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duckwalk
Feb 23, 2006, 4:50 PM
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bumped because this is the best thread on the subject and I recently did some damage to my finger. Here is some more info:
One of the nicest articles I found
www.wemjournal.org/.../?request=get-document&issn=1080-6032&volume=014&issue=02&page=0094
The effect of taping ( it does help)
ajs.sagepub.com/cgi/content/full/28/5/674
An ok article from the UK
www.thebmc.co.uk/safety/hp/articles/getting_a_grip.pdf
An ok article on Climbing.com
www.climbing.com.au/science/injuries.pdf
Hope this can help people wade through the BS before they choose their treatment ( if any ).
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drrock
Feb 23, 2006, 5:54 PM
Post #28 of 47
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Too bad to hear about your finger issue. I agree the article from Wilderness and Environmental Medicine (2003; 14: 94-100) is an excellent one. The first link you provided is not useable, but if you go to http://www.wemjournal.org/.../?request=index-html and search for "pully injuries", it comes up along with a letter to the editor. Great review and recommendations.
I had a complete A2 rupture in 10/03 and it is now completely healed as if it never happened, with the exception that my ring finger can't completely curl into a fist along with the other fingers. But the strength and flexibility remain excellent. It took 3 months with pretty bad pain while climbing lightly, then I could climb okay, then up until 6 months I could climb a little harder, and then after 6 months I was back to baseline. I taped tightly because of soreness/pain for about 1 year, and then there was no more pain and it was good as new. There was a little pain in between 6 months and a year, but I was able to pull down hard as ever.
The surgeons recommended surgery to fix it. I did a lot of reading and research, as you obviously have, and decided against it, and I am glad I did.
I don't know if this is legal, and I will pull it off if it is not kosher to post this, but this is the abstract from the article:
Wilderness and Environmental Medicine: Vol. 14, No. 2, pp. 94–100.
Pulley Injuries in Rock Climbers
Volker Schöffl, MD; Thomas Hochholzer, MD; Hans Peter Winkelmann, MD; Wolf Strecker, PD, MD
From the Department of Trauma Surgery, Teaching Hospital of University Erlangen-Nürnberg, Klinikum Bamberg, Germany (Drs Schöffl, Winkelmann, Strecker), and Privatklinik Triumpfpforte, Innsbruck, Austria (Dr Hochholzer)
Objective.— The closed traumatic rupture of finger flexor tendon pulleys in rock climbers appeared as a new complex finger trauma in the mid 1980s. The objectives of this study are to characterize this injury and to describe diagnostic and therapeutic guidelines. A grading system for the severity of pulley injuries was developed and used to set therapeutic pathways.
Methods.— Six hundred four injured rock climbers were prospectively evaluated from January 1998 to December 2001 with a questionnaire and standard examination protocol. Diagnostic ultrasound was performed in all rock climbers with finger injuries; if necessary, an additional magnetic resonance imaging was done. All pulley injuries were graded according to an introduced pulley-injury score (grade 1–4).
Results.— Three of four of the most frequent injuries were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%. One hundred twenty-two (20.2%) rock climbers presented an injury of the flexor tendon pulley system, 48 had pulley strains, and 74 had ruptures (a single rupture in 90.5% and multiple pulley ruptures in 9.5%). According to the pulley-injury score, 39% were grade 1, 25% were grade 2, 30% were grade 3, and 6% were grade 4 injuries.
Conclusions.— Pulley injuries were the most frequent injuries in rock climbers. Whereas grade 1–3 injuries respond well to conservative treatment, grade 4 injuries require surgical repair. We recommend the “loop and a half” technique of Widstrom and colleagues and, alternatively, the Weilby repair. We also recommend postoperative initial immobilization and early functional treatment under external pulley protection.
