I’ve been struggling with some climbing injuries recently and finally decided to visit a sports medicine doctor highly recommended by a friend. My issues were a recurring finger injury at the base of my right ring finger and pain in my elbows and thumbs. He rather quickly diagnosed the elbows/thumbs as flexor tendinitis and set me on a good rehab path which included mostly changing my bad habits at the computer and strengthening my extensors.
The finger issue was going to be more tricky as he wanted to focus on treating one thing at a time, so since I was going to be off climbing for 3-4 weeks anyway while treating the tendinitis this seemed a reasonable thing to do. Surely this much time off would heal things right?
Well, as soon as I had the green light to (lightly) climb again about two weeks ago, my second day out I started to feel that same pain and tenderness after about 30 minutes of light climbing. After calling the doctor, he referred me to a hand orthopedist.
I had my appointment with him yesterday and was given the sobering, though not surprising, diagnosis of a partially ruptured A2 pulley on my right ring finger.
This is probably the most common finger injury among climbers and now that I’ve had it officially diagnosed, I’ve likely had this injury about a dozen times over the last 18 years of climbing.
Ironically, there’s some good news in here. The bad news is that the pulley has a partial tear and hurts whenever it gets re-aggravated or re-torn.
The good news is that the doctor says there’s nothing that can be done surgically (that would actually benefit my condition) and the only real way to fix this is to not use it at all (i.e. stop climbing for an extended period of time).
Unfortunately, I don’t feel any pain after about 48 hours so it’s tough to know how long to rest. The doctor’s recommended treatment is to slowly start climbing again while doing two things.
First, tape the pulley strongly to give it support and keep it attached to my tendon. This is the second doctor I spoken to who specializes in treating athletes (including numerous climbers) that has strongly recommended taping fingers for pulley injuries. In addition, I’ve injured every single finger on both my hands (yes, including pinkies) and taping has always helped me in the recovery process. Yet, I still meet climbers who tell me taping doesn’t work or even makes the problem worse.
I’m officially going to say it right now – if you read or hear the contrary, that taping for pulley injuries is bad or does not help, it’s probably bullshit and I’d be highly skeptical of anyone stating this as fact. Forget for a moment what any climber or doctor has to say about this. Simply think of the biomechanics involved here. What do the pulleys do? They keep the tendon attached. So using tape for a short period of time while actually climbing is simply going to assist these damaged pulleys do their job. I have a hard time fathoming why climbers resist this idea.
If you’re looking for more information on this from a climbing perspective, I also recommend reading Training for Climbing by Eric Horst. He’s done a ton of research on this over the past thirty years and comes to similar conclusions.
The second recommendation from the doctor was to avoid using the finger as much as possible while getting back to climbing and training. Easier said than done, but he has a good point. Part of the process will be training myself to avoid grabbing holds that will strain that particular finger. As climbers we rely on it quite a bit, but this doctor stated that the ring finger has 15% smaller bones and about the same amount less overall strength compared to the middle and index fingers. Unfortunately, he also said that climbers have a tendency to use the ring finger in ways that bear too much stress that could probably be avoided in many cases.
Over time this injury will heal as long as it doesn’t tear again. But every time it starts to hurt (due to tearing), the clock starts again on the healing process.
So now I’m at that delicate decision point of when and how to start back climbing. My tentative plan is to securely tape the injured area and start climbing again slowly on very easy climbs. I’ll likely stop every session short just to make sure I’m not pushing into that danger zone of re-injury and just see how things go. I’m also experimenting with cold water treatment to see if that helps.
I’d love to hear what everyone else has done with these kinds of injuries? Are there any treatments I’m not aware of? How long should one rest after getting a partial rupture of the A2 pulley?
Tweet This If you enjoyed this post, please consider to leave a comment or subscribe to the feed and get future articles delivered to your feed reader or email.
{ 4 trackbacks }
{ 41 comments… read them below or add one }
Thanks for this post. I’ve been struggling with what sounds like the same injury. Mine is on my middle finger on my left hand. The tenderness is at the base also. Just like you described, I take 2-3 days off from the gym, then, when I return, it starts hurting again after about an hour. I’m going to try taping it today.
Will, yep I’m finding from personal experience that it takes longer than those couple days for it to heal. Now that I have a definitive diagnosis, I’m hoping it will keep me from repeating the pattern. It’s so easy to think that since the pain is gone everything is fine.
Will,
I hate to break it to you, but if you pulley does have a partial tear, two days off isn’t really going to do anything. We’re talking weeks and months here. Based on your blog name (Gumby Diaries) I’m guessing you’re pretty new to the sport. Do yourself a favor and take it easy. “Climb through it” doesn’t really work.
I have a similar injury and have had a tough time diagnosing and treating it over the past two months. Do you know how the Dr. diagnosed it as a rupture as opposed to tenosynovitis?
I thought it was an A2 rupture but began to question it due to the way it felt when and after light climbing and in part due to this thread. I am convinced when by the argument of one of the posters there that many rock climbers get tenosynovitis and think it is either tendonitis or a pulley injury.
