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bababooey1
Nov 13, 2008, 9:33 PM
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i was climbing at the gym a few days ago and right at the top of one route i was in a spot where i had to support most of my bodyweight with my left hand using some ridiculously small hold. well, i strained and squeezed like hell for the second or two it took to move to the next position, and in doing so i felt something strange in my left forearm...not pain, not a popping, but it just felt weird. when i got back down to the floor i looked at the underside of my forearm, and it looked like there was a bulging/lumpish area just below my wrist. no discoloration(no bleeding, bruising, or anything), no pain, no decrease in range of motion, absolutely nothing noticeable other than the look of the bulge.
i iced it when i got home from climbing, but today the bulge is still there. now, if i keep my hand straight in line with my wrist or bring my palm towards my forearm or make a fist, the bulge disappears. if i move my open hand in the other direction(the back of my hand moving toward the back of my forearm), then the bulge comes out. still absolutely no pain and no discoloration or bleeding.
i have absolutely no clue what this could be, but after a mostly fruitless search the only thing i can come up with that seems plausible is a muscle or fascial hernia. from the little info i could find about this online it seems like it is only a cosmetic concern and that surgery is not needed, but im sort of scared to do anything that puts strain on my forearm for fear of having more muscle bulge through the fascia, if that is indeed what happened. despite this fear, i (stupidly, probably) strapped 60lbs on and did a few pullups just to test myself and i had absolutely no pain. felt perfectly normal other than the fact that my grip is still a bit worn out from climbing(this with both hands though, not just the left side). what freaks me out is that the bulge/swelling is not constant like it would be with any other run of the mill injury(like a sprain, partial tear, etc.).
has anyone ever heard of this or ever had something like this happen? thanks.
(This post was edited by bababooey1 on Dec 3, 2008, 10:54 PM)
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suilenroc
Nov 13, 2008, 9:56 PM
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In reply to: anyone heard of a muscle or fascial hernia?
Yeah i've heard of a muscle, its those things that bouldrrs use... As far as fascial hernia (makes me vomit a little in my mouth just saying it) sounds like a good Q for your Doc and not the site!
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bababooey1
Nov 13, 2008, 10:07 PM
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i asked here because i figured that since it happened while climbing, there is a pretty good chance that someone else here might have had it happen to them as well, or might have known someone who had it happen. posting here is a lot faster than waiting a few weeks to get an appointment with a sports medicine doctor in my area. i very well may need to see a doctor, but isnt the purpose of a message board for rock climbing injuries to discuss rock climbing injuries?
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doktor_g
Nov 13, 2008, 10:36 PM
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Bababooey1,
I think that you are on the right diagnostic track. Technically it could be a hernia (something somewhere it's not supposed to be - like your small intestine in your scrotum). That is, it sounds like the body of a fexor muscle (carpi, pollicus, digitorum etc.) of the hand/forearm is somewhere it's not supposed to be. Thus a hernia. The question is why it's there though. I've never seen a forearm muscle or tendon blow-out. What I HAVE seen is a ruptured biceps tendon. In these injuries a large ball of muscle (the bicep) creeps up the arm towards the shoulder. The patient can generally still flex their arm with reduced strength. Sometimes the pt (older men mostly in my experience) don't endorse any pain, just a funny sensation or slight discomfort. As I recall though the muscle bulge becomes more pronounced when they FLEX at the elbow. In your case, I'd suspect if there was a rupture that the buldge would become more noticable with flexing your wrist or closing your fist. That's opposite what you said I think. Still though my money would be on a tear. Biceps tendon ruptures are commonly treated without surgery except in cases of profound loss of strength or elite athletes. You might fall into the later catagory. Even though it doesn't hurt, I'd baby it for a few weeks at least. Work on cardio fitness and avoid the bouldering gym and crag unless your the belay bitch. In that case, break with your good hand on a gri-gri. Give it some time to heal. Of course, a physical exam by an orthopedic surgeon sooner rather than later is always the right course of action. The sooner a flexor tendon ruputure is seen and treated definatively the better. I just saw a hand laceration in a piano player and the orthopod said fix it in 10 days or he's in trouble. So. As always don't delay expert consultation
Good luck,
Grover
(This post was edited by doktor_g on Nov 13, 2008, 10:38 PM)
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bababooey1
Nov 14, 2008, 3:17 AM
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doktorg, thank you for the reply!
i am going to go ahead and make an appt with a doctor who specializes in hand/wrist/upper extremity.
i have a few more questions if you dont mind answering:
1. what is the treament/recovery outlook like for a hernia? will fascia heal on its own? i know that surgery for hernias in the abdomen is common, but in that case its the intestine protruding through the muscle, which im guessing could lead to problems if it gets pinched off or passage is otherwise obstructed. but with muscle being herniated, it doesnt seem like that danger would be there. i guess the only problem i could see is that the hernia could get bigger through future straining from climbing/exercise. but then again fascia must serve some purpose if its there, so maybe it is a problem to have the muscle pushing through.
