The climber’s finger : imaging of finger flexor tendon pulley injuries

INTRODUCTION: Finger flexor tendon (FT) pulleys are delicate anatomical structures whose primary function is to anchor the tendon sheaths to the underlying bone. They maintain the tendons in close proximity to the phalanges, thereby stabilizing them during finger flexion. This arrangement allows for efficient force transmission, preserves an effective lever arm, and prevents bowstringing, ensuring a full range of motion. These structures can be accurately assessed using high-resolution ultrasound (US) or high-field magnetic resonance imaging (MRI). METHODOLOGY: We conducted a structured narrative literature review on the imaging of finger flexor pulley injuries in climbers, searching PubMed/MEDLINE, Scopus, and Web of Science. The search strategy combined the following keywords: "finger flexor pulley injuries," "climber's finger," "pulley rupture," "pulley tear," "rock climbing injuries," "human finger flexor pulleys," "ultrasound," and "MRI." References of selected articles were manually screened to identify additional relevant studies. Included studies addressed anatomy, biomechanics, clinical presentation, diagnostic criteria, imaging findings, and management of finger pulley injuries. Both experimental (cadaveric) and clinical studies were considered if they provided relevant imaging or diagnostic insights. CONCLUSION: A detailed understanding of the anatomy, biomechanics, and both normal and pathological imaging appearances of finger FT pulleys-particularly through dynamic and functional imaging-is essential for accurate assessment of traumatic injuries. This knowledge supports clinicians and surgeons in selecting the most appropriate therapeutic strategies.