In the space of a few decades, the frequency of injuries of finger pulleys has increased significantly due to the rise of indoor climbing, bringing the trauma that leads to pulley ruptures: overloading. Among the five annular and the three cruciform pulleys, the A2 and A4 are the strongest and most important for a good finger winding. From a biomechanical point of view, the loss of pulleys leads to a “bowstring” effect, reducing the tendon course which translates into a loss of grip strength and a reduction in digital mobility. Depending in the severity of the injury, the treatment can be conservative (thermoplastic protective ring and rehabilitation) or surgical (direct suture or plasty). Conservative treatment is now the preferred option for treating finger pulley injuries. Surgery is still the exception rather than the rule and is reserved for extensive lesions involving several pulleys and for top-level sportsmen and women.