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collateral ligament tweak (Read 6681 times)

ghisino

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collateral ligament tweak
January 13, 2016, 01:06:55 pm
tweaked both index fingers' recently, probably while trying a finger crack in annot. some pain on the outside of the PIP joint when palpating it, and unusual swelling for a few days (now almost gone).

since this is different from usual pulley tweaks, i have no clue how i can speed up things a little, apart staying away from finger locks and bringing them back in gently when the pain goes away.

anyone has useful input?

Lund

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#1 Re: collateral ligament tweak
January 13, 2016, 01:49:22 pm
(a) don't fuck with it too much or rush it: it can turn into chronic, synovial cysy type territory quite easily

(b) some stuff here: http://www.aafp.org/afp/2006/0301/p810.html

This recommends buddy taping for a few weeks.  I would do that.  At the very least, avoid crimps and holds where your hand rotates the grip as you load it - that can reinjure the healing sprain easily.


Schnell

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#2 Re: collateral ligament tweak
January 13, 2016, 03:02:57 pm
May not be relevant to you given you've injured your index finger, but I've always found openhanding involving dropping fingers a big risk for collateral ligaments, though I also had one that was aggravated by crimping. My strategy is to check holds carefully to see if pulling on them means the joints are torqued laterally in a way that'll aggravate the injury (probably obvious but by this I mean where the fingertip is laterally flexing away from the injured side of the joint).

duncan

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#3 Re: collateral ligament tweak
January 13, 2016, 04:31:23 pm
ghisino I'm not clear if you mean thumb side or middle finger side of your index finger. I'm interested in other's experiences as I'm just over 3 weeks after a middle finger PIP collateral tear. Also from finger-jamming. Mine was initially red and very swollen and it's still a bit swollen locally and bruised-looking so probably a grade III.

The advice I received is long-term recovery is usually good if you don't rush things. I was advised a grade II should take 4-6 weeks but this was from a non-climbing physio., so perhaps err on the side of caution. I'm expecting mine to take ~12 weeks. Chronic instability and synovitis is a risk of you're not patient. Any joint stiffness from relative immobilisation should resolve quickly. I've some finger-jamming BHAGs so I'm trying to be cautious.

Buddy-tape, though this might not work so well if it's lateral (thumb side) index. My biggest challenge is to "climb like a physiotherapist" (Hazel Findlay) for a bit. As Schnell says, consider the likely load on the structure involved and drop off immediately if it's not quite right.

TheTwig

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#4 Re: collateral ligament tweak
January 14, 2016, 01:06:38 am
No matter what you do be fucking careful! Collateral ligaments don't mess around. I destroyed the one on my middle finger doing gymnastics about 7 years ago (put my hands down to break my fall and the finger bent sideways under a shit load of force) and to this day I'm paranoid as hell about holds where my fingers are a little rotated on the hold. It took well over a year for my finger to get to to a new baseline and still gets tweaked every now and then. Oddly enough knocking it on things is more painful than any kind of twisting action

Schnell

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#5 Re: collateral ligament tweak
January 14, 2016, 11:52:59 am
I'm interested in other's experiences as I'm just over 3 weeks after a middle finger PIP collateral tear. Also from finger-jamming. Mine was initially red and very swollen and it's still a bit swollen locally and bruised-looking so probably a grade III.

The advice I received is long-term recovery is usually good if you don't rush things. I was advised a grade II should take 4-6 weeks but this was from a non-climbing physio., so perhaps err on the side of caution. I'm expecting mine to take ~12 weeks.

The most serious collateral tear I had took about 12 weeks, maybe slightly more. I heal very slowly though so that might be an anomaly. It took less time than a serious pulley injury but that might be because I found it easier to work around as I described in my post above.

wsmith

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#6 Re: collateral ligament tweak
January 14, 2016, 01:35:45 pm
I did my collateral while getting my middle finger stuck in a mono as I moved off it with an upwards/sideways motion. Swelling for a week or so but found I could get back into climbing after that as long as I avoided any twisting actions (like others have said) and hitting holds dynamically with that hand since that often results in some twisting . What set me back most was randomly hitting/catching it on stuff, not necessarily while climbing.

Took 10-12 weeks before all pain disappeared but I could climb at my max from a few weeks after injuring it (although that may have slowed recovery).

2 years later now and the finger is still slightly larger where it happened.

Scouse D

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#7 Re: collateral ligament tweak
January 15, 2016, 08:51:13 am
My collaterals have been perma damaged in both my middle fingers. Like others have said it is twisting on holds/backhand holds and pockets which aggravate them. However, I just climb through the pain now which doesn't seem to worsen them. Once warmed up the pain goes and I  able to use most holds comfortably.

erm

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#8 Re: collateral ligament tweak
January 15, 2016, 10:40:50 am
Fairly soft joints here. Tweaked these ligaments in the middle and ring fingers of both hands repeatedly. Joints are now clearly larger than they were and some range of motion has been lost from the ligament thickening.

Most of the damage comes from crimping in me. If i just enter the position on a surface my fingers are clearer under torque. This lead me to open hand obsessively for years.

Buddy taping when you first go back and then x taping the side of the joint for as long as you feel (although the x tape will need reapplying often to maintain tension).

