Partial Rupture to A2 Tendon Pulley

by Tom Markiewicz on February 27, 2009

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?

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