[EdGowSmith]

I injured the A2 pulley in my ring finger (left hand) 3 and a bit years ago, which took ~8 months to heal. I then reinjured it in the same place a few months later, and at the time was diagnosed by a physio as a partial tear of the A2.

This injury did not respond well to rehab, though, and over the last two and a bit years I have seen 3 other physios who have suggested different rehab programs that I have followed to no avail. I have had an ultrasound of the finger which didn't reveal anything. I was diagnosed by one physio as having nerve issues (radial nerve) but despite extensive rehab for it (and significant improvements in non-climbing-specific hand strength tests) there was no noticeable improvement with my finger. There is a lumpiness at the base of the finger that is not reduced with massage - I have been told by one physio to continue massaging it, and by another not to worry about it and not to aggravate it by massage.

I am getting to the point of desperation with this injury - there isn't agreement from physios on what is wrong and I haven't been able to get an explanation for why it is taking such a long time to heal.

Does anybody have experience with an injury with a protracted healing time such as this?
Secondly, does anybody have recommendations of anything else I could try?

[teapot]

I have a quite similar experience with a protracted A2 pulley injury. Like you it has been over 2 year, and like you the MRI 8 months ago showed no sign of injury or even scar tissue. I was convinced that I had fully ruptured a pulley and that there was bow-stringing as a result. The MRI proved for me that was not the case.

I have had previous pulley tweaks and they have cleared up relatively easily.

In the last 8 months, since the MRI I have seen very gradual improvement and have finally moved from open handing to some crimping. My open handing is stronger than ever! I still get some tenderness at the base of the finger.

I think the improvement for me took the realisation that it was not going to recover fully.

Yours sounds more debilitating so my experience may not be much help.

[abarro81]

I think the improvement for me took the realisation that it was not going to recover fully.

Yeah, I have this on two fingers too (not pulley injuries though). It took some emotional trauma to come to terms with the realisation that I needed to climb/train on what I could do rather than what I wanted to do. I think you have to manipulate your motivation to not get psyched for things you know will be dangerous, since the comedown of then realising you can't really do those things is sucky (1st world problems and all that, but it does matter if climbing is a big deal to you)

One is an old collateral/PIP injury on my right hand which has been re-injured various times - this isn't a major limiting issue on individual moves, but I do have to keep on top of it as it gets swollen/sore relatively easily. E.g. I can crimp on it, but I couldn't climb hard crimpy stuff every day, or train heavily on crimps, or use back 3 half-crimp safely, and I suspect it will always mean that the hardest fingery stuff is no longer an option as I can't knuckle down (no pun intended) and focus on this style. Also means twisty monos are incredibly dangerous and I struggle to train front 2 on smaller holds. Often if I have a big session where I piss it off I then need to just do 3 finger drag the next time I climb/train to let it calm down and reduce the swelling

On the left hand I have a volar plate injury which healed, then seemed to "stretch" a bit, rather than rupture. The consultant basically said that they couldn't tell me whether I was likely to rupture it again but it may now be more prone to it. If I push it I feel it stretch more and more, and it feels horrible and inhibiting. When climbing hard on anything other than open handed holds I now tape the joint "shut", which kind of works, but also means I'm slowly destroying the end of my finger through permanent bruising. I can't really bone small crimps anymore like I used to, and I need 1-2 days a week (plus rest days) where I don't tape shut (therefore not training hard on half crimp or small pinches) to avoid the bruising becoming too bad. Have to avoid certain holds too where they feel dangerous. For a long time I thought I would never really crimp hard on that hand again, but with the taping strategy I can do it on larger edges fine now, so long as it's not so frequent; the biggest problem is the bruising (and that you're weak when you tape one finger in a messed up position that avoids hyperextension of the DIP)

Both those injuries mean that I can't train and climb as I would like to - you can't just pick what you want to do based on whatever you fancy, and what you want to train based on what you want to work on (e.g. I would have done my hangs 1/2 crimp this morning, but knew I had to do f3 drag to save the bruising of taping the joint shut)... But I've been able to work out how to train around them, and focus on things where they're not limiting factors, e.g. by being mostly psyched on steeper climbing on bigger holds, avoiding temptation to try hard UK sport routes too much, doing more onsighting and quick ticks (I find that less agro as you're not using the same holds endlessly)...

It's not clear from the OP how bad it is now - whether it's totally buggered or slightly inhibiting but not getting better from that point? If the former it sounds like you need MRI and a specialist to talk to (maybe go see Volker in Germany??) if the latter it may be that you can work around it, accepting that you're fingers will probably never be the same again..

[jwi]

+1 on the go-and-see-Dr.-Volker plan; he has helped a lot of people.

[EdGowSmith]

Thanks all for the replies.

It seems like you've not had the most luck with your fingers Alex. Thanks for taking the time to write all that.

