The closed traumatic rupture of finger flexor tendon pulleys in rock-climbers represents a new complex finger trauma first observed in the mid 1980s. While initially the diagnostic and therapeutic approaches varied, nowadays a standard proceeding is being applied. After clinical suspicion and eliminating the possibility of a fracture by normal radiographs, pulley strains as well as singular or multiple pulley ruptures can be diagnosed using ultrasound. If the ultrasound fails to give a definitive diagnosis, an MRI should be performed. In the case of a singular rupture, a conservative treatment with initial immobilisation and early functional therapy is indicated. In the case of a multiple pulley rupture, a surgical reconstruction is mandatory. We favour the "loop and a half" technique of Widstrom and colleagues 1989 and, alternatively, the Weilby repair 1978. Post-operative initial immobilisation and early functional treatment under external pulley protection should be performed.