[Robsons]

SO...10 weeks of training, feeling stronger and stronger in preparation to my first time to Catalunya on Saturday.
Last night I thought I'd have a fun session on the new blocs at Reading. I was climbing well and feeling strong. Jumped on another problem which involved a two finger pocket and suddenly "POP", my finger gave way and I fell off. No pain, but as soon as I tried to apply any resistance to my left ring finger I felt pain and had NO power!!!

Off to A&E...
As I work at the wall and coach daily I told the guys my livelihood depended on it...luckily two of the Dr.s in A&E (including the head Dr. for the night) were climbers.

Today I went in again to see a hand specialist. He believes I have a full rupture of the A2 pulley, but obviously needs to see MRI to confirm.

I am off on holiday on Sat (now sunbathing), so delayed the MRI to a week Tuesday.

My question to you guys is the following:
Having read AS MUCH AS I CAN do on this forum, Dave's blog, Athlon website, Nicros etc...is leaving it the best option????

I read Adam Lincoln had these, but somehow managed to climb after it happened...absolutely cannot do this...too painful!
I've been icing/heat (Lewis reaction) and applying a little pressure for massaging...but don't know what to do?!?!

I need to get back climbing asap, but don't want recurring injuries?
When I asked the Dr his opinion, he said if it is only one pulley rupture, then probably bes to leave it. Multiple, then op!?

As well as depressed beyond belief, angry and emotional, I am now confused...

Any help would be hugely appreciated!

Thanks,


Robin

[clm]

I popped one second day in font and with heavy taping had a really good weeks climbing. Audible but doubt it was a full rupture.

[Robsons]

Was it not outrageously painful when pulling? If I put my fingertip to my thumb and press it is ridiculous!!!

[Sasquatch]

 

I would say absolutely NO to the surgery. 

Maybe someone else knows better, but I think in almost all cases surgery is truly a last resort. If in two years you still haven't recovered, then maybe think about surgery.

As far as the being able to climb on it. I've had two similar incidences one was about 12 years ago.  That one was ridiculous.  Couldn't put pressure on it for about 6 weeks, It eventually healed as strong as ever, just took time.  The other was about 3 years ago.  Turned out to be an attachment point for the tendon on the side of my index finger.  Felt brutal until I taped it, then felt fine. 

Dave recent website post about active type recovery from injury is very timely.  Good Luck.

[GCW]

 My thoughts are on the wiki.

[Nibile]

I'd say avoid surgery.
many climbers I know recovered from pulley ruptures without surgery.
I don't know if this may be of some help, but in Italy there is Dr. Parra, AKA "Doctor Laser". he developed a new type of laser, which seems to make miracles. a friend of mine went from full A2 rupture to one arm deadhangs on the good rungs of the BM in two months.
Dr. Parra has trated the likes of Alberto Tomba, Ana Ivanovic, Rafa Nadal, Roger Federer, Mario Cipollini and a few more.
a pricey last resort?
anyway good luck, and keep the fucking faith.

[Robsons]

Thanks Nibbs - like the sound of miracle treatment...Had a look at his website...wonder how much it costs??
Cheers GCW, but where on the Wiki? (Sorry, but couldn't see it?)
Good to hear Sasquatch...as soon as I can, I'll start training my front two and other hand...as well as working on my weaknesses - core and flexibility!

[andyd]

The ice treatment feels like the right thing to do, however I have been advised by a specialist that it's BS. Save yourself the bother of freezing lots of ice. Sorry about your finger mate and I hope you enjoy the sun.

[Robsons]

With reference to the icing - I am currently doing as advised by Dave Mac et al...The Lewis Reaction whereby you use cold water and a few ice cubes to cool the injury before putting it into a warmer environment (warm water), thus flooding an area which is renowned for poor circulation.
Are you talking about merely icing Andyd? As this is considered foolish as prevents blood flow?

[mrjonathanr]

Bummer, bad luck. Does DM not advise letting inflammation settle for 72 hrs before Lewis -type stuff? No NSAIs initially either, inhibits healing reactions inc prostaglandins.
I can't see what's wrong with ice, diminishes inflammation and ultimately increases blood flow although tissues are fragile when cold so look after it.

[Paul B]

With reference to the icing - I am currently doing as advised by Dave Mac et al...The Lewis Reaction whereby you use cold water and a few ice cubes to cool the injury before putting it into a warmer environment (warm water), thus flooding an area which is renowned for poor circulation.
Are you talking about merely icing Andyd? As this is considered foolish as prevents blood flow?

Surely its way too early for this? Ice, ice, ice. Buy some Voltarol gel and use that too. Speaking to a trainee physio recently, the various processes involved with tendons healing suggest that you'd be premature doing this within 6 weeks of the initial injury. At that point hot/cold treatment could be applicable but opinion seems to be split; general consensus is that climbing promotes more blood flow than this anyway.

