Ultrasonographic Diagnosis of A2 or A4 Flexor Tendon Pulley Injury: A Systematic Review

  1. Department of Physiotherapy, Universidad Camilo Jose Cela, Madrid, Spain
  2. Eskura Osasun Zentroa, Beasain, Spain
  3. Orthopedics Department, Clínica Pakea-Mutualia, San Sebastian, Spain
  4. Ultrasonography Department, Clínica Ercilla-Mutualia, Bilbao, Spain
  5. Department of Physiotherapy, Universidad de Sevilla, Seville, Spain
  6. Department of Plastic Surgery, Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain


A2 or A4 annular finger pulley tears are common injuries in rock climbers. This study reviews the measurement procedures used and tendon-to-bone distance data obtained on high-resolution ultrasound images when diagnosing isolated rupture of the A2 or A4 pulleys. Out of 3447 records extracted, only 7 remained after applying the exclusion criteria. In diagnosing a complete rupture, tendon-to-bone distance used varied widely from 1.9 to 5.1 mm for A2 and from 1.8 to 3.1 mm for A4. Our findings point to a lack of consensus diagnostic criteria for pulley injuries and identify technical details needing further research.