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Painful DIP (Read 6325 times)

bigironhorse

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Painful DIP
May 30, 2019, 05:53:42 pm
Ive had an aching DIP on my right hand ring finger for about a month now. I took the last two weeks off climbing and pain stimulated by pressing on the joint seems to have decreased. However, I just did an easy circuit down at the wall and it was aching pretty badly for most of the time, even though I was almost exclusively on jugs.

I'm thinking a stress fracture or synovitis is the likely culprit. Anyone got any advice for differentiating these? What should I be doing to expediate recovery?

I'm keen to get a proffesional opinion on this but not sure who to see? Physio? Orthopaedic? Homeopathist? MRI seems to be the gold standard for diagnosing stress fractures, but not sure how to go about getting one, or if knowing that its a stress fracture is even useful in terms of getting it sorted.

Cheers.

cheque

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#1 Re: Painful DIP
May 30, 2019, 06:10:27 pm
Have you read the classic ďStress fracture in a knuckleĒ thread? If not itís worth it just for Stallioniís Tiggergram joke on the first page but the upshot of the whole thing if I remember correctly was that pretty much no-one turned out to have a stress fracture- itís much more likely to be a cartilage/ volar plate  injury which is what I had on both middle fingers. It takes ages to heal. Barrows had one too and knows a lot more about it than I do from what Iíve read of his posts.

My physio said it wasnít worth diagnosing as whatever it is the method of healing it (basically donít piss it off while itís getting better and deal with the postural issues that caused it in the first place) would be the same no matter what the specific details of the injury were.

People who know more than me will no doubt post on here soon though. I hope it doesnít turn out to be too bad.
« Last Edit: May 30, 2019, 06:24:19 pm by cheque »

spidermonkey09

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#2 Re: Painful DIP
May 31, 2019, 11:47:19 am
I had a painful PIP on my middle finger for ages, which flares up from time to time. It got particularly bad winter of 2017/18. I went to a physio who suspected synovitis but also advised that they are notoriously tricky to both diagnose and treat and suggested careful management might be more beneficial than rest; he had personally tried resting his own with no success.

Techniques I have used have ensured that the finger is now very manageable with only occasional pain. It remains chubbier than the other joints but doesn't hurt or affect my climbing. None of these probably have any scientific back up behind them so make of that what you will.

- Forearm massage - reducing trigger points in my arms has improved both my elbows and my fingers.
- acupressure rings - cheap and easy to use while driving
- taping the finger either side of the joint whenever I go climbing. I theorise that this prevents me getting the joint into an overly aggressive, acute full crimp position.
- aggressively stretching the finger laterally, a la Julian Saunders advice (easily googalable). This hurts like fuck when the joint is stiff the day after a big session but I think has been beneficial in maintaining full range of motion in the joint.
- less crimping, particularly inside. I tend to drag holds wherever possible and half crimp before full crimping.
- I also sport climb more than boulder currently which obviously has advantages.

Hope this helps and good luck!

bigironhorse

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#3 Re: Painful DIP
June 01, 2019, 03:38:26 pm
Thanks for the replies. From reading other threads here is some more relevant information.

There is no restriction of movement in the joint, it just aches all the time and this increases a lot when I do anything remotely strenuous to the finger. Like easy climbing or gardening. Its also swollen on the right hand side of the finger on both sides of the DIP. It doesn't really hurt pressing on the swollen part, but does hurt pressing underneath the finger on the swollen side, mainly in two spots either side of the joint.

I'm leaning towards volar plate avulsion now. Still keen to hear any recommendations for physio or orthopaedic in Sheffield if any has any.

Thanks.

bigironhorse

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#4 Re: Painful DIP
June 04, 2019, 02:46:30 pm
Had another exploratory session at the wall last night. Finger wasn't aching as much as last week, probably just because I was on easier stuff. Weirdly, hold size doesn't seem to relate to pain. It was only painful when there was any kind of twisting or lateral force going through the finger. Does this help with working whats up with it?