2. how are tendon ruptures treated without surgery? what is the recovery outlook like for nonsurgical treatment?
this really has me bummed out because climbing and working on pulling strength is what i love most. i am just going to take the next 2 weeks or so and work on running i guess. bleh, i hate running.
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doktor_g
Nov 14, 2008, 5:21 PM
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1. Well recovery will likely be brief and robust since you've lost little strength or function. Again 'technically' it may be a hernia. The orthopod may disagree though. I'm thinking 'partial tear' would be something he/she will say. Since it is 'reduceable' (that's henia lingo for the ability of the thing that's displaced to return to the right place) it's unlikely that the muscle would become 'entrapped' or 'strangulated' (more hernia lingo). If it's a muscle hernia through fascia and the orthopod deems that it will do you little harm, you might just get to play Popeye at the community theater!
2. Tendons and muscles run through fascial sheaths. The muscle has a 'power zone' that allows it to contract most powerfully at certain lengths. If there is only a partial tear or a tear within a sturdy muscle sheath, the scarring to the sheath or adjacent fascia will allow the muscle to sorta reattach, but outside of it's power-zone permenantly. This is the reason that I reccomended a ortho guy. He/She will be able to assess your strength in specific muscles and tendons and bring a high level of experience and diagnostic accumen to bear on your problem. They can advise you on possible loss of function. This is a 1000 times better than I can via rc forums. I may be entirely wrong on the diagnosis. So, to answer your question. Non surgical treatment is rest and the passage of time.
Run, you poor bastard.
Glad you're going to the expert and stay positive.
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onceahardman
Nov 14, 2008, 9:25 PM
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Yours is an interesting case.
Certainly muscle could herniate through fascia, though it rarely does.
In the interest of brevity, during what I hope will be continuing discussions, you need a little bit of very basic physiology.
Moving your palm (and/or fingers) toward your forearm is defined as flexion of the wrist (and/or fingers). Moving the back of your hand toward your forearm in the opposite direction is defined as extension.
When you flex your wrist, the bulge disappears. When you extend the wrist, the bulge appears. Right?
When you flex the wrist, (naturally) the wrist flexors are firing. They bulge. It is possible that the bulging of wrist and finger flexors is hiding the injured flexor. Likewise, when you extend the wrist, the flexors relax, and the presumable damaged flexor pops out.
Muscle tears are not always painful. My own biceps tear was painless.
But there usually is some bleeding (bruising, ecchymosis).
If you were in my clinic, with the symptoms you describe, I would strength test each finger flexor individually. As well as you can, compare the strength to the same finger on the uninjured side. Until proven otherwise, I suspect a muscle (or it's associated tendon) is torn. Only because I've never seen the herniation you suspect. Make sure you test the DIP and the PIP seperately.
A torn muscle should test weak, and painful for a partial tear, but could be weak and painless if the tear is complete. It cannot test strong if you do the test correctly.
None of this precludes seeing a doctor to rule things out more definitively.
I wouldn't call you "stupid" for doing weighted pullups, because I personally try not to call people stupid. But, I DO wonder what your reasoning was. Pullups are much more of a large-muscle exercise, not so much a finger flexor specific exercise.
Let me know what happens, and keep in touch when you have a diagnosis.
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bababooey1
Nov 14, 2008, 9:43 PM
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i managed to get an appointment this coming wednesday with the chief of hand and upper extremity orthopaedic surgery at a nearby university, so i am not going to do anything at all until then.
as for why i did weighted pullups...well it was weighted pullup day in my workout routine and since i had no pain or other symptoms commonly associated with injury and since i absolutely HATE missing workouts, i figured what the hell. i did realize i was probably making a mistake after about 2 warmup sets, so i stopped before getting to doing towel pullups with my working weights.
what do DIP and PIP stand for? what would a test for each look like? just want to be prepared and educated when i walk into the dr's office because i know how important it is to be your own advocate when so many doctors are just "wham bam thank you mam" these days.
i will keep you guys posted after i see the doctor on wed.
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onceahardman
Nov 14, 2008, 10:03 PM
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DIP = distal interphalangeal joint
PIP = Proximal interphalangeal joint.
There is a joint where your finger(s) come out of your hand, the MCPs = metacarpophalangeal joints.
moving out the finger(s) the next joint is the PIP.