If its a full rupture then I've got no first hand advice to offer as I've never been there. However, partial tears are a regular occurrence for me. Ice and take as little time off as you can before getting back to pain free climbing. This will be depressingly easy but stick with it. If you feel pain the day after; you've done too much, do less next time and ice until you feel you can have another session (try to get it right next time). Outside always seems to hurt less than inside.

I've actually followed my own advice with my latest injury and by careful management its improving much faster than any prior injury. Do what it takes, its much easier than the long term implications of not doing so!

Studies relating to tape don't seem overly relevant to the rehabilitation of finger injuries but from my own personal experience I've found that bending the finger at around 30' and taping from the A2 up over the knuckle helps.

[Nibile]

I've been told that after 24 hours icing does harm, because it restraints bllod flow. But ice and warm water seems fine to me. I'm no doctor though.

[GCW]

Cheers GCW, but where on the Wiki? (Sorry, but couldn't see it?)

Here.

[Barratt]

Two weeks ago I popped my A3 in quite some style. Panic, fear and regret... i'm sure you know these feelings well by now 

I went to see the guys at the Clinic in Sheff (Rick, team gb physio) and received really good advice. The point here is that you'll just get confused with the vast amount, and varrying quality, of information on the net. My suggestion would be to give Rick a call, with the medical advice you have already received i'm sure he will be able to give clear, concise information that will be of benefit not only physically, but mentally as well.

Hope this helps.

Oh, and after two weeks i can apply pressure with no pain. Bowstringing is massively reduced with the advised H taping, i'll be starting climbing again in a week, obviously easy open hand stuff... and it was a full rupture

[Snoops]

I've been told that after 24 hours icing does harm, because it restraints bllod flow. But ice and warm water seems fine to me. I'm no doctor though.

RE: THE ICING
for the first 10-14 days the area undergoes acute and then sub-acute inflammation -  a huge influx of white blood cells, increase in blood supply (angiogenesis) etc.
Doing the warm water (Lewis reaction) is a very BAD idea during this time. The injury site will become more swollen and more inflamed and the end result may be more scar tissue

Cold water/icing will help - it will help most in the first 72 hours after this the benefit is reduced, although it won't harm.
Save the LEWIS stuff for 2 weeks later.

[Nibile]

Thanks beast, hope not to need your advice though!!!
Touch wood emoticon?

[andyd]

What snoops said

[Robsons]

Awesome, thanks for the advice guys...Snoops, I will stop the Lewis then and head straight for ice...
Once initial inflammation has gone down - any knowledge of acupuncture to finger?

[andyd]

Have you tried magic beans and tarot cards to go with the acupuncture?

[Sasquatch]

I've got some snake-oil that'll work wonders too!!!!

 

[mrjonathanr]

Have you tried magic beans and tarot cards to go with the acupuncture?

The Chinese have been at this for over 4,00 years now and have parallel traditional/western hospital systems in place.

Would they not have stopped with the acupuncture after the first 1,000 years or so if it wasn't proving clinically effective?

Just a thought, although it isn't something I'd naturally consider for an injury like this.

Homeopaths, crystals, Uri Geller - all fit for 101 however.

Robsons : good luck with this, Bennett and Barratt have good advice I think.

[Nibile]

Four years isn't much though.

[Snoops]

Awesome, thanks for the advice guys...Snoops, I will stop the Lewis then and head straight for ice...
Once initial inflammation has gone down - any knowledge of acupuncture to finger?

Me no nothing about acupuncture....at least nothing informed.
Being a surgeon I'm a little sceptical, however it does work for a cohort of people with chronic problems (especially chronic pain)
Never heard of anyone doing it for acute injuries though...so no comment 

[slackline]

Awesome, thanks for the advice guys...Snoops, I will stop the Lewis then and head straight for ice...
Once initial inflammation has gone down - any knowledge of acupuncture to finger?

Google Scholar is your friend (third hit).

The Chinese have been at this for over 4,00 years now and have parallel traditional/western hospital systems in place.

Would they not have stopped with the acupuncture after the first 1,000 years or so if it wasn't proving clinically effective?

Plenty on assessing the efficacy of accupunture in general

[biscuit]

Not read the efficacy stuff of accupuncture but i can only say that having had chronic sciatica for ages; due to job consisiting of 1 hr commute in car, sitting at desk, driving in car for up to 4 hrs a day, sitting at desk and then driving home. It was crippling me and i couldn't sleep much due to it either. Dr and physio wasn't working ( anti inflammatories and stretches ) but after 1 treatment of accupuncture i felt a massive release of tension and relief of pain. After 4 treatments it was totally gone, shortly after so was the job 

She was a UK qualified Dr but had also studied Chinese medicine for 7 yrs.

