP with only about 10 degrees ROM. The MP joint has automagically changed its ROM to try and accommodate the now restricted PIP ROM - so I can actually "get it out of the way" for, say, a slap. ALL agree that I should be VERY happy with that. I'm not there yet, but I can lift weights and grab whatever I wish. Horrible in the cold.

That's it.

As to the O.P. question: no, complete ruptures never heal, but scaring and adhesions can make the area "firm."

Ryan Johnson wrote: Ruptured my A2 pulley on Saturday (left hand ring finger).  Finally got into a hand specialist/surgeon Wednesday.  Surgeon said I ruptured the A2 pulley, surgery is not recommended, and that the pulley will never actually heal.  I get a different impression from what I have read.  Is it true that a ruptured A2 pulley will never heal and that when I return to climbing I will be relying on the A1 and A3 to do the work the A2 use to do?

It depends on your definition of "heal".  The pulley itself will never be quite the same as it was before the rupture.  But that is true whether you get surgery or not.  

More importantly though if you treat it properly, without surgery, the *use* of your finger will be the same.  

Whether you call that "healed" or not is a matter of semantics.

For a single full pulley rupture, or even that plus a partial rupture of the next pulley adjacent to it, I wouldn't even consider surgery.

I highly recommend you (and anyone who has been injured or may be in the future - meaning everyone) buy a copy of the book "One Move too Many".

Cheers,

GO

Any advice on how to NOT rupture a finger pulley?

grog m wrote: Any advice on how to NOT rupture a finger pulley?

Warm up your body before climbing, but especially your fingers (rubber band extensions, finger tendon glides, squeeze a soft ball).

Use an open handed grip. Full crimp (with the thumb) is stronger but increases the forces on the pulley.
Don't try cruxy moves over and over and over.
Stay hydrated.
Listen to your body.

grog m wrote: Any advice on how to NOT rupture a finger pulley?

in addition to the above suggestions (warming up, flossing your tendons etc.), preventative taping is never a bad thing. I still tape my left ring finger even though its been fully healed for about a year now.

So it has been close to a year and a half since my injury and initial post.  It is probably good to return and report what I have learned and experienced.  In short, I actually seem to be better off now than I was before my A2 pulley ruptured.  For a couple of years before the accident I struggled with the pulley getting a little sore towards the top when I over did it, requiring taping and time off to recover--over and over again.  Now it never, ever hurts no matter how hard I push it.  However, I do have to be careful with my A2 pulley on my ring finger on the opposite hand.  

After the injury I sought advice from two hand surgeons.  The first one told me the pop I heard was a complete rupture, that it would never heal and that I was not worth more than five minutes of his time (the last sentiment was implied).  The second surgeon described a scenario where I would heal to an extent; that the pulley would never be very tight and supportive but that it would likely not be flapping around in my finger if I stayed off it and gave it a chance.  He also predicted that I would not have too much trouble with inflammation.   He was correct. I have not struggled with inflammation.  When I first started climbing again my knuckle felt really weird and strained but it has adapted so it feels normal now.  I do not tape it at all.  It bowstrings less now than after the initial injury so something happened that caused it to firm up a little in the area where the A2 pulley ruptured.  

I found the book "Climbing Injuries Solved," by Lisa Erikson to be helpful.  None of the doctors I saw wanted to splint my finger as recommended by the research Erikson cites so I splinted and tapped it myself in hopes something good might have come of it.  No surgery was definitely good advice.  The body is amazing at adapting.  I just turned 46 and am enjoying climbing regularly with my kids and am right there with them when it comes to setting goals and striving for climbing dreams though they progress much faster than I do.  

grog m wrote: Any advice on how to NOT rupture a finger pulley?

IMHO, regular hangboarding of virtually any variety/method/protocol helps a ton by isolating and loading the fingers in a more controlled manner than actual climbing.  Even if you're not hell-bent on increasing finger strength for performance reasons, I think (especially for aging climbers like myself) regular hanging serves as valuable injury prevention.

While climbing, avoid (as much as possible) making repetitive tweaky moves and, especially while figuring beta for a climb, don't be afraid to just fall versus trying to "save" yourself from doing do.