Ruptured Pulleys

A few months ago I was at a rock climbing gym for fun and fitness with my kids when I injured my right hand’s ring finger. The gym staff downplayed the injury, only recommending icing and resting the finger for a few weeks. I was eager to get back into climbing so I took their advice.

After a few weeks I took the injury to a doctor. She ordered an X-ray and, seeing no fracture, treated the injury like a common sprain. She splinted the finger in a bent position and left it at that.

With hindsight, I now know I should have seen an orthopedic hand specialist as soon as possible. The original injury was a rupture of the pulleys that hold the flexor tendons against the finger bones. This weakened my grip and made certain motions painful. Over the weeks, lack of proper splinting allowed bowstringing of the tendons and “volar plate contracture” which is a tightening of the ligament that keeps the joint from hyperextending, resulting in a finger that won’t straighten. Now I have two problems.

Because I didn’t see a specialist right away, the straightest I can get my finger to extend is about 45º. This makes typing difficult because I can’t reach the upper right keys without moving my whole hand. I can’t even flatten my hand to wipe a table or give a nice pat on the back. These little things add up to make a bent finger a rather significant handicap.

A few weeks ago I found a hand surgeon and an occupational therapist, and last week I got an MRI. The occupational therapist, trying to help me straighten the finger, made a splint that lets me apply straightening forces with Velcro straps. He told me to wear it six times a day for an hour. I also visit the OT 1-2 times a week for manual stretching. He exhausts his own hand strength applying maximum force for a few minutes at a time. The therapy hurts but it helps measurably. The splint also interferes with everything I do, but one week of this treatment improved range of motion by about 3º.

Today the surgeon presented the MRI images to a board of hand surgeons and then went over the results with me. There are several different surgical paths available, none of them very appealing. There are also non-surgical options such as progressive casting. At any rate, range of motion must be restored before pulley reconstruction surgery can even be considered.

After discussing all of the options, we agreed to continue splinting on an even more aggressive schedule. This should get results more similar to what a cast would give but I would be able to remove the splint to stretch the finger and to continue participating in activities involving the hand.

I removed the splint to type out most of this but I must wear it for the rest of the day. I will keep typing and mousing though it will be slow and painful.

The best I can hope for is to regain full range of motion through months of splinting and therapy. This seems better than surgery followed by recovery involving months of splinting and therapy. After that, we must evaluate the pulley situation and decide whether to repair them internally with surgery or simply to rely on external support such as tape or orthotic rings when activities require.

Velcro, I beseech thee!

5 thoughts on “Ruptured Pulleys

  1. Man, that’s a bummer… Sounds as inconvenient and painful as a condition called “trigger finger”, which welders often get. It’s the carpal tunnel syndrome of their industry.

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