I also tried Dave Macleod’s cold water treatment. I think it may have helped a bit, but I think the light climbing he suggested and I tried with it made it worse.
Eric Horst was very helpful over email as well, and suggested rest. I think he is right, and I’m taking another month off, praying it will work and I can climb injury free when the weather gets nice.
I had a torn finger pulley several years ago. My hand surgeon at the time gave me cortisone shots, twice, which seemed to help. Ken Duncan, in Fort Collins is an orthopedic surgeon specializing in hands AND a 5.12 climber – you might ask him for advice.
Hope you get better soon, dude! What computer habits did the doctor tell you to change? we all sit too much in front of the screen and might be harming ourselves more, than while climbing
I’ll probably say it can’t hurt, but that might not be the case, particularly if it evokes a false sense of safety. This article links to two credible studies that conclude differently.
http://adventurehealthclinic.com/2008/12/19/rock-climbing-finger-taping-and-injury/
“The British Journal of Hand Surgery also featured a nice study, by A. Schweizer, concluding that circular taping is minimally effective in relieving A2 pulley force and is probably ineffective in preventing pulley ruptures.”
So, two decent studies have found that finger taping does not prevent injury.
Please, consider all the data before you spray the magic of tape. Someone might not be as lucky.
Mike – he felt the finger then made me pull on it while he watched and felt it. He then did the same with the good finger on other hand and immediately came to his diagnosis. Hands / fingers are all he does so I guess it’s an experience factor. he told me he’s had at least 150 climbers come through his office with this exact issue. The sports medicine doctor made it sound like tenosynovitis could be the issue, but aside from injecting cortisone the treatment is about the same.
sibylle – Thanks , I’ll keep him in mind.
climbbig – Proper posture mostly. I have a really bad habit of slouching while working at the computer all day. Basically he recommended the standard tweaks to your posture in front of the computer you see written up everywhere – feet on floor, arms at 90 degree angle while typing, not resting arms/wrists while typing and mousing, etc. While I’ve read these a million times, it’s taking the pain in my elbows and thumbs to finally make the change.
Rags – I’m not sure I’m convinced taping while recovering from an injuring gives a false sense of security. If that’s the case, and a climber thinks the tape will cause them to be healed and able climb anything, then that’s not an issue with the tape but the person.
Nowhere in my post did I say taping was a magical cure. I simply stated that a) in my experience it has helped, b) practicing doctors have told me it is a good idea and c) if we think about what is happening inside the fingers it makes sense that it should help this issue. Not every issue, but the one I’m talking about in the post.
In my opinion there is a big difference between studies done on cadavers and the experience of actual practitioners on healing athletes.
Finally, you chastise me for not mentioning these two studies because “someone may not be as lucky.” The two studies you mention state there is no benefit to taping so that also means that taping is not hurting them either.
So I’ll state it again, in my experience taping while injured (not to prevent an injury) has helped. I have also spoken to doctors who agree and have approved this treatment path.
If it makes everyone feel better, here’s a disclaimer covering this entire post:
I am not a doctor. This blog post and its comments are not intended to be medical advice.
Hey Tom,
I’ve had that injury several times before, could be as little as one month, as long as nine. I had a good one last year that took 9 months to heal fully. Sounds like yours is minor, in which case I’d take a month off or just go climb hand cracks in the creek. massage and icing combo usually gets the blood going in the area.
In terms of ‘taping’ for pulley injuries… Yeh it works – but you have to tape your pulley SO TIGHT that you finger will go BLACK!
!
Think again about the physics / mechanics of it. Try to hold your ‘crimping’ tendon right close to the bone… (at the A2 pully region) Notice how ‘little’ the tendon flexes out . Also notice the magnitude of force – given even a little light crimping…
Now tell me that some taping is going to ‘hold the tendon in place’ when you crimp down… It won’t even offer any support unless it’s super tight – and if anyone has even tried climbing with super tight tape – you will realise that your finger is black within the half hour…
Easiest way to ‘keep climbing’ so long as you’re not trying to ‘push grades’ is to keep your finger open hand – again look at the physics / mechanics – with open hand – your finger is straight across the A2 pulley – thus there is no force acting on the pulley and it can heal or at least you won’t make it any worse…
If you tape over your whole finger – you can help force it to stay straight and this can also reduce further injury – but in essence – you will have to take at least 4 weeks to get a total recovery – even for a partial tear – since cartilage has no blood supply and can only repair from mineral / protein diffusion (slow!). For bad tears / complete ruptures – you are looking 2 months minimum up to 4 months – of keeping compression etc over the pulley to help it graft etc and make sure that the healing process is not disturbed…
Great article with a lot of good information.
I have had such an injury and your finger can repair to be stronger than it was originally. I agree that using open-handed holds are a good way to minimize risk. I tend to get hurt on tight crimps, which is where the A2 is going to be at greatest stress.
