Dear Sir, The fibro-osseous digital flexor pulley system serves to maximise the biomechanical efficiency of the flexor tendon apparatus. Most commonly, the flexor pulley system has been described as having five annular (A1-A5) and three cruciate pulleys (C1-C3). Closed ruptures of the annular pulleys have been identified in rock climbers and non-climbers (Schoffl and Schoffl, 2006). The diagnosis can be made clinically if tendon bowstringing is detectable otherwise diagnostic accuracy is improved with ultrasound or magnetic resonance (MR) imaging. Isolated annular pulley injuries are treated conservatively, multiple pulley ruptures require surgical repair (Schoffl and Schoffl, 2006). To date little attention has been given to injuries of the cruciate pulleys. We report five isolated cruciate pulley ruptures in rock climbers, along with their clinical and diagnostic assessment, treatment and outcomes.
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