Key Words: pulley rupture, sport climbing, rock climbing, flexor tendon
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wzrdgandalf
Feb 23, 2006, 6:56 PM
Post #29 of 47
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I think everyone should check out the newest Rock and Ice, there is an article about taping and how to care for your pulleys in your fingers. It says that taping should only really be used to immobilize your fingers to make sure you remember that you are injured. By taping your fingers you arent actually giving your pulleys any support unless you were to put them so tight that the circulation would be cut to your finger creating a tourniqet. Let the Pulley heal on its on and you might want to get an MRI to see the true damage done to your finger.
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drrock
Feb 23, 2006, 7:15 PM
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Right you are Gandalf, partially. The recommendation not to tape comes from an article where investigators took a bunch of cadaveric forearms, put them into a crimp position, then pulled with progressively more force on the finger tendons until the pulleys popped. Then the repeated it with fresh dead arms to which they had applied athletic tape around the pulleys in a manner in which they deemed similar to climbers' taping their fingers. The tape did nothing to "support" the pulley or to prevent the rupture of the pulleys in terms of load applied to the tendon. So they concluded that taping is not helpful to prevent rupture or to bolster the pulley strength. Can't argue there. But I see two reasons why this can't be 100% applied to us (me and anyone else with a tear or partial tear).
1) Psychologically you know the tape is there and I for one found it useful and was able to climb harder with the tape on. It also reminded me I had an injury so that I was more careful in how I used that finger, as you mention.
2) These cadaveric arms had the pulleys intact, and this was not the case for me, so the study does not apply to those of us who know the extent of our injuries and it includes a full or even partial rupture. When my pulley was fully ruptured (completely gone), using tape probably did prevent *some* bowstringing of the tendon. Do I have evidence for this? No, but in my mind it makes sense. And that is what matters right?
I agree with you otherwise, and reading threads and articles is the only way to educate ourselves, since most physicians don't know this condition exists, much less what to do for it.
Thanks, peace.
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wzrdgandalf
Feb 23, 2006, 7:32 PM
Post #31 of 47
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Good point drrock, I still tape my fingers so that i know that i have a screwy finger and should favor it a little. I guess a little mental help is better than nothing because not climbing... isnt really an option for many of us.
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drrock
Feb 23, 2006, 9:30 PM
Post #32 of 47
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Haha, right on Gandalf.
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geeyoupee
Nov 18, 2006, 8:03 PM
Post #34 of 47
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hey i was climbing yesterday at a comp and i didnt get to warm up too well because it was too crowded and now my ring finger feels wierd. when i flex my ring finger i feel a stinging sensation in the a4 pully i believe. when i was climbing i didnt notice the pain but it only happens when i flex it. when i got home i noticed that if i pressed on the a4 pully hard, i could flex my finger and feel no pain at all. is this because im pushing the ligament(not really sure if its called that) to the bone and its sorta allowing the pully to hold it. would you guys call this a minor tear because it doesnt really hurt that much but its noticeable. could i just tape it up and climb lightly? or do i have to give it full rest? am i allowed to do pull ups or hangboard while resting? i heard that open hand doesnt stress the pullys and only crimps do. well im pretty bummed because theres a crap load of new routes that they put up for the comp that i want to do. thanks
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capibara
Jan 29, 2007, 11:26 PM
Post #35 of 47
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My fellow climbers, im currently out of the sport i love because of a2 ruptures on both ring fingers, waht a pain in the arse this has been. ive been already out for 4 long month an still going. cause of my desperation i admit a have made several mistakes to worsen my condition, so here its what and what not to do from my experience;
1)Make a commitment to rest as long as you can even with the pain gone, do not go back to climbing the first day it sopped hurting.
2)if the dessire is umbearable, do not under any circumstances crimp anything.
3)If anyone knows what prolotherapy is and its thinking about it as a solution, think again, like its been said in this forum before, dr.s are like mechanics they'll say whatever to get you money. i did it and it was a huge setback.
4)Avoid any sports in which the fingers get a beating throuh strain or strong vibrations, exp: bike, tennis, golf. etc.
5)stop climbing inmediately, do not wait 6 months till the pain and the injury are uncontrollable
for all of u injured crank-masters that would like to eat stone for breakfast, my deepest condolences.