I have found taping to be helpful in the recovery process. Secession from climbing for a few weeks after such an injury along with isolation of the finger are also key. Rest, ice, NSAIDs, and isolation are the standard formula here. Return to climbing gradually and slow down or stop if it’s too soon. If you are disciplined you can put the injury behind you forever quickly. If you rush things you could have the problem dogging you for years.
I have NOT found taping to be helpful in preventing injury (as opposed to recovery from an injury). The stress put on the A2 during a crimp is tremendous and the tendon/A2 combo is right against your finger bone. I suspect a little tape on the outside of your finger is of minimal help when faced with these sorts of localized and intense forces.
The anticipation of pain is a major hurdle for some climbers that causes them to be hesitant to make dynamic moves, use tough holds or commit and follow-through. It’s a lot like the fear of falling on lead. These injuries can tap your performance in really subtle ways, so treat them seriously, professionally and objectively.
So if you feel taping helps and makes you climb with more confidence… whether it really helps or not… tape up. Even a false sense of confidence is still confidence. I would wear rabbit ears and permanent clown makeup if I felt it would make me climb better.
…but based on your post you know this! Thanks again for sharing your experience.
Thanks for the feedback Jim. I actually found a certified hand therapist who is also a climber and have been receiving treatment from her for the past month or so. I’ll be writing up a post soon that details the rehab program she has me on. A big issue we found is a large knot of scar tissue on the injured tendon sheath.
Great write up. I’m having the same problem with the A2 pulley on my left ring finger. Though I haven’t officially been diagnosed with it, I’m fairly confident that I’m suffering from it. Crimps are nigh impossible, and bearing weight in an open/closed crimp hurts too much. I took two days off, and it felt great — unfortunately, climbing on it for about half an hour just brought the pain back.
I’m now currently on an indefinite hiatus in hopes of recovering fully. A friend of mine suggested I try taking glucosamine chondroitin with MSM and fish oil pills to help promote healing while resting. No active resting — just straight up staying off my finger. Unfortunate those, since I’m suffering from climbing withdrawal.
Best of luck to you in your healing process — I look forward to hearing more about your visit to your hand therapist.
first, thanks for the article. i appreciate that people are sharing their experiences in this arena. i’m in the same boat: RH ring finger, A2 partial, possibly partial on C3 as well but difficult to determine w/o ultrasound. i’ve been off of climbing now for about eight weeks and am really missing it. i have a prescription for a rigid plastic ring, which i’ll have filled this week, then i’ll hopefully be able to start reintroducing climbing into my life. a couple things to consider, regarding taping:
1) depending on the study, 0.5 or 1mm of abnormal excursion is considered bowstringing (mine feels identical from affected to unaffected hand, yet crimping is impossible w/o a lot of pain)
2) tear off some tape and wrap it tightly around something to simulate a finger. i’m thinking a pencil core with several layers of paper towels would be in the ballpark.
3) squeeze your “finger” and if you can distend the thing 1mm, you haven’t achieved much protection. some, sure, no doubt. but as much as you need? i’m kinda doubting that. if it’s rock-hard, yep then i buy it.
4) days after i first did this to myself, i found an article where army researchers took nine cadavers and rigged up matched right and left hands to a stress-test machine to simulate crimping, with one finger taped and the matched one on the other hand left untaped. the results (link below) are that the various pulleys ruptured at the same stress on each hand — meaning, the taping either wasn’t done how we do it, or it didn’t help, or perhaps cadaver ligaments don’t behave like ones in living climbers. there are lots of “what-ifs” but to me, this is about as thorough a study as i’ve ever read about this.
5) i’m suspecting that your (and my) taping may well have a lot to do with thickness of tape on the finger pad, and how if we do it enough, it tends to become more and more rigid… something one could achieve with a ring, perhaps. i would think the best protection would be a very solid ring that wouldn’t deform, and is fit as close as possible to the ligament and which compresses the tissue enough to prevent (much) bowstringing.
what’s my conclusion? i’m sure gonna wear the thermoplastic ring, if i can get it on over my fat finger. would i tape if i didn’t have a prescription ring? yep, sure would, even though it appears to be illogical given the study results. why would i? basically because i think that how i would do it would be more rigid than the researchers did.
link: http://ajs.sagepub.com/content/28/5/674.abstract
Thanks for the feedback Leif. Let me know about your experiences with the thermoplastic ring. I’m not familiar with that at all.
this thermoplastic is ivory-colored and heated to about 110°F in warm water. once it attains that temp, it’s pliable yet isn’t painful to wrap around your finger and shape it a bit — you can also cut it if you have a heavy-duty shear (e.g. what one would use for hardware cloth). once it cools, it’s really pretty rigid. you can compress a finished ‘ring’ more than 1mm but that takes quite a bit of force — more than i think one who’s recovering from our injury would allow the tendon to exert on the A2 anyway. it can be resized by re-warming and re-shaping, as your swelling goes down. that’s where the good news comes to a bit of a jerky halt.
in practice, a ‘ring’ done with this restricts the curling of the finger by blocking the natural compression of the fleshy part of the finger, to the point of discomfort — the more you curl, the more uncomfortable the mashing gets. in order to actually have one restrict bowstringing to the degree a ligament would (meaning, to protect the injured ligament), i think it’d have to be thinner than this plastic (this is about 1/8″ thick), and painfully tight, to the point of restricting blood flow. so… unfortunately i think that this isn’t the panacea i had hoped for. i’ve been doing some various exercises per the therapist, and during this week it has been getting better — hard to say, though, whether the therapy is the larger contributor, or if using it fairly strongly for a bathroom remake is the prime factor.
