Pulley Injury

Well done! You’ve taken the first steps to understanding and rehabilitating your Pulley Injury! Once you read this page answer the questions on the sheet given by your physiotherapist at Musculoskeletal Physiotherapy Australia and bring that to your next treatment session. Recovery from your Pulley Injury is crucial in order to achieve your goals and gain rapid and long-lasting results. Your physiotherapist at Musculoskeletal Physiotherapy Australia has requested that you read this page so that you understand your condition and know how to best manage in between physiotherapy consultations.

What is a Pulley?

Pulley InjuryAs I’m sure you can appreciate, hands are complicated. There are 27 individual muscles that operate the wrist and hand. Yes, 27 of them each side! These muscles act to flex (bend) and extend the wrist and fingers, move them side to side, rotate the wrist and do all kinds of things with the thumb. Pulleys are ligamentous material. You’ll find ligaments throughout your entire body, however pulleys act a little differently to most. The muscles that flex the fingers (and many other muscles that operate the wrist and hand), originate in the forearms, which is where Pulleys come into play. Without pulleys, when we flex our fingers, we would have bow-string effect, where the tendon of the finger flexors bows out from the finger, under the skin. While this would actually make us stronger (better line of pull), it would also make the fingers more difficult to use. The pulleys act to hold the tendon against the bones of the finger.

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 (see image above). 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?

A detailed history, taken by your Musculoskeletal Physiotherapy Australia Clinician, of the pain or injury can help to diagnose the injury, while a physical assessment of the fingers, hand, wrist, elbow and surrounding structures, can determine the specific structure/s affected and the best course of action in treating the condition. Treatment will depend on the grade of the tear. For less severe tears, manual therapy and a graduated strengthening program will be needed to rehabilitate the fingers. In some cases, the ligament may be completely ruptured (grade III), and surgery may be required to reattach the ligament. In a grade III tear, it is still important to attend physiotherapy before and after surgery in order to speed up rehabilitation, and minimise the risk of long term disability.

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 strengthening activities such as bicep curls and wrist curls, until you have seen a Musculoskeletal Physiotherapy Australia Clinician, as they may cause muscle imbalances that may slow your rehabilitation.
  • REMAIN ACTIVE, while avoiding aggravating activities, especially activities that involve stress on the fingers, for example activities that require strong gripping.
  • For RELIEF, try applying heat to the affected area. If using a heat pack, be sure to heat based on the guidelines of that particular heat pack, and always wrap the heat pack in a towel to avoid burn. CEASE if you have any negative reaction.
  • For RELIEF, applying ice to the area may help to reduce some pain and inflammation. However, this can be uncomfortable when applied to the hands. Be sure to wrap the icepack in a towel, and only apply for 10 minutes every 2 hours. CEASE use if you have any negative reaction.
  • RECEIVE physiotherapy care to get your joints, ligaments and muscles de-loaded and moving freely with no restrictions.
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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