Have been in contact with physio but not sure there will be much benefit in going to see a physio without some kind of imaging to help diagnose the problem / rule out what it isn't.

owensum

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#5 Re: Painful DIP
June 05, 2019, 04:32:26 pm
Ive been suffering with something similar since January. Mostly over it now. I just thought it was synovitis, but volar plate avulsion seems maybe more accurate (I'd never heard of it until you posted this).

For reference, my pain was in the index finger DIP joint, on the outmost and lower side of the back of the joint. Like you, lateral force seemed to cause the most pain, or when the joint was in an overextended position, i.e. full crimp. Particularly noticeable on crimpy gastons.

Splinting while sleeping was the absolute best thing I did. Buddy taping with a velcro-secured piece of elastic during the day was helpful, and buddy taping with athletic tape was good while climbing. Training 3 finger drag on hangboard helped. The Julian Saunders finger stretches were good once the worst of the pain went away (), though painful and sometimes made the joints click. I tried to only do this when my hands were warm. Voodoo flossing the finger was good, though contrast hot/cold baths didnt seem to do much. Light finger rolls were also good (15-20 lb dumbbell).

Rice bucket made it worse. Crimps definitely made it worse, and probably the culprit that caused the injury. Open handing holds was important for recovery.

spidermonkey09

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#6 Re: Painful DIP
June 05, 2019, 05:14:34 pm
As above, I had heard of volar plate injuries before but googling around makes me more convinced that was what I have/had rather than synovitis, as my joint is now disfigured!

Second the Saunders stretches, although I also endorse the pain!

bigironhorse

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#7 Re: Painful DIP
August 05, 2019, 02:58:17 pm
Finally went to the docs about this last week. Just got x-ray results back and they said it is indicative of bone erosion and inflammatory arthritis  :'(. I'm having a blood test for inflammatory markers tomorrow, so should know more in a week or so.

It just seems so unlikely to be arthritis: came on during a period of intense training and climbing, and only one joint affected (ankles aren't great but that has been the case for years).

owensum

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#8 Re: Painful DIP
August 05, 2019, 04:01:24 pm
Finally went to the docs about this last week. Just got x-ray results back and they said it is indicative of bone erosion and inflammatory arthritis  :'(. I'm having a blood test for inflammatory markers tomorrow, so should know more in a week or so.

It just seems so unlikely to be arthritis: came on during a period of intense training and climbing, and only one joint affected (ankles aren't great but that has been the case for years).

http://drjuliansaunders.com/ask-dr-j-issue-173/

It sounds like most doctors associate this type of synovitis with arthritis. However, climbers can get it as a consequence of joint stress, but doc probably doesnt know that. Let us know how your diagnosis progresses.

Mine still hasnt gone away, in fact it got worse after I took a break from climbing. But its improved rapidly recently with finger rolls, hangboard 3 finger drag and wearing arthritis gloves at night.

spidermonkey09

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#9 Re: Painful DIP
August 05, 2019, 04:11:41 pm
Finally went to the docs about this last week. Just got x-ray results back and they said it is indicative of bone erosion and inflammatory arthritis  :'(. I'm having a blood test for inflammatory markers tomorrow, so should know more in a week or so.

It just seems so unlikely to be arthritis: came on during a period of intense training and climbing, and only one joint affected (ankles aren't great but that has been the case for years).

Fingers crossed (no pun intended!) for you that it isn't arthritis; as you say it seems pretty unlikely.

Don't think I've got anything to add beyond my post higher up beyond that mine was really bad for a while and is now almost always fine. Its very plausible you'll be fine in a few months. I never actually stopped climbing while sorting mine either. Finger rolls (mentioned above) are great; absolutely desperate and get a mighty pump on too!

Bradders

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#10 Re: Painful DIP
August 05, 2019, 05:27:56 pm
I've had something very similar to what Spidermonkey describes in the PIP on my right hand index. Again, finger rolls have been brilliant, along with voodoo floss. I now do both 6 days a week and it's getting a lot better!

spidermonkey09

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#11 Re: Painful DIP
September 13, 2019, 04:52:04 pm
Resurrecting this thread as pain in the chubby digit has annoyingly returned over the last week or so. Pretty sure this is a volar plate injury now but keen to experiment with some of the things others have mentioned on here. Not sure going to a professional is going to help as a) I first hurt it over two years ago and its been mostly fine since and b) i'm not going to stop climbing as I'm about to go to Spain!