Hey folks,
I injured a pulley on my right hand ring finger 3 years ago (A3). I took a month off from all climbing. When I returned, I taped my finger with a figure eight pattern. I taped a loop around the pad above my knuckle that then crossed to a loop around the pad below my knuckle. I then put another strip of tape crossing the opposite direction, forming a criss-cross with the first strip. The criss-cross was on the underside of my knuckle, where your finger creases. I taped it with my finger in a flexed position. The result was that it was taped into a position where I could not straiten my finger. (I hope that description makes sense) At first, I also then taped my ring finger to my middle finger. I later stopped taping them together, but kept the ring finger individually taped. For the next 4-6 weeks I only climbed on juggy routes, to avoid any crimpy finger tip strain. I was able to get my climbing fix in and keep my self in decent shape without pushing the envelope of difficulty. A buddy that worked at the local indoor gym put up a route where all the right hand holds were juggy and all the left hand holds were crimpy. I ran endless laps on that while I recovered.
I have now injured a pulley on my right hand index finger (A1/A2). I have rested it for 3 weeks. My finger has remained swollen in the A1 area. I do not recall lingering swelling with my previous injury. I am now 2 days away from my first night of indoor lacrosse, where I am going to be swinging a stick and shoving/punching. I plan to tape it in the same fashion as before. Unfortunately, since I will be wearing lacrosse gloves I can’t effectively tape it to the adjacent finger. I am a righty, but I have a feeling I am going to be playing lefty alot. Who knows, maybe it will force me to work my off side more and make me a better player in the long run… hehe
Good luck to all you fellow injured athletes who don’t have enough common sense to stay parked on the couch, living a “safe” life. I bet if my hobby was watching NASCAR, I’d be a lot less banged up… lol
It has been great to follow this thread.
My right index finger A2 has healed slowly. It doesn’t have it’s full range of motion. I was shocked to find that fist jams (where your finger is totally bent) were some of the more difficult holds to get back into. I guess anything where the finger is not straight (like making a fist) is when you are going to stress the injury. So it sort of makes sense. I bought a giant wad of silly putty and knead it in my first during the day. It helps a lot with the flexibility and range of motion, but it’s still not back where it was several months ago.
Still climbing, however, but it sure has been and remains a nagging injury.
i’m now 86 days into my recovery and doing most everything (except climbing, wringing washcloths and turning really tight jar lids) normally with little to no pain. well, military-style pushups still hurt, which is surprising, so i’ve kind of modified my style a bit for those.
i haven’t resumed climbing because i’ve been stressing out the finger enough by a complete bathroom remodel including delivering and installing about 2500 lbs of tile. i went to one therapy session, paid my $$, but honestly don’t believe i learned much beyond what i already knew, and i got some toys and putty to mess with. to the previous poster who got the big wad of putty, be cautious of squeezing the stuff for any length of time, unless you’ve built up to it over a few weeks. heard about someone who got distracted, watching a movie, and re-ruptured his A2 from two hours of putty-exercise.
i do a few juggy climbing moves just to test the waters, but i haven’t staged a full session at all yet, since gripping a texture gun for half an hour ends up making the finger sore for 36 hours. not a good ratio. crimping, oy, i just don’t wanna think about it. this darn injury is just plain slow, and very annoying at that. for those who think they can spring back in a hurry, either yours is a mild injury, your tissues are highly vascularized, or you’ve got a serious case of YMIS and may be heading for a worse mess soon.
liquid mojo, good luck with your lacrosse. gripping the stick may well be really taxing. i’m curious to hear how it went.
First night of lax went well. The figure eight taping method that I had used before didn’t work though. My previous injury was to the A2/A3 area, with my knuckle being the main area that needed taping. Therefore the figure eight/criss-cross method worked because it restricted the range of motion of my knuckle, while re-enforcing the pulleys on either side. This time my injury is in the A1/A2 area, so it is more where the finger meets the hand. After taping and retaping a bunch of different ways, I finally settled on just wrapping the A2 pad of my finger (between my hand and knuckle). I wrapped it as tight as I could without making my finger turn purple. With the thickness of the stick’s shaft, I didnt have to close my hand too tight to have a good grip. I can’t close my index finger tight enough to hold anything skinnier than say a highlighter. Gripping something thicker like an axe handle is ok. Generally, when defending an offensive player, I would shove them away with both fists, with a punching motion. Instead of using my fists, I used my forarm and elbows. I had to over commit more than I would like, but I was still able to jack them up pretty good and save some stress on my hand… lol… My finger felt ok after Friday night’s lax game, but then on Sunday I replaced some light fixtures and my finger was killing me from twisting little screws and wire caps. I swear my wife thinks I was trying to get bonus sympathy points for replacing the fixtures, but she wasn’t buying it after I played lax and insisted my finger was good enough to play the season… lol
Have been told I have a ruptured finger pulley, right ring finger (no MRI yet but it’s worse at the base of the finger….A2??). 1st doctor recommended surgery though he acknowledged he’s only performed the surgery maybe 5 times. I’m in California – don’t mind traveling for a second opinion. Any suggestions on hand specialists who are more familiar with treating this injury? I saw the one name listed above, Ken Duncan in Fort Collins. Anyone else? Tom, you mentioned you found a certified certified hand specialist, where is she located? Thanks.