Gus-Phoenix
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drrock
Jan 30, 2007, 3:34 PM
Post #36 of 47
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Thanks for the note Capibara. I didn't really know anything about prolotherapy, but after reading a bit, I would tend to shy away from that. Sounds kind of scary. Wiki has a nice intro to it in case anyone has never heard of it.
http://en.wikipedia.org/wiki/Prolotherapy
Anyone out there get any benefit to their pulleys from prolotherapy?
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capibara
Jan 30, 2007, 4:21 PM
Post #37 of 47
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drrock. im triying diferent crap to see what makes the fingers react. That actually seems t be the problem, their not triying to heal.
ill keep posting any progress, for now im just massaging the area and im planning on starting cold and warm baths today.
any extra tips from anyone wolud be graetly appreciated
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cantbuymefriends
Jan 30, 2007, 4:21 PM
Post #38 of 47
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Just chiming in here.
Did a (partial) pulley rupture on my left ring finger on a slopey crimper around Dec 10. Don't know what A-number it is, but it's between the first and the second joint on the finger, counted from the tip. Bad pain for a few days, but hardly swollen at all.
Rested about 10 days, went for an easy climbing session with taped finger. Pain a little worse the following day, but not really that bad.
Rested for another 10 days and went climbing again on Dec 28. The pain was almost gone by now, so I made a bad tape job, but I tried to climb easy anyway. Next day the finger was swollen to 1.5 times its size (looks like a pregnant guppy...) and the finger and better part of the palm of the hand was just numb!
1 month later and nothing has happened! The numbness went away in a few days, but it's still as swollen, painful and a bit stiff as it was after the last climbing session. OK, it's a little bit better because now I can grip with my hand without a numbing feeling!
Luckily with good taping I've been able to do some ice-climbing, due to different hand position and that you grip, not crimp, on the axe handles.
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zeke_sf
Jan 30, 2007, 4:41 PM
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Am I wrong, or are half of us hen-pecking as we type?
I had my first taste of tendon trauma recently. I basically tweaked it on a sloper, and, of course, kept climbing for another 1/2 hour out of stubborness. When I flex my right ring finger I feel pain in my upper forearm (where, I believe, the tendon attaches). I can completely curl my ring finger into a fist, so I don't think I have ruptured a pulley, and it only hurts when there's resistance applied. The closest thing I could find is that it is a a flexor tendon injury, but the only medial advice I could find deals with surgically repairing ruptures, which I don't believe I need. Any advice from the injured masses? (Sorry for the thread hijack, I'm just excited to see a related thread).
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cchildre
Jan 30, 2007, 4:46 PM
Post #40 of 47
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Well, had A-2 and A-3 problems awhile back. Did some light climbing over the last six months, but nothing serious. Finally felt things coming back together and pulled my hamstring really badly. Took another couple of months off to heal fully, plus winter months being what they are. So now like eight months out, I truly feel ready to get back to cranking, and I think taking too much time has really benefitted my healing. I can still feel some, not pain, but a tinge of discomfort, in the finger. I feel fulll strenght and confidence again.
First and foremost. Warm up! My injury was exactly because I worked my project with no warm up. Stupid thing indeed. I am ready for the spring to be a busy one, getting back to normal.
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drrock
Jan 30, 2007, 4:55 PM
Post #41 of 47
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zeke_sf wrote: Any advice from the injured masses? (Sorry for the thread hijack, I'm just excited to see a related thread).
Well, I'm no longer injured, but I would just have general advice that you already know. Rest, drink lots of water, take Aleve, ice, stretch, and warm up very well before climbing and if some particular move hurts, do something else. Sucks but it will get better if you let it.
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menjop
Apr 28, 2007, 3:59 AM
Post #42 of 47
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Okay, this seems to be the big "pulley injury" thread. I've read through the excellent resources here, but I figured I'd post my story and solicit opinions/advice.