Questions are basically:

- what is voodoo flossing? Googling suggests its basically wrapping the finger very tight until numb and then removing to stimulate blood flow?

- splinting a finger overnight; presume this is with tape and a lolly stick?

Currently the finger feels totally fine when I wake up and is getting stiffer and more painful through the day (office job so perhaps not moving it enough?

Googling suggests Barrows had a pretty severe avulsion; not sure mine is this bad as its never gone 'pop' so suspect it is a strain. How are your fingers coming along bigironhorse?

bigironhorse

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#12 Re: Painful DIP
September 13, 2019, 05:23:45 pm
I have been meaning to post back to this thread for the last week.

I have now had blood test and seen a rheumatologist. Both suggested arthritis was highly unlikely.

I have also seen John Ostrovskis at the clinic in Sheffield. He did some manipulations, strength tests and an ultrasound scan. Following this, I am 100% certain that I have torn the collateral ligament on the ulnar side of the DIP in my right hand, close to the proximal attachment. He said that an avulsion is possible but not visible on the scans.

Apparently this type of injury is pretty much unresponsive to rest, so I have been having shockwave therapy to help stimulate repair and I'm cautiously optimistic that this is helping. Progressive loading also encouraged, not sure exactly how much pain is acceptable when climbing though so need to ask him next time. If you are Sheffield based, or anywhere local, I would absolutely recommend you go and see him, I wish I had gone 2 months ago.

Have not experimented with voodoo flossing, but I think you have to wrap in tight in elastic (piece of theraband for eg) and then move it through the full range of motion.

abarro81

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#13 Re: Painful DIP
September 13, 2019, 09:20:15 pm
When I splinted for the DIP volar plate rupture it was with a thermo-molded plastic splint that the OTs at the hand clinic made for me - the idea being that reaching full extension in the DIP was blocked but flexion in DIP and PIP was still possible. I'm not sure I had avulsion (that's where you rip some bone off right?).. the doc never mentioned that anyway..

I now have what I would consider to be a "stretchy" volar plate (though I think this may make medical sense) - I now tape the joint closed so it can't really hypertend. Consultant couldn't tell me whether it was more prone to rupture or not. Worth pointing out that my injury caused almost no pain, just meant that my finger pointed the wrong way and felt horrible and weird. Not sure if that would be the same in PIP though.

My PIP on the other hand is semi-perma-swollen from an old collateral ligament injury. That's fine most of the time then gets angry again for a few months - sore and swollen, can only drag on front 3 safely.. Sounds maybe more like what you have? Unfortunately I have no idea how to fix it to avoid it being v injury prone...!

spidermonkey09

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#14 Re: Painful DIP
September 13, 2019, 10:57:36 pm
Thanks for the info BIH. I think I'll definitely go and see him if it sticks around into the new year.

Barrows has described my symptoms exactly: mostly fine and occasionally pissed off. Maybe it's collateral ligament rather than volar plate, although that area of the finger is also a bit sore. Maybe it's both!

Hopefully a few months spent dragging holds on overhanging terrain will fix it...

bigironhorse

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#15 Re: Painful DIP
September 14, 2019, 12:23:28 pm


Hopefully a few months spent dragging holds on overhanging terrain will fix it...

Yes that is my go to protocol for finger niggles, but this one is completely different. I can crimp at pretty much full power and it doesnt hurt, as long as its a straight pull. As soon as the finger is loaded in a weird direction or twisted is when i can feel it. I think this fits well with it being a collateral though.

TobyD

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#16 Re: Painful DIP
October 07, 2019, 11:35:02 pm
 I've long felt that collateral ligament sprain is responsible for far more finger issues in climbers than most people credit. The common self diagnosis of some pulley issue is likely, I suspect to be very often incorrect.