bonnie, sorry to hear it. definitely get an MRI (high-def if they offer that, because you’ll need to see tiny details). even the digital x-rays show some soft-tissue detail, often enough for diagnosis. how much bowstringing? persistent swelling, pain, all that good stuff? i went to dr. christopher brian, who works out of a couple clinics here in colorado. he’s a certified hand specialist. it’d be worth calling first as a referral -slash- pre-op consult. he was quite knowledgeable and cordial. i’d definitely have him examine my hands if i did this again.
Bonnie – I’d think it would be healthy to be skeptical about getting surgery for a torn pulley. From all the research I’ve done and doctors I’ve talked to, surgery for this injury is the very, very last option. I’d start with finding a certified hand therapist near you: http://www.htcc.org/
I found a hand therapist who is also a climber which made a huge difference. Her name is Kim Raupp and you can find her contact info through that site. I’ve made great progress with her help. I had a partial tear of an A2 and it has taken many months of rehab (6+ months now), but I’m making great progress.
Tom & Leif,
Thanks for the input. I have fairly substantial bowstringing & some swelling at times. It’s not all that painful (maybe I have a high tolerance for pain??!!). It’s more achy/uncomfortable and annoying in that my grip strength is quite diminished but I definitely would not consider it really painful. I was originally told I have trigger finger a few years ago and I’ve had two cortisone shots during that time. I went back to the doctor a couple weeks ago figuring I’d need the trigger finger surgery since I don’t want to have anymore shots and that’s when I was told about the pulley rupture. I’m a very active person but not a climber… only tried it a few times. I’m on the computer all day for work (accounting) and we live in the mountains so all our recreational time is spent outdoors – riding (road bike mostly), hiking/backpacking, skiing…lots of gardening in the summer and shoveling snow in the winter. I don’t recall a specific incident that caused the problem, just noticed it happening over time. All my online research so far indicates it’s a common climbing injury and that’s how I ended up on this post. I definitely plan on seeing more than one doctor for additional opinions and I’ll check out the website to locate a certified hand specialist near me. I’ll post again soon with an update in case my research and input can help someone else. THX!
Thanks Bonnie. Please update us on your progress and good luck!
bonnie: i’m no doctor (and don’t even play one on tv) but i’d be skeptical (just as tom suggests) that you have more than a tear. hearing you say you had no definite incident (e.g. climbing-related or a fall off the bike and caught yourself somehow), i’m doubly skeptical about a rupture. bowstringing, swelling, loss of strength, limited ROM and some mild pain certainly are signs of ligament distress, but i get the impression that a complete rupture results in serious debilitation. this makes me think that surgery may not necessarily be in order. tom’s right too that this surgery is a last resort. it *does* seem to work per reports i’v'e read and when i consulted with dr. brian, but it’s quite invasive (there are pix online, fyi; just do some persistent googling), it borrows some tendon from elsewhere to make your new ligament (and thus you have a second incision), and takes its own sweet (sour) time to heal, just like a tear.
if it’s totally torn, waiting a couple weeks now won’t result in any worse outcome. i’d say, do nothing with it, really nothing (though typing was fine for me even the same day it occurred). do this “nothing” for a couple weeks and see if you have any improvement in the pain and ROM area. do not expect (or demand) any strength from it at all for several weeks.
I’m going try and do “nothing” with that hand for a couple weeks (hard as that will be when it’s my dominant hand!). There isn’t enough snow yet to ski and no outdoor riding as it will be too hard to brake without using that hand….guess I’ll stick to hiking and indoor bike. By the time I see the next doctor for a second opinion I will be far better prepared with lots of questions about the surgery and especially re: alternatives to surgery…that thermoplastic ring you mentioned previously sounds interesting.
More to follow on this post in the coming weeks – thx!
I tape my finger to a stick and its useless. I get this dyno jamming finger sticking straight out but I really can’t use it. Sig’ weakens the affected hand, such an efficient group, but I’m healing. Light climbing keeps my life going while I heal up for my future projects. D.
