There is a wide range of healing time given in the literature as to when a pulley is healed and ready to bear heavy loads. The extent of injury, including grade and number of pulleys involved will factor into the timeline for healing graded progression in strengthening back to rock climbing.
Most often treatment or a pulley injury involves protective splinting or taping and reduced loads to allow the tissue to heal. Only rarely is surgical intervention necessary.
Lower grade annular pulley injuries typically heal in approximately 2-3 months, and after 4-6 months they can withstand heavy loads (Schoffl 2003). The initial loss of strength after rupture resolves in about 6 months (Schoffl, 2006).
Another study involving rock climbers concluded that most climbers with Grade I and II injuries can achieve full recovery within 6 weeks. Continued protective taping is recommend for up to 3 months following injury. Grade III injuries should be immobilized in a thermoplastic splint or soft-cast ring for 10 to 14 days follow by gentle mobility under tape protection after the initial immobilization. Gentle climbing can often begin in Grade III injuries 6–8 weeks after injury and full function achieved after 3 months with protective taping continuing for 6 months. (Crowley, 2012)
Grade IV injuries should be surgically repaired. This is done to prevent a functional deficit related to reduced flexion at the distal interphalangeal joint. Clinically it is this loss of flexion that should guide the need for surgical repair. (Crowley, 2012)
The rehabilitation period of an isolated complete rupture of an A4 pulley is considered to be shorter than that of an A2 pulley.
A Critical Review of Injury in Rock Climbing Volume 15 & Number 6 & November/December 2016 Schoffl VR, Einwag F, Strecker W, Schoffl I. Strength measurement and clinical outcome after pulley ruptures in climbers. Med Sci Sports Exerc 2006;38:637– 643.
Scho ̈ ffl V, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers. Wilderness Environ. Med. 2003; 14:94-100.
Timothy P. Crowley, The Flexor Tendon Pulley System and Rock ClimbingJ Hand Microsurg (January–June 2012) 4(1):25–29
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