Continuing out, the furthest joint (= most distal) is the DIP.
The thumb has only a single IP joint.
The fingers have TWO flexor tendons each. One (flexor digitorum profundus) flexes the DIP. The other (flexor digitorum superficialis) only goes across the PIP.
Since both cross the PIPs, MCPs, and wrist joints, they assist in the flexion of these joints as well.
In reply to: what would a test for each look like?
Rather than try to describe classic test positions, just think about it. Try bending each finger against resistance. You will probably use fingers of the other hand to apply this resistance. You might try completely flexing all fingers, then prying them out, one at a time, with the other hand. This would be kind of a "break test", that is, how much force is required to "break" the action of the muscle being tested. If you test all the DIPs, and find a weakness, test the PIPs, and see if there is any difference.
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onceahardman
Nov 14, 2008, 11:00 PM
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*responding to myself brain fart*
One additional piece of advice:
If you ask a surgeon what to do, they have a tendency to say, "cut it open and fix it".
Keep in mind, you can NOW do pullups with 60 lbs on you. How much better can you get with surgery?
Unless you are a forearm model or something, and the bulge really bugs you.
Of course, if it turns out you have something that is dangerous or likely to worsen with time, well, then you'd reconsider.
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bababooey1
Nov 15, 2008, 12:03 AM
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thanks for the advice. believe me, i am VERY much anti-surgery(and anti-drugs in general). i will also be spending the majority of this weekend on my computer and in the library educating myself as much as possible about the hand/forearm muscles/tendons so that i can have more than a superficial discussion with the doctor.
not to sound ridiculous, but i would be very upset if my strength was limited to doing pullups with 60lbs, considering what i usually workout with and where i planned to progress to. but judging how those post-injury pullups felt, 60lbs was definitely not even close to pushing the envelope in terms of what my grip could handle. i guess that makes me feel somewhat better about the state of my arm for NOW, but i am just concerned about whatever happened getting worse because i trained when i should have been resting because the symptoms are so benign that they are almost nonexistent.
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onceahardman
Nov 15, 2008, 12:12 AM
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Did you test your fingers individually yet? What was the result?
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bababooey1
Nov 15, 2008, 12:16 AM
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i just tried and i cant really tell. it seems like my right fingers are a bit stronger, but maybe that is just my mind messing with me, or maybe its because i am right handed and my right side is stronger in general. either way, there is definitely no glaring weakness in any of the fingers.
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onceahardman
Nov 15, 2008, 12:28 AM
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In reply to: there is definitely no glaring weakness in any of the fingers.
Well, that's good news, and tends to rule out muscle/tendon tear...IF you are doing the test correctly.
It would be a pretty impressive self-diagnosis to pick up this fascia/hernia theory you've got. But as I've often told patients, "You know your own body better than I do."
Rather than speculate further, wait until you see the specialist. I wouldn't train hard, but there is no compelling reason to not train at all.
Dangerous things to look for include numbness/tingling (nerve signs), and cyanosis (turning blue) of the fingernails/tips. (vascular/circulatory signs). Depending upon severity, these could be E.R. visits.
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bababooey1
Nov 15, 2008, 1:15 AM
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about self-diagnosis of the hernia theory...i was right on a far stranger thing earlier this summer. a few months ago i cut my upper thigh and developed a really nasty infection. after months of fighting it with a variety of different antibiotics, i broke out in a weird mystery rash on my arms and face. i went to SEVEN different doctors including infectious disease specialists, dermatologists, university dermatology specialists, allergists/immunologists and they ALL fought me tooth and nail against my theory that it was an id reaction(also know as autoeczematization). well, after refusing to get railroaded into what i believed to be a mis-diagnosis of a contact allergy, i finally went to see a doctor who was a family friend and he agreed with me, treated me according to that theory and bam i was healed in one day. i definitely have incredible respect for the knowledge and experience that doctors have, but at the same time this was my body and i had been paying extremely close attention to it as the rash developed. not to toot my own horn, but i was a science geek in highschool and college and i can pick up an atlas of contact dermatitis at the local medical school library and understand it enough to know that their theories just did not make sense.
anyways, didnt mean to get off topic...thanks again for helping me think through this! i will watch for those symptoms that you mentioned, but it has been several days now with no change so i dont anticipate any of them developing now.
(This post was edited by bababooey1 on Nov 15, 2008, 1:15 AM)
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onceahardman
Nov 15, 2008, 7:31 PM
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In reply to: i was a science geek in highschool and college and i can pick up an atlas of contact dermatitis at the local medical school library and understand it enough to know that their theories just did not make sense.