Rocksteady

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#9 Re: collateral ligament tweak
January 22, 2016, 09:14:47 am
My collaterals have been perma damaged in both my middle fingers. Like others have said it is twisting on holds/backhand holds and pockets which aggravate them. However, I just climb through the pain now which doesn't seem to worsen them. Once warmed up the pain goes and I  able to use most holds comfortably.

I think I might have this. Have had tender joints in left hand pinky and middle and right hand middle fingers for a long time (upwards of two years). I had it checked out originally and the hand therapist I saw said it was probably arthritis and I would have got it anyway and I should eat anti-inflammatory foods and keep climbing.

So I did. Occasionally hurts if I knock my finger sideways on something but little pain when actually climbing and I have got stronger.

Now I wonder if actually they are all collateral ligament tweaks. Though I'm also now concerned I might have synovitis. After a climbing session I often have reddened areas at the cuticle. Anyone else get this, is it symptomatic of something?

Scouse D

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#10 Re: collateral ligament tweak
January 22, 2016, 09:35:56 am
The way I see it is that it could be synovitis and it could be collaterals. Either way I'm not going to stop climbing so I just try not to piss it off too much. If I am no longer able to manage it I may well need cortisone injections in a few years but I'm not going to worry about it. My mate Laurie has a similar issue which was diagnosed (correctly or not) as arthritis. He similarly just manages it and doesn't climb on it when it's really bad. Come to think of it he hasn't mentioned it for ages.

TobyD

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#11 Re: collateral ligament tweak
January 22, 2016, 11:59:25 am
The way I see it is that it could be synovitis and it could be collaterals. Either way I'm not going to stop climbing so I just try not to piss it off too much.

That's a decent management strategy for more or less (non serious) finger injury, in my opinion. Add in sensible icing after climbing, stretching a little and not scarfing down NSAIDs and you're there. Many people worry incessantly about diagnosis, but it really makes very little difference to how you should deal with it, in my opinion. The most effective approach is probably to address what has caused anyone with a tweak to have that problem, especially if it is persistent; and make changes to climbing style / habits accordingly.

For example, if I get any finger tweaks it is usually likely lateral collaterals on ring fingers; clearly because I crimp too much, and tend to drop my pinky off on many grip types, especially in full crimp. It seems obvious what i need to do to help limit recurrence? Having said that, if anyone has what they've found to be a radically better idea let me know!

Lund

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#12 Re: collateral ligament tweak
January 24, 2016, 07:00:35 pm
The way I see it is that it could be synovitis and it could be collaterals. Either way I'm not going to stop climbing so I just try not to piss it off too much. If I am no longer able to manage it I may well need cortisone injections in a few years but I'm not going to worry about it. My mate Laurie has a similar issue which was diagnosed (correctly or not) as arthritis. He similarly just manages it and doesn't climb on it when it's really bad. Come to think of it he hasn't mentioned it for ages.

I second (or third) this.  Once you've a chronic injury - which is what you've got (and me too, haha) - then really the only thing you can do is manage it.  The outcomes from any kind of surgery/injection blah are likely to be non-miraculous anyway, and might even make it worse - so if it doesn't stop you doing anything, then why mess with it?

That said... if you can stop it getting chronic by being sensible in the acute phase... then that's the sweet spot.

paulwelford

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#13 Re: collateral ligament tweak
February 07, 2016, 09:25:30 pm
As per Lund's advice, I would avoid climbing in the acute phase if it causes pain.
Finger ligaments take longer to heal than ligament injuries in more proximal joints.

Unlikely to have serious ligamentous injury (eg rupture) without significant traumatic event (normally rugby or something equally foolish), especially given both index fingers affected.

Try this test and let us know what you find:

https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/71/29-PIP-MdPhlx-LigRep/218/29_phalanx_PIP_CollateralLigament_1es.jpg

- You are looking for excessive movement (laxity), a 'spongy end feel', any strange relocation clunks and lastly pain reproduction.

Initial management is as others have recommended:

bath in icy cold water, 10 mins every few hours.
buddy tape if this helps with pain.
remove tape to exercise finger several times daily.
gentle massage to painful area will be fine too, and might possibly help with circulation/swelling.
if the fingers starts to curl and becomes difficult to straighten over the next week, you will need to spend a few weeks in an extension splint.

TobyD

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#14 Re: collateral ligament tweak
February 07, 2016, 11:33:14 pm
The way I see it is ...He similarly just manages it and doesn't climb on it when it's really bad. Come to think of it he hasn't mentioned it for ages.
Once you've a chronic injury - which is what you've got (and me too, haha) - then really the only thing you can do is manage it. 

But, are they chronic injuries or a habit / style causing a recurrent injury? You could change either of these with a bit of effort. (Well possibly a lot of effort).

Lund

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#15 Re: collateral ligament tweak
February 08, 2016, 09:47:21 am
The way I see it is ...He similarly just manages it and doesn't climb on it when it's really bad. Come to think of it he hasn't mentioned it for ages.
Once you've a chronic injury - which is what you've got (and me too, haha) - then really the only thing you can do is manage it. 

But, are they chronic injuries or a habit / style causing a recurrent injury? You could change either of these with a bit of effort. (Well possibly a lot of effort).

It's a chronic injury.  Or rather, it's in injury that will never heal.  You can't heal what literally cannot heal: this is what I mean by a chronic injury in this case.

 

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