Pulley Flap Tear: Ultrasound Diagnosis A 28-year-old male, a regular amateur climber, felt and heard a "crack" in his fourth finger while making a hold, which prevented him from continuing his activity. Four days later, an ultrasound was performed. The static view revealed a complete tear of the A2 pulley in its ulnar portion, with the pulley remnant interposed between the phalanx and the flexor tendon, associated with moderate regional inflammatory changes. The dynamic ultrasound in the transverse plane, with resisted finger flexion, showed separation of the tendon from the bony line of the proximal phalanx, confirming tendon instability. Within the spectrum of pulley injuries, multiple tears are the only relative indication for surgery. In this patient, conservative treatment with EPI sessions was chosen, as identified in the ultrasound study at 6 weeks, complete formation of a fibrous tissue in the path of the pulley that is competent in the dynamic study associated with resolution of the symptoms and progressive return to his sports activity, without relapse in the following 2 years.