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angry
Jan 8, 2010, 2:56 PM
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So in late Jan of last year I blew the pulleys in my ring finger. I've climbed like shit most of the year because of this.
Once the strength returned (I'm probably 80%) I never got my flexibility back. My finger is perpetually bent. It looks like Duputrens (sp?). I can work it back and forth and with A LOT of force can get it to straighten for a second. If I forcefully push all the hardened scar tissue forward toward the knuckle, I can straighten it then. Did I mention that the finger is approx twice the diameter that it was?
I can barely crack climb. The bent finger has gotten so stiff that I can not force it past the cracks if it's tight or flared hands. Of course most finger cracks are a no go too.
I've made an appointment with the ortho next week to get it evaluated. I would assume he'll prescribe me a routine of massage and maybe an injection to break up the scar tissue although at this point there is nothing he could do to make it worse so I'm open to anything.
Is there anything specific I need to mention to him? Chances are this ortho will have never seen a climber or treated a hand injury. There is also no chance that he'll be able to refer me to one who has. Lets assume he's a well trained doc and good at his job but lives on a tiny little island where no-one climbs. How do I get him to actually help me, not just tell me to stop climbing?
Sorry if this sounds cynical but I've yet to experience a doctor who looks for a solution to any problem I have. Ever.
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dolphja
Jan 8, 2010, 3:19 PM
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the ortho doc may refer you to a plastic surgeon. we see these cases about twice a month. it's not a quick fix kinda deal and there's always the rehabilitation phase.
good luck angry
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angry
Jan 8, 2010, 3:24 PM
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Why a plastic sugeon? All the scars are under the skin. Other than being crooked and bigger, the finger looks like any other finger.
Is it that the plastic surgeon would be better able to remove the scar tissue that's blocking the joint from moving? I'd imagine that an orthoepedic surgeon would be the one for the job. I'd also imagine that there is a lot that they would try first prior to surgery, injections, massage, ultrasound, PT, etc.
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dolphja
Jan 8, 2010, 3:31 PM
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yea, they'll try to do less invasive procedures before surgery is recommended. an ortho physician will likely try steriod injections and range of motion exercises to try and break down the scar tissue. i'm sure you've been doing ROM exercises since shortly after you were injured. the next step would likely be injections, which the ortho doc can administer. if they don't get any progress that way, they would probably refer you to a plastic surgeon for scar treatment and tissue repair. plastics usually specialize in that more so than ortho doctors do when it comes to hands
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johnwesely
Jan 8, 2010, 4:54 PM
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My finger still does not completely straighten out from a pulley rupture over a year ago. However, it was about as bent as yours, and now, it is almost straight. I attribute this to being young and doing daily finger stretches.
I would extend my finger as hard as I could, past the normal range, for 10 seconds, then release. I would repeat this till soreish, and then follow up with a massage. I would do this every other day because doing it every day made the finger sore. YMMV.
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granite_grrl
Jan 8, 2010, 7:43 PM
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I was actually thinking plastic surgeon too. I have two big scars on my sides, they healed really badly. I went to the PS and he gave me injections to break up the scar tissue.
Anyway, I wish I some more useful info to give you, Angry, but I don't. Good luck!
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onceahardman
Jan 9, 2010, 12:19 AM
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In reply to: Is there anything specific I need to mention to him? Chances are this ortho will have never seen a climber or treated a hand injury. There is also no chance that he'll be able to refer me to one who has. Lets assume he's a well trained doc and good at his job but lives on a tiny little island where no-one climbs. How do I get him to actually help me, not just tell me to stop climbing?
Well, I really can't think of an ortho who has NEVER treated a hand injury. Certainly there are hand specialists, but EVERY ortho will have been "in the field" for hand surgeries while doing his/her residency.
First off, tell him the problem exactly. Don't come off as cynical or skeptical. Come off as very curious and driven to do whatever it takes to maximize your functional potential. Tell him you have done considerable due diligence on the problem.
Following many/most hand surgeries, the hand is splinted or casted such that the MCPs are flexed, while the DIPs and PIPs are fixed in extension during this early healing phase. This appears to be reflected in your problem. In fingers, it is much easier to regain flexion than extension.
Not to piss in your cheerios, but surgical outcomes from this kind of likely adhesion of a flexor tendon tend to be less than 100% satisfactory.
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angry
Jan 9, 2010, 12:51 AM
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onceahardman wrote: In reply to: Is there anything specific I need to mention to him? Chances are this ortho will have never seen a climber or treated a hand injury. There is also no chance that he'll be able to refer me to one who has. Lets assume he's a well trained doc and good at his job but lives on a tiny little island where no-one climbs. How do I get him to actually help me, not just tell me to stop climbing? Well, I really can't think of an ortho who has NEVER treated a hand injury. Certainly there are hand specialists, but EVERY ortho will have been "in the field" for hand surgeries while doing his/her residency. First off, tell him the problem exactly. Don't come off as cynical or skeptical. Come off as very curious and driven to do whatever it takes to maximize your functional potential. Tell him you have done considerable due diligence on the problem. Following many/most hand surgeries, the hand is splinted or casted such that the MCPs are flexed, while the DIPs and PIPs are fixed in extension during this early healing phase. This appears to be reflected in your problem. In fingers, it is much easier to regain flexion than extension. Not to piss in your cheerios, but surgical outcomes from this kind of likely adhesion of a flexor tendon tend to be less than 100% satisfactory.
I prefer my cherios with piss in them. It's the only thing that gives them flavor.
I'm well aware that surgical outcomes aren't great. In fact, I will push him to attempt to resolve this non-surgically through injections, massage, or magic. If I do in fact need a surgery, so be it. Even though the finger is fairly strong now (as said earlier, likely 80%) it's what has been done to my crack climbing that really bothers me.
While I personally am in Bermuda, my heart and my passion is in Wyoming, Utah, Colorado, and anywhere else that gives me the opportunity to hang it all out on what we call tard. I'm willing to accept a physical ceiling on sport as long as the only things that ever hold me back on cracks are age and my head.
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aerili
Jan 11, 2010, 3:51 AM
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Plastic surgeons are to general orthos like needlepointers are to hacksaw wielders. If a non-hand surgeon was to work on your finger one day, which would you rather have as the alternative here?
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