I tape my finger to a stick and its useless. I get this dyno jamming finger sticking straight out but I really can’t use it. weakens the affected hand. Light climbing keeps my life going while I heal up for my future projects. Works so far. Really is an isolate to rest option. Works. D.
today is day 101 for me. crazy to think it has been this long. i *just* now was able, finally, to touch my fingertip to the very top of the palm, in the fleshy part above the palmar creases near where the finger attaches (approximately at the A1). i don’t consider this full ROM because it felt kinda stiff and sore, but i *did* do it under the finger’s own power. yaay. now of course i’m taking down my climbing wall for a couple weeks to install tile. grr. but i’ll be back at it.
Hi there–
I also have a diagnosed A2 pulley injury. I did not have the privilege of getting a hi-def MRI, but I can say that when I went to my first orthopedist, (supposedly a hand specialist) he said oh its tendonitis and gave me a cortizone injection in the hand. Upon going for a second opinion a few weeks later as I was unimpressed both with his bedside manor as well as course of treatment, as the injection only brought the swelling down…I was imediately diagnosed with an A2 pulley injury (unknown if its a tear, rupture or something else. I was sent to a CHT (Certified Hand Therapist) who made me a “pulley ring” out of thermoplastic material. This ring was cumbersome irritating and annoying. It was near impossible to do any normal daily activities. I went back and she was able to make me a new one, according to the protocols, the ring has to be at least 3/8 of an inch in thickness. I was able to go online to http://www.silversplints.com and find a metal pulley ring that may work better. As soon as hear back from them I will post the information.
The problem I’m having currently is after 2 weeks of therapy its gotten almost impossible to move that finger (left hand ring finger) without excruciating pain. Any ideas…I’m up for anything at this point, I want and need my finger back.
I should also mention that prior to the pulley ring my finger was approx. 3-4 cm from being able to touch my palm, now im more like 6-7.
Mike
mike, wow. sorry to hear about your injury and how poorly the diag was conducted. to be honest, i never used my thermoplastic ring. i was smiling in agreement as i read your experience with yours; it’s just not worth it for most, i think. mine hurt my finger (skin and all) wearing it, and i really didn’t feel it conferred any benefits so long as i was very gentle with the finger.
so…… that said, and keeping in mind i am not a doctor….
1) un-wear the ring and cancel your order, too
2) don’t use your finger for anything at all that involves force — no climbing, period, no biking, no wringing of a washcloth, shaking hands… zip! heck, add to that pulling up your socks. even now five months after my initial injury i’m careful about everyday things like squeezing out washcloths, opening bottle lids, etc.
3) therapy should be administered in such a way that if it hurts a little while doing it, STOP before something really bad happens, wait 24 hrs, and if it still hurts, that line of therapy should be suspended indefinitely. if 24 hrs elapse and you have no pain when you’re not using the finger, then consider gentle therapy of that type acceptable, and continue on the careful path toward recovery.
4) if you have persistent swelling, that indicates that stuff is fubar in there. yes, a moderate degree of swelling is natural… but a lot, the kind that restricts motion, is not healthy. stop using that finger.
5) expect that recovering ROM will take a heck of a long time. if you need to speed it up, plan for a convenient time to visit the hospital for reconstructive surgery, and then start over at square one with obtw a big incision and some missing tendon tissue from somewhere else in your body.
this is tough love… sorry to be blunt, but you don’t have and won’t have your finger at this rate. sounds like your initial injury might have been more severe than mine, and here i am, age 40, five fricking months out and still not climbing. it’s pissing me off but there’s nil i can do about it. be nice to it. the therapist i went to did NOT give me much confidence in her ability (despite being certified in something hand-related). she had never seen an A2 injury before, which blew my mind, and i haven’t been back. i can tell you that exercising a torn A2 simply stresses out the very little healthy tissue that’s left. just…don’t.
(please all, pardon what probably seems preachy here. i just cringe at what i’m sure mike’s feeling, and i believe strongly that the therapy is too aggressive. i’m happy to discuss or retract, but it’s my take.)
honestly, i think you’re too early for therapy. my hand surgeon said
[got cut off. sorry i went on and on.]
my hand surgeon said that doing nothing — no exercise at all, no therapy, nothing — will be the best approach early on. i described the cool-water treatment i had been doing, and he said bravo, keep it up.
It’s been an interesting couple months since I last posted. I’ve now been to 3 orthopedic surgeons (all reputable, board certified hand specialists), two CHT and had an MRI. Last post, I had only been to one doctor who diagnosed a ruptured pulley and said I needed surgery. He didn’t instill much confidence when he said he’d done perhaps 5 of these surgeries with maybe 3 or 4 being successful.
Second doctor had the same diagnosis and said he could do the surgery but warned about the potential for scar tissue forming that could leave me no better off than prior to the surgery considering the expense and rehab time (as in months) for extensive PT post surgery.
The 3rd doctor suspected the same diagnosis (ruptured A2 pulley, right ring finger) but said he needed an MRI to confirm. He used the same fishing rod/bowstringing analogy as doctor #2 to explain what was going on, expressed the same concern for scar tissue forming and the potential for not much improvement post surgery. He then very firmly said if it were his hand, he WOULD NOT have the surgery and said if I still wanted the procedure done I’d have to work pretty hard (as in plead!) to convince him to do it. He also sent me to a CHT to have a plastic ring made.