Again not sure on actue injuries though.

My wife likes homeopathy, well it makes her think she is getting better quicker anyway and doesn't cost much, personally i think it's a load of 

[Moo]

I think you've got a better chance of winning the lottery than you have of getting a molecule of what your trying to dilute into one of those little white tablets homeopathy uses.

[Oldmanmatt]

I think you've got a better chance of winning the lottery than you have of getting a molecule of what your trying to dilute into one of those little white tablets homeopathy uses.

Only by three or four orders of magnitude...

[mrjonathanr]

Not if you put the ticket through a shredder then throw a bit in the sea, it'd be much more effective then.

[lukeh]

Thankfully I've not had experience of acupuncture on my fingers, but I have had acupuncture on a knee injury, which along with some deep massage and some weird movements done by a chiropractor left my knee fine in no time.

While not directly applicable I felt it worth mentioning that the acupuncture was nothing to do with pressure points or dodgy pills. The chiropractor explained it as a bit like micro surgery; using the needle to lightly lacerate stubborn tendon/scar tissue (by wiggling the needle), which promoted regrowth in a tendon injury which was borderline between chronic and acute and so needed a kick start to get healing again...  (problem was where the hamstring tendon inserted by the head of the fibula/me not doing anything about it for months!)

[Dexter]

not got a huge amount of experience in this area but a few years ago a popped something really badly and couldnt touch pockets at all but could still crimp without pain so spent a couple of months forcing myself just to crimp everything even the slopiest of slopers. Not ideal but it meant I could still climb. Not sure how applicable this is though

[andyd]

I say try anything once, but try not to get caught.
In the absence of Tim Minchin, I'll steal his line...

"You know what they call “alternative medicine” that’s been proved to work?
Medicine.”

Get amongst the diclofenac. Tell your doctor it happens a lot and ask for a big box. I think they can give you 82 tablets at the most.

[rodma]

Firstly I think i met your mate in albarracin yesterday, but i think you are already en-route to catalunya.

I had a full rupture two years ago, a couple of weeks before heading to Hueco, which was my first ever visit there, so was more than a little disappointed. Icould birds-beak ok, since this completely took my ring finger out of the equation and found one problem that I could do if i stacked my ring finger on top of my middle finger, since this kept it elongated and allowed me to use my pinky for increased strength.

I couldn't tape it at all, since any pressure was very painfull, but five months later I could form a full tape pulley as tight as you like with no discomfort at all, but If i don't tape, the tendon bowstrings out like a bicep.

I don't believe that there is any miracle cure and surgery sounds v. bad, a friend had considered it until they told him that it would give him the strength to "hold a pencil", which was not what he was exactly looking for.

Anyway, I can one arm a small campus rung half-crimped with no discomfort at all (well, in that finger anyway) if that's any consolation. It took a while to build back up to this, but that is where I was at prior to the rupture.

[Ru]

A different view.

Surgery: I know both a climbing injury specialist orthopaedic surgeon who reckons that surgical repair of pulleys is fine, and someone that's had it done and reports no loss of strength afterwards (climbs 8b in the frankenjura).

Not surgery: the aforementioned surgeon also points out that a ruptured pulley with bowstringing gives about a 4% immediate strength increase in that finger due to the mechanical advantage of having the tendon run in a straighter line.

[boulderingbacon]

diclofenac is ok but ask the doc for tramadol way more powerful but they dont like giving them out because they can be addictive.  i got given them off a bloke at work who had them for sciatica so i told the doc i had been given them an they worked so he prescribed me some.

[fatdoc]

mad thread... woooo on the *mate gvin me tramadol*


get it legit...

acupuncture... well good in certain scenarios... this one... not ckear or evidence based, from my understanding anyways...

[mrjonathanr]

Mmm, bacon, fatdoc is better than averagely positioned to dispense advice, amongst other things. tramadol's an analgesic, but not anti-inflammatory like diclofenac which would be more appropriate I expect. I'm sure Robsons can live with the pain, it's the frustration which is harder to bear.

[boulderingbacon]

yeah sorry did sound a bit mad there but i was prescribed it, was just saying i first tried it from a friend which i should of stated that you shouldnt do. i didnt realise robsons wanted an anti inflammatory as i wouldnt of suggested it, i thought he wanted a way to climb through the pain which that would probably help.

[petarar]

I have used acupuncture on both myself and others for finger injuries. Unfortunately made no difference whatsoever. The key to a quick recovery is early controlled loading of the structure.