This just happened about 2 hours ago, at the gym, second-to-last move of the last climb of the night. Basically a big layback on a crimpy piece, and POP -- left little finger, in the neighborhood of the A4.
Didn't hurt at first, but it sure didn't feel right, so I bailed on the climb and got some ice. The finger basically hurt all over after a while, but now it's just that area around the tendon and pulley, and only if I squeeze it. The tenderness actually isn't along the centerline of the finger; it's more toward the ring finger. I can actively flex the distal joint, although it hurts with resistance. No swelling, no bruising, no perceptible bowstringing.
Based on what I've read here, I'm guessing Grade 1 (pulley strain)? Does that sound reasonable? Should I see a doctor? Take glucosamine etc? (I'm guessing Ibuprofen isn't necessary, since there's no inflammation). Lay off climbing?
This really sux if I'm gonna be laid up, with the weather just starting to get nice (I was planning to head up to the Gunks next month). Honestly, it doesn't seem too bad, but that was one hell of a pop for such a small finger.
Anyway, if anyone cares to offer a diagnosis and/or advice, it'd be much appreciated.
Thanks,
John
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drrock
May 9, 2007, 7:15 PM
Post #43 of 47
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John-- missed your post and you probably are all healed up by now, but in case not, yeah you probably strained a pulley. Since you can still flex, your tendons should be intact. Is it still bothering you? When I tweak a finger now, I just keep climbing if I can and tape it pretty tight. If it is sore enough that it hurts with every move, I do give it a couple weeks to heal and see how it goes. I think ibuprofen works really well and so does icing, but haven't gotten into the other stuff like glucosamine, supplements, etc. I am not sure what glucosamine would be useful for in this particular case, even in theory. How is the finger a couple weeks later anyway?
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menjop
May 9, 2007, 7:41 PM
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Hi, thanks for the reply. I was a little freaked out when I wrote that, since I wasn't sure how bad it was and how long I was gonna have to go without climbing, tennis or playing the guitar (essentially all the things that keep me sane(ish)). Not quite healed up yet -- still stiff and a little sore, but I can weight it now, and it's improving each day. I haven't climbed since it happened, but the guitar playing is getting there. I was originally targeting Friday (two weeks) for an attempt on the wall at the gym, but I may wait until it's 100% to be safe.
Anyway, thanks again.
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booyuhka
Oct 6, 2008, 9:09 PM
Post #45 of 47
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Just wanted to thank all of those that have provided very useful information. Im currently gingerly climbing through two A4 pulley strains(possible ruptures)... both on my middle fingers. Ive been injured now for about 4 months and although things havent gotten worse, they havent gotten much better.
Id say in the past 5 years these are probably my 4th and 5th strain/rupture... Ive had a couple clear up fairly fast around 3 to 4 months but I had one injured for what seemed over 6 months maybe closer to 9... finally it getting better when I was able to climb outdoors exclusively vs indoors. (Now mostly climbing inside... ha... yea, not much of a surprise why these arent getting better) Luckily ive managed to climb through all of these injuries and not take too much time off in any particular occurrence.
But its good to read all of the success stories and be reminded of things that I should/shouldnt do. Just wanted to share my experiences and say what a great thread.
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bertrand
Oct 13, 2008, 7:52 PM
Post #46 of 47
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Hey Drrock, I hurt my finger this weekend in Yosemite and just read through your whole thread, trying to do a quick diagnosis. You guys are way advanced in the terminology and analysis, and I got a headache from some of the articles.
I was hoping you could help me categorize this:
**The pain started after topping out on a 13 pitch mid-grade climb..and it was COLD, we expected 80 degree weather, but it snowed on us and I was constantly blowing on my hands to keep from going numb. **The pain is at the middle (proximal knuckle) and ONLY when I extend my finger, not flex.
Any idea? flexor and pulley injuries hurt only when you curl your finger, not extend, right? Many thanks to anybody who can comment.
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Toxins
Mar 11, 2009, 8:11 PM
Post #47 of 47
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i understand this is 6 years later but thanks for the advice. just what i needed to hear!!!!
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