The ring has helped a lot – yes, it’s cumbersome but the support is great – with the ring I can make a complete fist, without it my ring finger only bends about 60% and then just flops around while the rest of my fingers continue bending into a complete fist. With the ring I can pick up a carton of milk, without it I wouldn’t dare try because I have such limited grip strength. My knuckle on that finger is about 1/2 a ring size bigger than the base of my finger so the plastic ring is overlapped (similar to those old spoon rings from the 60s or 70s – for those of you old enough to remember them!). The overlapping allows the ring to expand just enough to get over my knuckle and then it contracts back around the base of my finger. The CHT shaped the base of the ring that presses against the finger on the palm side of my hand as a straight line rather than curved like a normal ring – that straight surface (about 3/8 to 1/2 ” across) pressing against the finger keeps the tendon in place much closer to where it’s supposed to be – a normal curved ring wouldn’t give as much support. As I said in a previous post, this has never been what I’d consider a painful injury, it’s annoying, uncomfortable at times and achy but not painful (maybe I have a high tolerance for pain??!!). It’s been more of a functionality problem for me. My sports are skiing, hiking, riding (road bike) and I find I’m still OK holding a ski pole. Shifting and braking with my right hand on the bike is probably where I have more of a problem – we’ll see how the ring helps with that issue when I start riding outdoors again in the spring.
I finally had the MRI earlier this week, went back to Dr. #3 and then the CHT. This was a miserable MRI – if you’ve ever had them before, just laying there on your back is totally manageable. For this MRI, I had to lay on my stomach, head turned to the left (no massage table opening so my head could face straight down!) and the worst part…my right arm was completely stretched out above my head with my hand propped on a platform, left arm was bent and tucked against my chest. I had to lay there in that awkward position, completely still for almost 40 minutes. I don’t normally sleep on my stomach so it was brutal. About halfway into the MRI, my hands started going numb, my lower back was aching and by the time it was over both arms were numb up to my shoulders. It felt like they had to slowly peel me off the table. The MRI was way more uncomfortable than the injury itself!
Turns out A2, A3 and A4 pulleys are all ruptured…yeah, not good news. Dr. #3 reiterated he still would not recommend the surgery. He suggested the silversplint pulley ring Mike mentioned in his post. I discussed it with the CHT and the problem is those rings are round like a normal ring – similar to a wide wedding band and I want a ring that will be squared or straight across on the palm side edge of the ring that presses against my finger to give me maximum support. The CHT made two new plastic rings so we could play a little with the shape and width. Once I get a good template I plan on finding a jeweler who can custom make a ring with the straight part that seems to be working the best. I’ve also researched online and there are a few companies who make ring “hinges” so the ring can expand to get over an enlarged knuckle and still provide a snug fit where it’s suppose to. I’m determined to find a jeweler who can make exactly what I’m looking for with the straight section and hinge – I anticipate having to go through a couple prototypes before getting it right. If I have to wear this ring the rest of my life rather than having surgery, it will be worth the effort. I’ll post again with more info once I figure out about the ring.
Happy Holidays to all!
PS – I just saw Leif’s reply to Mike’s post. My injury is a complete rupture. When I asked the doctor (#3 – the one I liked the best) if I could injure it further by delaying or not having the surgery or by continuing to use it he said no, “it’s already done”. He also didn’t seem too surprised that it wasn’t painful. Maybe a partial tear is more painful than the complete rupture?? At any rate, for me, the ring has helped tremendously. Though it is a little bulky, I still gain more wearing it even with the awkwardness of it. That’s why I’m on a mission to get one custom made that provides the same support without the bulk.
Thanks everyone for this info-brimming thread. I’ve finally reached my 90th day of rest after severely rupturing my A2 pulley on my left ring finger. After the first month I consulted a doctor and a sports therapist. Both concluded that I had a partial rupture upon looking at my ultrasound results. I have full range of motion in my finger but it seems like I still have inflammation in my finger after three months of rest. I can’t crimp anything or really use my ring finger other than for typing. Also, there is palpable scar tissue around the A2 pulley. I’m wondering if the scar tissue is slowing my recovery or if it is preventing full recovery. Any thoughts on this would be greatly appreciated.
Hi all-
(Disclaimer: I am neither a doctor nor therapist, and this will most likely be a long and jumbled post as I have a lot to say with no tactful way of saying it)
Just wanted to post an update and let you know that Leif may have been right(and by may have been I mean DEFIANTLY). However Leif, you were only right about the fact that my injury was more severe than originally diagnosed. I had a follow-up appt today after speaking with my doctor last week about severe finger pain. He consulted one of the leading Musculoskeletal Radiologists (my doctor specializes in sports injuries…he works with a few NFL teams in the tri-state area) to look at my MRI. They concluded together that I have a complete rupture of not only the A2 pulley but also A3 and partial separation of A4. So with the MRI reading of a significantly more severe injury new options were discussed which I will get back to in a moment. In the mean time I was reformed a new ring also out of the thermoplastic material HOWEVER (major improvement) it is now held together with some cloth medical tape, rather than velcro—this combination is MUCH better. Between the 2nd and 3rd knuckle on my ring finger just a plain piece of tape to reinforce A4. This is to treat pain (place your hand flat on the table for this explanation) on the top of the finger distal (farthest) from the last joint but proximal (closer) from the nail bed. This may commonly be referred to as trigger finger, but my tendon does not snap.
