Schoffl et al developed a grading scheme for injury to a finger's pulley mechanism. This can be used as a guide for patient management. The authors are from Klinkkum Bamberg and Friedrich Alexander University of Erlangen-Nuremberg in Germany.
General guidance:
(1) Ultrasound can be used for the initial assessment in order to determine the dehiscence of tendon from bone (defined as a distance >= 2 mm).
(2) MRI may be helpful if the diagnosis is uncertain.
(3) Conservative therapy is used for single ruptures while surgery is used for more complex injuries.
The grading system (Grades 0 to 4) for pulley injury is described above.
|
Grade of Injury |
Surgery? |
Period Immobilized |
Rehab- ilitation |
Pulley Protector |
|
1 |
no |
none |
2 to 4 weeks |
tape |
|
2 |
no |
10 days |
2 to 4 weeks |
tape |
|
3 |
no |
10-14 days |
4 weeks |
ring |
|
4 |
yes |
14 days after surgery |
4 weeks |
ring |
where:
• The protective ring for Grade 3 or 4 injury is soft-cast or thermoplastic.
|
Grade of Injury |
Easy Activities |
Full Sport (time from injury) |
Need for Protector |
|
1 |
after 4 weeks |
after 2 more weeks (6 weeks) |
3 months |
|
2 |
after 4 weeks |
after 4 more weeks (8 weeks) |
3 months |
|
3 |
after 8 weeks |
after 4 more weeks (12 weeks) |
6 months |
|
4 |
after 16 weeks |
after 8 more weeks (24 weeks, 6 months) |
12+ months |
Specialty: Surgery, orthopedic