In the first week you want to protect the pulley, increase blood flow to help healing and maintain range of movement
H-taping  throughout the day.
Cold therapy -bowl of cold water (no ice) keep in for 20 minutes. moving fingers through full range throughout. repeat x2 daily
Move hand and fingers through a full range of movement regularly through out the day.
General exercise such as running or swimming will also increase blood flow
Eat well, keep hydrated and get plenty of sleep

In week 2 you need to begin to progressively load the tissue to encourage correct alignment of the repairing tissue.
You can do this in various ways but i recommend this method.
Stand on some bathroom scales in front of your fingerboard, gentle apply pressure to a hold without increasing  pain. Start with open hand sloping holds. The scales are so you can measure progress and see how much of body weight you can take. There must be no increase in pain before or after the exercise.

In actual fact there are 3 phases to taking a hold and i would recommend re-training all 3.
contact 
hand stretches out and then pulls into position
Hold is held for 5-10 seconds
 
I would do sets of 10 to mimic an average length boulder problem.
rest 2 minutes between sets and do between 5 and 10 sets depending on fatigue and pain.(Remember gentle enough to not increase pain. This maybe 1% effort initially)

Follow this with the movement in cold water described above.

I would also recommend hand strengthening exercises as these muscles are often weakened following a pulley injury and help provide active stability to the finger.

When you can take 50% of your body weight without pain you are probably ready to begin climbing.
It is also worth massaging and stretching the forearm muscles as these often become tight following a finger injury.

[GCW]

Why are you H taping in the rest phase?

[petarar]

h-taping in rest week to protect injured structure and minimize bow stringing. Gives it a chance to knit together a bit before you begin loading but maybe better than splinting as doesn't fully immobilise finger. I have no evidence to back this up

[Robsons]

Right, firstly I would like to say thank you to everyone who has responded so far - hugely appreciated!
I am now back from Catalunya and at times it was torture, but mostly used it to increase the psyche for another trip!
So the finger is still painful upon compression (mainly to the sides), but improving daily. I have been doing a lot of water bathing and I think that has really helped...I have taped to immobilise during the days (at 30% bent)...mainly to stop using it whilst getting to crags etc...been going through full range of movement and doing light massaging.
Next step is the MRI on Weds...I think I will then start to do some very light climbing with a completely immobilised finger...and start on the pull-ups, core, flexibility etc...
I am getting bowstringing, but it is not really noticeable unless I pinch the finger and feel for it...not very visible?

I'll basically keep updating this as I go, purely for future injuries and a point of reference...any further info will of course be very welcome.
I have to say a thanks to Rick from the clinic in Sheffield too as he took some time out of his day to speak to me and then sent me a very informative email...apparently Vera On the Dutch team has recently gone through the same...Essentially what has been said on here: 2 weeks out (icing/water treatment)' 2 weeks light rehab, then back into climbing...progressively fo course.

Rodma, yep, you met my mate Adam in Albaraccin - he was looking strong after the bouldering sessions!
Thanks again.

[Robsons]

So, got my MRI results back and the "hand specialist" was rather useless to be honest!
The radiologist report said full A2 rupture, but we didn't have the imagery to go through together. He said he trusted his radiologist, but I wanted to see them to ensure that A1/A3 were intact etc...I have been getting a fair amount of pain in my palm (catching feeling (scar tissue?))? He went off and came back saying he thinks/is pretty sure it is just my A2 that is ruptured.
Pain, he said, is my guidance. I can start exercising as long as it doesn't hurt.
It is still inflamed - hurts to press side of fingers and in A1/palm. I have gained more power back (but we are talking from scratch - it went and I had nothing!)
Not that happy with the appointment I went to X-Ray and asked for my MRI results...they gave them to me on disc.
I have exported them to my comp and chosen the most relevant ( I think?) - I am no expert and need advice - anyone have any clue as to the health of A1/3?
I think some show the bowstringing of A2 fairly blatantly - not sure about the rest??

Cheers,

Robinhttp://www.flickr.com/photos/olearyrobin/

[Fultonius]

i thought he wanted a way to climb through the pain which that would probably help.

Hmmm....taking military strength painkillers to allow you to climb through fairly serious pulley injury doesn't sound much like a sensible route to recovery...

[fatdoc]

Keep off that tramadol dude.... Yr finger is speaking to u...

Christ... By the law of averages u must be 20 yrs younger than me...

Let's not get into steroid injections from abuse of of tissues not given time to heal then injured again... That was a bad time for me... In fact it ended my serious progression in the sport.

Rest...

Crikey... Do something else for a few months... Bike, canoe, run... Playstation.. Whatever..


Easy for me to say..

Give it time mate!

[Robsons]

Not taking ANY anti-inflams...don't intend to either...