If this patient weren’t a rock climber, what would he be?

This 35-year-old male rock climber has injured his ring finger while engaging in his favored pastime.

  • What do the pink arrows on image 1 depict?
  • What about the orange arrow on image 1?
  • On image 2, what is indicated by the purple arrows? Bear in mind that this axial projection is in the proximal one-third of the proximal phalanx.
  • What is the most common pulley to be torn?
  • What is the mass identified by the green arrows on image 3?
  • For a bonus question, see if you can think of another hobby that would be likely to produce the same injury (hint: it is not often culturally associated with rock climbing).

Axial T2-proximal phalanx

Axial T2-mid to proximal phalanx

Sagittal 3D SPIR

  • The pink arrows on image 1 indicate a tear of the ulnar side of the proximal A2 pulley.
  • The orange arrow points to an intact pulley (it was mildly sprained elsewhere).
  • On image 2, the purple arrows point to the more distal aspect of the A2 pulley, which is stretched but remains present.
  • The A2 pulley is the most common pulley to be torn.
  • The green arrows on image 3 point to the normal volar plate which appears more conspicuous due to finger flexion as it is compressed or accordioned due to finger positioning. It is often confused with a mass!
  • Another hobby (or sport) that can lead to pulley tears is bowling.
  • We showed you a similar case in February 2017. But it did not show the sagittal projection with a flexed finger, so-called “bow-stringing sign” of pulley failure.
  • For more case review, visit MRI Online.
  • Newsletter Signup