/ A2 Pulley Rupture: Surgery or conservative approach?

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mathesar - on 27 Jul 2015
Dear All,

Looking for some consensus regarding A2 Pulley rupture; I've had a ultrasound scan 12 days ago that confirmed I've ruptured the A2 pulley in my ring finger on my left hand.

Advice for treatment seems to fall almost 50/50 between surgery and conservative approach.

Just hoping a few peeps could give their own experiences from either treatment. Details on recovery times?
Anyone use the NHS for surgery?

I'm unsure what choice to make?



PS hope this is the most appropriate forum for my topic?
althesin on 27 Jul 2015
In reply to mathesar:

Climbing partner had repair last year, excellent surgeon, poor result, so on that basis I would recommend conservative management first.
mathesar - on 27 Jul 2015
In reply to althesin:


I wonder if you could expand on what was the reason for the poor result? Did it pop again?
I have reservations on the success rate of either treatment; probably less so with surgery.
If it was a tear I'd have no issue with conservative approach.
climberchristy on 28 Jul 2015
In reply to mathesar:
I had same rupture to same finger on left hand. My surgeon (nhs) was brilliant. Told me surgical repair is ONLY option if its a full rupture not just a partial tear. think of the pulley like an elastic band thats snapped. If theres no material left attached then the two ends are floating about seperately. How can they re-attach without intervention?Result was excellent. That finger now feels stronger than ever. Its been 3 years since surgery and no pains or even a hint that it will reinjure. Recovery was 2 weeks with no use of hand to grip at all eg no driving. Then about 6-8weeks physio and gradual use. I started climbing after about 4 months. My climbing partner is a physio and he too said as soon as i did it that surgery was only option. Good luck with it.
Post edited at 06:12
mathesar - on 28 Jul 2015
In reply to climberchristy:

Cheers Climberchristy

I hope you can answer a few follow up questions: How long was it between injury and surgery?
What was the waiting time for surgery ie once someone say a specialist or GP confirmed it was rupture and surgery was needed, how fast or slow was the NHS?

Can you provide a little detail on what form the physio took, was it a combination of massage & exercises?

PS can you tell us the name of surgeon?

cb294 - on 28 Jul 2015
In reply to mathesar:

Full rupture : Surgery

Partial: Conservative

Either : Loads of tape for the foreseeable future!

BobbyH - on 29 Jul 2015
In reply to mathesar:

Not an A2 pulley, but a ruptured central slip extensor (over the back of the PIP joint of my index finger) - took a few weeks to get to see a consultant through the NHS, but he basically prodded it, diagnosed the rupture, and asked what I was doing the following day. 24hrs later and I had a new central slip extensor. 1 month of full rest and 3 months of rehab/scar tissue stretching later and i was back climbing just as strong as ever and with the bare minimum loss of flexion.

so +1 for an excellent NHS experience. Expect I just got lucky though.
mathesar - on 30 Jul 2015
In reply to BobbyH; et al

Thanks peeps who contributed
I can only hope the NHS will come up trumps



juanbrein - on 30 Jul 2015
In reply to mathesar:

How to start, I've been climbing for almost 10 years now. The second year I had a full A2 pulley rupture. Bummer.

Same dilemma as you. After reading endless sources and taking advice from different people including doctors, friends and climbers... I came up with a hand doctor that was specialized in rock climbing injuries.

He basically told me:

Only go to surgery if you had a multiple pulley rupture and your finger is mechanically affected. That is, you can't bend it at all , you can see tendon bowstring and there is no way your body will be able to recover by itself. Unless you are a professional climber that has access to high skilled surgeons and proven recovery treatments on rock climbers in the past, don't do it.

Thing is the hand, is one of the most complex mechanical systems in our body. You screw it... and the consequences can be very bad.

On the other hand the conservative treatment is actually very effective. I rested for 3 months... yes I know... is a bit of a bummer. Look for other activities, running, cycling, etc. Then started to climb slowly. In 6 months I was climbing at 70 to 80 % of my capacity before my injury. 1 year later I was fully recovered.

The forth year of my short climbing career I had the same on my other hand. Damn it! Did the same thing...

Today I'm way more careful than I used to be... I understand my body much more and have less injuries. I don't go to the absolute limit any more though.

Hope it helps and good luck with whatever you decide to do.



John Kettle - on 30 Jul 2015
In reply to mathesar:

If you decide to go for surgery, be aware you can request your surgeon on the NHS (may have to travel to get to the best one, but it's worth it!). Many of the best private surgeons also operate on the NHS.
I have a friend who didn't treat his fully ruptured A2 at all! Continued with his career as an alpine guide. 27 years on it's still bow-stringed (he can't straighten it) but he's climbed 8a/E6/V7 on it and clocked up 27 full alpine seasons. It's just as strong as his other fingers, but he can't hold slopers so easily, and he can't hand jam with that hand as it mangles the knuckle.
chrissyboy - on 30 Jul 2015
In reply to mathesar:

I did my A2 pulley, tell tale bowstring white line.
Hand in very cold water 5- 6 times a day was definitely the key.
It took 3 months but no surgery and its 100% good.
Hope you get it sorted.
climberchristy on 31 Jul 2015
In reply to mathesar:

Hi. I went to a and e the same night i did it. Doctor there referred me straight to hand specialist. Saw him within a week. Surgery about two weeks later. Consultant surgeon is called mr middleton at north tees hospital stockton-on-tees. Excellent guy. very friendly. Understands climbers. cannot praise him enough. His registrar is a climber. Physio was just lots of stretches to keep finger mobile. In later stages these used warm up putty. I would def speak to a specialist because as i said earlier if is def a FULL rupture then i think a consultant will advise surgery. My repaired finger is now my strongest!! Good luck. Christy.
mathesar - on 31 Jul 2015
In reply to all:

Thanks again for the contributions the difference in whether or not to opt for surgery over the conservative approach is a little baffling.

I wished I went to A&E in the beginning as it seems a bit more direct. I went to the minor injuries unit instead as your told not to clog up A&E unless it's a real emergency.
All they did was an X-ray = it's not broken and tendon is OK = not snapped. Go home!
I opted for private funded ultrasound scan to find out if I had rupture my pulley = expensive and not the rapid turnaround I was expecting from a sport injury clinic.

Anyone think I should walk into a A&E dept now?
Wait for sport injury clinic to advise?
Go through my GP?

I hate injuries especially when my friends can keep climbing without me! Boo!

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