Age / Sex : 43 / M

Chief complaint : Left 3^rd finger pain after lifting a furniture with a pop sound.

What is your diagnosis?


Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy: 지충근 (Choong Guen Chee), 서울 아산 병원 (Asan Medical Center)

A2 pulley injury (Rock Climber’s finger)

Discussion

Findings:

• Thickening and increased signal intensity of the A2 pulley, 3^rd phalanx, Lt


• Flexor tendon and sheath pulled away from volar aspect of 3^rd phalanx (Bowstring sign), Lt


• Fluid infiltration between the flexor tendon and 3^rd phalanx

Differential Diagnosis: none

Discussion:

References:

1. Crowley TP. The flexor tendon pulley system and rock climbing. J Hand Microsurg 2012; 4:25–29


2. Martinoli C, Bianchi S, Cotton A. Imaging of rock climbing injuries. Semin Musculoskelet Radiol 2005; 9:334–345


3. Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers. Wilderness Environ Med 2003; 14:94–100

4. Gupta, P., Lenchik, L., Wuertzer, S. D., & Pacholke, D. A. (2015). High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries. American Journal of Roentgenology, 204(3), W314-W323.