[roddersm]

Hi all,

I have injured my index finger from over crimping on a boulder problem. I'm pretty sure its not a pulley injury as the pain is mostly on top of my finger just past the 2nd knuckle (phalanx) and around teh knuckle. When I intially injured it my finger was slightly swollen on the inside of the knuckle and just below (around the A2) but this has subsided now and was getting a really sharp pain around the knuckle when contracting or extending my finger.

I've rested for a few days and haven't climbed since but the finger is still painful around the knuckle and is aggrevated if i squeeze the knuckle (or do any general housework etc. ). I'm beginning to suspect it might be a stress fracture as I'm not sure what else this could be?

Has anyone else had a similar problem or have any other ideas what it could be.

If it is a stress fracture can I still climb and what is the best treatment?

Cheers,

Rodders.       

[The Sausage]

It's probably the best part of impossible to diagnose without actually seeing it. There are so many structures within that part of the finger - if you look at gray's anatomy, you'll see how the extensor mechanism divides into 3 parts, and there are slips going off to the lumbrical and interosseous insertions. If it doesn't start to settle, my advice would be to go and see your GP and see if you can get a referral to a hand surgeon. If it settles in the meantime, all well and good.

Did you feel it 'go' when it happened? and what were you doing when it happened? was there any popping sound? or did it just come on later/the next day?

[Reprobate_Rob]

I'll second the Sausage on this - too hard to tell without proper diagnosis, but it does sound like an extensor issue.
Not wanting to scare you, but I fully ruptured my central slip extensor in my index finger a couple of years back.
Thankfully took it to the GP sooner rather than later, got quickly referred to a specialist who diagnosed the central slip rupture and called me in for a reconstruction op the next day. Did a very good job too - apparently they nicked a bit of each of the extensor slips on either side, joined em together and stuck it back to the bone.
Took a couple of months of stretching and ultrasound to break up the scar tissue after, and I've lost a tiny bit of flexion in that finger - not that I ever notice it. Two years on and i'm cranking harder than I ever was and the finger's fine (shame about all the pulley strains on the others though).

Anyway, definitely, definitely worth getting it checked, coz if it is this, and you don't, you'll end up with a boutinierre deformity (fucked finger) - have a google.

Course, it could easily just be a strain, partial rupture or any number of other things.

Hope it doesn't turn out to be serious, but get it checked asap.

[roddersm]

Thanks guys. Shit thats not the good news I was looking for.

Sausage I was bouldering last sunday for 4 hours or so mostly on a problem with a couple of really crimpy pulls on the left hand and when I finished my finger was a bit sore but nothing too bad. Did an hour on the wall on the tuesday with a bit nut not much discomfort so just thought it was a bit tweaked. Went back to the same problem that I originally hurt it on (how stupid was that but I was off work and wanted to get it ticked) on the wednesday and towards the end of the session my finger had deteriated and become pretty sore and a bit swollen on the inside of the knuckle and around the a2.

After the sesseion it was pretty sore and swollen and I had limited movement for a day or so. There was no pop or rupture just a deteriotation and increase of pain after the final session. Not sure if this makes a difference?

Like I say the swelling has gone down and its definitely not as tender or sore but every so often I get a sharp pain at top of the knuckle when I extend or contract the finger (but not always) or say i contract the finger 4 or 5 times in a row it will start to hurt at the top of the knuckle. Also If I squeeze the finger around the joint, either on the sides or above and below, then this feels sore and tender.   

I hope that this is not a central slip rupture as rob was saying? How long before you were climbing/training again rob?

Is the GP the best route to go? Would A&E do an x-ray? I usully find that the A&E staff and gps are pretty unhelpful with sports injuries especially something like this and would rather avoid going but that boutiniere deformaty sounds pretty bad.

Also do you think it would be stupid to try doing a bit of open handed training at the wall or barwork or if it was a central extensor problem could this make it worse?

Thanks alot guys.

[roddersm]

Also Rob if it is say a partial rupture or just a strain of the central slip (it certainly seems that this is where the pain is) and the inside lateral band do you know of what treatment might help this?

thanks again.

[Reprobate_Rob]

Really didn't mean to panic you there fella, it could be any number of things, but the only way of knowing is to get a proper diagnosis.
I'm far from medically trained, I just know what I was told about own injury.

It was 2/3 weeks after I initially hurt it that I went to the GP and 2 weeks after that I got to see the specialist, who just diagnosed it by touch in a matter of minutes (x-ray wouldn't pick it up, you'd need an MRI which would take forever and basically isn't required) and told me to come back the next day for the op.
Think it was splinted for 6/8 weeks after surgery, after which the new tendon was supposedly at full strength and could withstand the mauling require to regain the flexion.
I was told to start climbing (gently) immediately, physio every week or so to stretch and ultrasound and by around 3 months from initial injury I was climbing back at full strength, if not a bit better for the lay-off, i reckon.

