Sonographic evaluation of digital annular pulley tears

Objective. To evaluate the sonographic (US) appearance of digital annular p ulley (DAP) tears in high-level rock climbers. Design and patients. We performed a retrospective analysis of the US examin ations of 16 high-level rock climbers with clinical signs of DAP lesions. M RI and surgical evaluation were performed in five and three patients respec tively. The normal US and MRI appearances of DAP were evaluated in 40 and t hree normal fingers respectively. Results. Nine of 16 patients presented a DAP tear. In eight subjects (seven with complete tears involving the fourth finger and one the fifth finger), US diagnosis was based on the indirect sign of volar bowstringing of the f lexor tendons. Injured pulleys were not appreciated by US. Tears concerned the A2 and A3 in six patients and the A3 and A4 in two patients. A2 pulley thickening and hypoechogenicity compatible with a partial tear was demonstr ated in one patient. MRI and surgical data correlated well with the US find ings. Four patients had tenosynovitis of the flexor tendons but no evidence of pulley disruption. US examinations of three patients were normal. In th e healthy subjects US demonstrated DAP in 16 of 40 digits. Conclusion. US can diagnose DAP tears and correlates with the MRI and surgi cal data. Because of its low cost and non-invasiveness we suggest US as the first imaging modality in the evaluation of injuries of the digital pulley .