Collectively (it was like a parade in the exam room today, orthopedist, radiologist, hand therapist) we discussed options for rehab/attempting an increase of ROM (Range Of Motion). While I brought up the fact of the ring being non-conducive to my daily life, the answer to this was we can try the new reformed and refashioned ring with a new thinner material. Passive therapy and light stretching seems to be the course of treatment recommended. Surgery while a viable option is not my surgeon’s first choice. Get that, a surgeon who doesn’t want to cut! Anyway, he said if we operate there’s one of a few likely things that will happen,
1-Status quo – things will stay the same — No pluses or minuses in ROM or pain
2- Drastic Improvement
3-Drastic Decrease of ROM and increase in pain
For Leif:
The exam concluded with my doctor assuring me (I brought a trusted friend who is in the medical field with me today to ask/remind me of questions that I was not/would not think of) that its important to remember that at this point in time, I have ruptured the pulleys…That’s it, they are gone, it’s not like a cut that will heal and reseal, the pulleys have torn, so the ring is to be a PERMANENT partner. He also encouraged getting a second, or in my case third, opinion (which I will forgo as I am very very comfortable with this doctor, and his skills).
What I have decided: I think that I will attempt to keep seeing my therapist, and see if there is any increase in ROM and pain relief. I have set a goal of approx. 90 days. My birthday is in April, so I will (optimistically) wait until then to make any rash decisions. I will attempt to keep the ring and continue to search for other options (much like Bonnie said) from the thermoplastic ring solution as its acceptable but not by any means near where it needs to be if it will be a permanent “appendage” to my finger.
I welcome all responses as I have thick skin and can take the tough love. Thank you all for being as supportive and volunteering as much information as you have, It’s nice to know that I’m not the only one out there that struggles with these same issues.
Silversplints.com got back to me also– It is 110 euros for that pulley ring….I will post when if and when I get more information
@Bonnie–If you find someone to make that ring, please let me know, I may want to have one made….Please PLEASE keep us updated on your progress. I can promise to try to do the same.
for anyone whose your ruptures are severe and/or complete, obviously take my ‘no ring’ thing with a big grain of salt in such cases. i hope you’re able to eventually manage w/o your pulleys by various means. i’d be curious to know ultimately how the silver rings do, for those who have them.
mike, bonnie: i just cringe, hearing what is going on in your fingers and (eek) count myself fortunate that i’m not in the same boat (or so i think and so it feels, anyway, having had no MRI). question for you then: do you have essentially zero strength in the affected fingers? i did early-on, e.g. 2 lbs before it hurt enough that i didn’t dare squeeze harder.
Just read your A2 injury article. I feel your pain, I’ m just recovering from an A3 partial tear on my left ring finger. I climb about 150-200 days a year about half that is outdoor days and climb upto 5.13+. I’ve injured the same pulley several times to varying degrees. Looking back I have injured it once every 2-3 years or so for the past 15 years. I’ve never had a formal doctors appointment regarding the finger injury. My injuries are such that I always can climb, with only discomfort at the time, but the finger is sore and swollen for a day or two after climbing. This is the first time I’ve injured it on real rock. This time I took 2 weeks off after the initial injury, then climbed for 3 months pretty steady with the injury. It wasn’t getting any better so come fall I took 10 weeks off and I am now starting climbing again and I’m excited to say it is starting to feel much better. Here’s my take on recovery:
1. time off, usually it takes at least 6 weeks, I try and take up a new sport in the mean time and take the opportunity to work on my muscle imbalances and flexibility. I think I can actually improve my overall climbing if I am focused in my cross training.
2. Contrast bathing: seems to make a difference, especially lots of ice when ever the finger is sore.
3. I compulsively massage the finger, I think this helps and it gives me a good indication of how sore it is: how much it is/is not healing
4. after my rest period I have found that the finger is sore while climbing, but after several sessions (1-2 weeks) it begins to improve rapidly. This short period of discomfort has been consistent each time I am recovering. I think it has led to longer than necessary time off as it never feels good the first few days back when I am “testing it out”.
5. Tape: for me the tape is 50% psychological, reminding me I’m injured and 50% reduced movement: I try and tape enough that is it physically difficult to move the finger to the injurious crimping position.
6. Hydration & nutrition: I’ve tried a bunch of stuff, basically I think taking vitamins and eating right helps me heal faster. I’m sure dehydration has contributed to most of my injuries.
Anyway, there is my two bits, good luck.
Simon