If it hurts when you rub/put pressure on the bone just above your knuckle, and/or when you try to hyper-extend your finger, it sounds similar.
A quick google of 'central slip reconstruction' will tell you that standard treatment is splinting and rest for 6 weeks before surgery is opted for (obviously my doc thought otherwise).
I'd imagine this would give the central slip the best chance to repair itself, and prevent the lateral bands dropping to create the boutinierre deformity.
If that's not successful then surgery and a central slip reconstruction pinching bits from the lateral bands.

So my completely unqualified advice would be if the symptoms are sounding similar and it's seriously worrying you - splint it straight and taped to your middle finger, go see your GP, beg to see a specialist, get a proper diagnosis.

[roddersm]

Thanks Rob, don't worry I know that you can't give a qualified diagnosis but thats been a big help in indicating what the problem might be. Hopefully its just a pull or mild tear and will repair itself. I'll maybe give it a few more days and then arrange to see the gp if its still sore. Thanks again. I'm guessing regardless I should avoid any type of climbing or pull ups for a while to avoid making it worse.

[The Sausage]

Hi again,
It certainly doesn't sound like a central slip problem to me. It sounds likely that you've strained your A2 pulley, as per the orignal tenderness and swelling.

Pain is a funny (as in wierd, not ha-ha) thing. There are a number of reasons that you may get pain where you do. It could easily be that one of the cruciate ligaments that crosses the joint has been involved too - don't worry. Soft tissue structures in the body, although they have dstinct names are often not particularly distinct structures. They have fibres that blend in with each other, and insertion points (where they attach to bone/muscle/etc) are often shared.

Sweeling in itself can cause pain - there is finite space in the body, and an increase in fluid often causes 'end-range' pain by an increase in pressure.

My advice would be to give it a few days to see if it settles. IF IN ANY DOUBT GO TO YOUR DOCTOR, TELL HIM WHY YOUR FINGER IS SO IMPORTANT TO YOU AND ASK FOR A REFERRAL TO A HAND SPECIALIST! Try some open handed dead hanging - don't go mad.

The other thing is that it's important to stress a structure as it heals. Give it a week, then tape the finger and load it on a finger board in (say) a half crimp position. You could stand on your bathroom scales to measure exactly how much weight you are putting through the finger. Use symptoms as a guide, it may be uncomfortable and swell a bit (scar tissue breakdown), but his is necessary, but avoid any actual pain. Give it 48 hours to make sure it doesn't feel any worse, repeat with a slightly larger load. It may take 6 weeks at least before it feels good enough to crimp with full body weight.

The other thing is, be creative with your training (i'm sure you are!) I did loads of bar work, working on my lock and shoulders/core  & open hand strength when I had a bad finger this winter, and I definitely feel better for it now. It's a bad time of year for it obviously, but be sensible and systematic, and strict with yourself and i'm sure it will be fine.

Disclaimer: I haven't seen your finger and frankly, you should probably ignore all I've sid and get it checked out as really i'm only guessing. So if you have any doubts, or it doesn't settle, or it gets worse, go to your doc.

[roddersm]

Thanks Sausage thats good advice I'll take it on board. I think I'll rest for a couple of weeks and see if it improves. My knuckle is still sore and seems to keep cracking which is painful has anyone came across this before?   

[Fultonius]

Aaah Fuuuuuck! Just lost all of a massive reply I'd been writing. Arse!

Much condensed version:

Rodders, did you ever get to the bottom of what was up with your finger?

Got a sore finger 2 weekends ago. Not sure if it was sore just before, or just after the first day's climbing, but both mornings it was a lot worse than the previous day.

On the last day it was pretty massive and the range of motion was about 75 degress to 10 degress. (straight being 0 degrees.)

Over the next few days the pain and swelling subsided and ROM increased. I initially thought it was some kind of infection as I had a tiny cut and no memory of any injury occuring.

In the next few days it was easier to work out exactly where the pain was:



It hurts if I crimp the desk (so I'm not doing that!). Pain only on the area shown. It also hurts if I press in that area.

It doesn't hurt and there is no wekness in the extensor tendon. I can resist quite forceful bending of a straight finger with no pain.

Things like pulling socks on can sometimes cause a sharp pain.

Openhanding on jugs/pullup bar seems ok.

I recently jumped onto doing an 8a sport route at Dumby - been working it and it's quite brutal crimping. Especially on the right hand... last session was probably about 5 days before the weekend or more.

I'm out in Azerbaijan so can't go to the doc/hospital just now.

I'm thinking it's possibly a stress fracture of the proximal phalanx near the PIP joint.

Any thoughts?