I should've been clearer about the current state of my injury. I can open-hand stuff fine (as you'd expect), but the finger doesn't respond well at all to crimping. I initially tried to reintroduce crimping by fingerboarding with a weighing scale, progressively increasing the load on my fingers over a period of a couple of months. I got up to bodyweight hangs but there was no transferral to crimping on problems, I suspect because my other fingers were taking the load in the static hangs. I then tried doing foot-on-campussing which had been beneficial for the previous injury, but alas didn't work well this time. Since then I've lost faith in / motivation for these progressive-loading schemes and just gone out climbing, trying to avoid aggravating it, which means (for the most part) not crimping at all. I have tried crimping again a few times but each time results in deep pain in the base of the finger that lasts for multiple days. I'm not sure whether that classes as "totally buggered" but it's certainly not great.

My situtation is not ideal for finger injuries as at uni I have no nearby outdoor climbing and no decent wall, only having a 50 degree board for training. This doesn't help with maintaining motivation when injured. Thankfully I'm leaving very soon. I think you both are correct in that I need to shift my focus to stuff I can do and try and get motivated on that rather than constantly working towards the end goal of being injury-free, whose realisation appears ever further away. It doesn't help that physios seem to be ever-confident that you'll be healed soon, giving rather generous timescales for recovery, which brings your hopes up only to be once again let down when you realise there has been no improvement.

It looks like an MRI may be the best option - how would I go about getting one?
It's obviously a big investment to go and see Dr. Volker, and I may need convincing that it'd be worth it. Is he unparalleled in the UK?

[Rocksteady]

I think the improvement for me took the realisation that it was not going to recover fully.

Yeah, I have this on two fingers too (not pulley injuries though). It took some emotional trauma to come to terms with the realisation that I needed to climb/train on what I could do rather than what I wanted to do. I think you have to manipulate your motivation to not get psyched for things you know will be dangerous, since the comedown of then realising you can't really do those things is sucky (1st world problems and all that, but it does matter if climbing is a big deal to you)

One is an old collateral/PIP injury on my right hand which has been re-injured various times - this isn't a major limiting issue on individual moves, but I do have to keep on top of it as it gets swollen/sore relatively easily. E.g. I can crimp on it, but I couldn't climb hard crimpy stuff every day, or train heavily on crimps, or use back 3 half-crimp safely, and I suspect it will always mean that the hardest fingery stuff is no longer an option as I can't knuckle down (no pun intended) and focus on this style. Also means twisty monos are incredibly dangerous and I struggle to train front 2 on smaller holds. Often if I have a big session where I piss it off I then need to just do 3 finger drag the next time I climb/train to let it calm down and reduce the swelling

On the left hand I have a volar plate injury which healed, then seemed to "stretch" a bit, rather than rupture. The consultant basically said that they couldn't tell me whether I was likely to rupture it again but it may now be more prone to it. ...Both those injuries mean that I can't train and climb as I would like to - you can't just pick what you want to do based on whatever you fancy, and what you want to train based on what you want to work on .

Alex do you know why you got these injuries? I suspect I have very similar problems albeit I'm climbing only F7b vs your level! Several of my knuckles are basically permanently swollen at the side and have what I'd describe as lateral instability. They were diagnosed previously as early onset arthritis but I actually suspect they are recurrent collateral ligament and volar plate injuries.

I have a big disparity between ring and little fingers, also mid finger is quite a bit longer than first and ring fingers - I wonder if I torque my fingers to try to maximise force due to disparity in lengths. I also have flexible/hyperflexible DIP joints when crimping - analogous to dropping a heel when toeing in on a board - so may be this predisposes me to more finger injuries.

[abarro81]

Alex do you know why you got these injuries? I suspect I have very similar problems albeit I'm climbing only F7b vs your level! Several of my knuckles are basically permanently swollen at the side and have what I'd describe as lateral instability. They were diagnosed previously as early onset arthritis but I actually suspect they are recurrent collateral ligament and volar plate injuries.

I have a big disparity between ring and little fingers, also mid finger is quite a bit longer than first and ring fingers - I wonder if I torque my fingers to try to maximise force due to disparity in lengths. I also have flexible/hyperflexible DIP joints when crimping - analogous to dropping a heel when toeing in on a board - so may be this predisposes me to more finger injuries.

Sorry for the slow reply!
The volar plate went snap on a crimpy undercut when releasing a kneebar (is that karma?!?). The PIP joint issue started with a tweak in a sideways mono, then got retweaked on a crimp a few weeks later when I thought it was doing ok, and has had good/bad periods since then but never fully recovered to where it once was in a longer-term way.

I also have quite a long middle finger, which I think does lead to some level of being injury prone, but that may just be an excuse I tell myself. It's always those fingers that I hurt - for years of relentless mid-finger injuries I've only ever had a couple of minor tweaks in the others.

Re DIP joint hyperextension - the specialist I saw seemed to think that it was hard to say whether this would naturally predispose you to injury (but thought that the fact I've now got more extension that I used to have and than I have on other fingers wasn't likely to be ideal). There are some people I know (e.g. Noble) who have horrible looking hyperextension in the DIP when crimping but love the crimp and don't injure easily on it, so I'm not sure it's likely to be as simple as more flex = more prone to injury...