One more little note on this. Sometimes I harp on people to learn a little anatomy, and very basic physiology. If you know some real basics, sometimes you can figure out your own problems better than a professional can.
It doesn't hurt to learn more about how your body works. At least, you can give better descriptions to your doctor.
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flydok
Nov 15, 2008, 9:07 PM
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You probably have a hernia of sinovial vagina of tendom (ganglion). If you fill pain or other discomfortable condition - may help operation. If you do not fill any pain or different simptoms, you may live without any treating. From time, bulge may disappeared. But if you begin fill any complication, you must to see orthopedic surgeon.
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bababooey1
Nov 15, 2008, 11:45 PM
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i think im in serious trouble if i have a vagina of any kind, let alone a herniated one!
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blondgecko
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Nov 16, 2008, 7:22 AM
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bababooey1 wrote: i think im in serious trouble if i have a vagina of any kind, let alone a herniated one!
In the anatomy world, "vagina" = "sheath". Yep - the sheath around your tendon is, technically, a vagina.
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onceahardman
Nov 16, 2008, 2:14 PM
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In USA anatomy class, they are more commonly called "invaginations", but the guy who mentioned "vagina sounds like ESL, and they do mean the same thing.
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boracus
Nov 21, 2008, 6:37 PM
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B-
Definitely one of the more interesting threads that I've seen in awhile and I'm not sure I've heard of too many people causing the injury you've described. From the sounds of how intensely you are able to train/pull the fascial tear/hernia theory sounds probable.
Since the fascia itself is one continuous structure that surrounds and also invests the muscles themselves an extremely powerful muscle contraction can tear the fascia anywhere from a muscles origin to insertion. Seems like most people simply blow out ethier end of a muslce tendon or the tendon itself rather than tearing the stocking like fascia surrounding the muscle belly itself.
Fascia will heal over time though w/ a tear in the epimysium and continue muscle contraction the fascia may be permenantly deformed. Usually this isn't a concern in fact for the rare instance of a compartment syndrome in the forearm the usual treatment is to go in surgically and perform a fascial release. This usually includes cutting some of the epimysium to alleviate the constriction on the muscles.
I'd certainly be interested to know what the ortho has to say though. But if the fascial tear is the case there's probably nothing to do about it, you'll have a permanent deformity in that tissue but it shouldn't effect your performance or ability to train/climb hard.
cheers, BA
(This post was edited by boracus on Nov 21, 2008, 6:40 PM)
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Ains
Nov 23, 2008, 12:58 AM
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ditto this guys reply. You must have been pulling wicked hard. Try this --bring your pinky and thumb tips together and pinch together. Compare your R and your L by looking at what tendons pop up in the under side of your wrist. Is it the same? If not you may have ruptured you palmaris longus. Not all of us have one. Doesn't do you a lot of good to know what muscle, but kinda cool if you did. Try it and see, but either way sound like you popped a tendon in half cranking like a madman. Kudos.
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bababooey1
Nov 24, 2008, 3:21 PM
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i had the MRI on friday, hopefully the doctor will call me sometime today to let me know whats up. i have high resolution imaging of the area with the bulge and also imaging of the entire forearm. tried to look at the images myself, but i really have no clue what im looking for. maybe i will try to figure out a way to upload the images when i get home tonight so you guys can take a look.
as for the thumb-pinky test, the doctor did that test(along with many others) and the results were not really conclusive for any of them. i let the 2 doctors and the nurse(it was an exciting mystery case for them, so they were all there for the exam) discuss the possibilities for a while before i brought up my hernia theory, but they seemed to agree that it was definitely possible.
what originally gave me the idea that its a hernia is the fact that the bulge appears/disappears in conjunction with the muscle moving to and from that area, there was never any pain, never any weakness, and never any discoloration(yellowness, bleeding, bruising, etc.) as i would have expected for a tear. but there are so many muscles and tendons in the forearm that im sure its possible i could blow a minor one without really noticing any loss of strength. hopefully the MRI will provide an answer. if not, the dr is going to have a co-worker do an ultrasound to see if that shows whats going on(apparently it is not standard procedure to use an ultrasound for something like this).
and i was pulling about as hard as i could on a vertical pinch grip. plus, it was near the top range of what i can climb(5.10+) and it was the last route of the night so i was already fatigued.
edit/// now that i think of it, one of the doctors said "he has a really nice palmaris" so im guessing that is not the problem.
(This post was edited by bababooey1 on Nov 24, 2008, 3:28 PM)
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Ains
Nov 24, 2008, 6:28 PM
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ha, weird.
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