{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:07:08Z","timestamp":1794330428305,"version":"4.9.0"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A2 pulley ruptures are common in rock climbers, yet diagnosing partial ruptures remains challenging due to variability in tendon-bone distance (TBD) measurements in ultrasound assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated TBD at multiple anatomic landmarks to differentiate intact, partial, and complete A2 pulley ruptures; compared landmarks for optimal ultrasound diagnosis; and investigated flexor tendon curvature as an additional indicator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty-two fingers from 14 fresh-frozen cadaveric arms were examined using high-frequency ultrasound. Fingers were assigned to 5 simulated groups: intact; low-grade partial (5\u2005mm), medium-grade partial (10\u2005mm), and high-grade partial (15\u2005mm) ruptures; and complete ruptures (\u226520\u2005mm). TBD was measured at 4 anatomic landmarks: distal edge of A2 pulley (point A), 5\u2005mm proximal to point A (point B), 10\u2005mm proximal to point A (point C), and the midpoint of the proximal phalanx (MPP point). Analysis of variance and Bonferroni correction were used for statistical analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TBD significantly differed between intact, partial, and complete ruptures at most landmarks. Point C reliably differentiated high-grade partial ruptures from complete ruptures (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05), whereas point A was most responsive to low-grade partial ruptures. The flexor tendon curvature correlated with increasing rupture severity, supporting its use in ultrasound diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TBD provides an indirect, objective, and reproducible ultrasonographic sign for assessing A2 pulley injuries, whereas tendon curvature serves as a complementary direct sign. Using both improves diagnostic accuracy, refines injury classification, and supports clinical decision making. These findings may guide management and rehabilitation strategies for climbers and other athletes with finger pulley injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032261435903","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T11:03:30Z","timestamp":1775214210000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound Diagnosis of A2 Pulley Injuries: Landmark-Specific Tendon-Bone Distance and Flexor Tendon Curvature in a Cadaveric Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5065-8228","authenticated-orcid":false,"given":"Xeber","family":"Iruretagoiena","sequence":"first","affiliation":[{"name":"University of Deusto"},{"name":"Physiotherapy, Upper Limb Unit, Eskura Osasun Zentroa, Beasain, Spain"},{"name":"Physical Therapy Department, Sputnik Investigaci\u00f3n, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-7934","authenticated-orcid":false,"given":"Volker","family":"Sch\u00f6ffl","sequence":"additional","affiliation":[{"name":"Klinikum Bamberg"},{"name":"Department of Orthopedic and Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany"},{"name":"School of Health, Leeds Becket University, Leeds, United Kingdom"},{"name":"Section of Wilderness Medicine, Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, CO"},{"name":"University of Bayreuth"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Blasi","sequence":"additional","affiliation":[{"name":"Hospital Germans Trias i Pujol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3340-1738","authenticated-orcid":false,"given":"Fernando","family":"D\u00e1vila","sequence":"additional","affiliation":[{"name":"Bidasoa Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Balius","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Diagonal"},{"name":"Universitat de Barcelona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Sala","sequence":"additional","affiliation":[{"name":"Universitat de Barcelona"},{"name":"Hospital Cl\u00ednic de Barcelona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda-Teresa","family":"Iglesias-Gaspar","sequence":"additional","affiliation":[{"name":"University of Deusto"},{"name":"Clinical Epidemiology and Research Unit, Hospital Aranzazu, San Sebasti\u00e1n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"de la Fuente","sequence":"additional","affiliation":[{"name":"Mutualia Cl\u00ednica Pakea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2009.04.049"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2016.08.006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2021.01.011"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12593-012-0061-3"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2016.10.005"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(80)80049-9"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10040206"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2023.1123857"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2014.01.041"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.217.1.r00oc40201"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-1999-8904"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-923378"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.02.2020.06"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1580\/1080-6032(2003)014[0094:PIIRC]2.0.CO;2"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2020.07.007"},{"issue":"4","key":"e_1_3_2_17_2","first-page":"6547","article-title":"Injuries to the finger flexor pulley system in rock climbers: current concepts","volume":"31","author":"Sch\u00f6f\ufb02 VR","year":"2006","unstructured":"Sch\u00f6f\ufb02 VR, Sch\u00f6f\ufb02 I. Injuries to the finger flexor pulley system in rock climbers: current concepts. Wilderness Environ Med. 2006;31(4):6547-6554.","journal-title":"Wilderness Environ Med"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2223010752"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14192149"},{"key":"e_1_3_2_20_2","article-title":"Imaging of primary periphyseal finger stress injuries in climbers","author":"Miro P","unstructured":"Miro P, Crawford A, Mills MK, Sch\u00f6ffl V. Imaging of primary periphyseal finger stress injuries in climbers. Skeletal Radiol. 2025;54(6):1215\u20131224.","journal-title":"Skeletal Radiol"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2005.24.10.1333"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200102000-00011"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032261435903","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10806032261435903","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032261435903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:33:34Z","timestamp":1777689214000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10806032261435903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":21,"alternative-id":["10.1177\/10806032261435903"],"URL":"https:\/\/doi.org\/10.1177\/10806032261435903","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"value":"1080-6032","type":"print"},{"value":"1545-1534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]},"article-number":"10806032261435903"}}