The truth is, none of it matters very much unless it's something very drastic (in which case it'd be easier to diagnose) as the management is the same. I currently have an achy swollen PIP on my first finger, which is deeply frustrating, especially as it seemed to start after an endurance session.

DavidM

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#17 Re: Painful DIP
March 20, 2023, 10:49:04 am
Thought I might get a little advice from people who have gone through this not seen a Physio as yet. I've got a severely Inflamed DIP joint middle finger, probably 40% bigger than same finger on other hand. Very red, swollen and sore to touch. That was over 2 weeks ago. I tried just doing lightly loading it on the fingerboard in half crimp and feels ok during session but next day swells and tender. Open handed hangs feel uncomfortable as they sit right on the DIP joint. Not sharp pain then crimping just feel like numb pain when joint is compressing. Feels like ice or contrast baths not helping much, massage aggravated it a lot.

Seen the Saunders article and posts about finger curls with people suggesting full blown rest isn't advisable either. So started doing the finger stretches and finger curls yesterday.

Few questions

1. Did you wait for the majority of inflammation to subside before trying the finger curls and open handed hangs rehab etc?
2. Did you avoid weight work on bar / rings etc as the pressure aggravates it next day?
3. Did anyone experiment with finger tips press ups outlined in below article?
https://stevenlow.org/beating-climbing-injuries-pip-synovitis/
4. Any tips for speeding up recovery?
« Last Edit: March 20, 2023, 11:02:51 am by DavidM »

MischaHY

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#18 Re: Painful DIP
March 20, 2023, 10:51:57 am
3. Any tips for speeding up recovery.

Get a physio on side now and get a proper rehab plan in place.

Apologies if you've already got this but didn't mention it.

cofe

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#19 Re: Painful DIP
March 20, 2023, 11:00:12 am
Obviously, see someone and get it scanned if you can to check there's nothing else going on beyond inflammation.

My PIP joint ballooned in early January Ė incredibly painful for about 8 days, and then just painful/achey. Never had this before in 20+ years. The main thing that helped was wrapping it in Coban tape from breakfast till evening. It helped bring the inflammation down and managed the pain/discomfort. I kept climbing throughout (no tape), but outside only and no crimping. Stopped hurting after 7Ė8 weeks and I'm reintroducing crimping now. I tried to avoid doing anything that might have pissed it off.

spidermonkey09

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#20 Re: Painful DIP
March 20, 2023, 11:56:04 am
I had something similar to this on a middle finger PIP joint years ago. For ages I thought it was joint synovitis, then maybe a volar plate injury, and eventually concluded it was a collateral ligament. Think Barrows has had something similar too.

I did loads of different things with varying degrees of success. Flossing the finger with a theraband helped, as did the Saunders range of motion stuff. Icing it helped straight after a climbing session.

The thing that made it worst for me was full crimping, so I got in the habit of taping either side of the joint to prevent the finger getting into a really acute angle. I still do this now to keep it at bay. I also made a distinct effort to minimise crimping when indoor climbing, to the extent that even now on the board I mostly open hand stuff. I never really stopped climbing as no amount of rest seemed to help it. Like cofe I tried my best to avoid pissing it off but tolerated a certain amount of pain. Eventually it eased and ebbed away, has come back a few times briefly before disappearing again. The joint remains bigger than the equivalent on my other hand. perhaps tellingly it was last painful in 2019 when I was crimping a lot on Yorkshire lime. I went to spain for 3 months and did loads of climbing on jugs and never had a peep out of it.

I would see a physio but don't expect miracles. I saw a physio and they were very honest and said there was little research into what might be causing it and rest was unlikely to help too much. Its good to chat it through but they aren't all seeing and all knowing I guess and I am sceptical whether a full rehab plan would have helped me any more than what I ended up doing; namely the common sense approach of not pissing it off and climbing around it as much as possible.

edit: lol just saw this wasn't a new thread and I've just reproduced everything I wrote years ago. as you were!

cofe

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#21 Re: Painful DIP
March 20, 2023, 12:25:09 pm
The other thing I did a lot of was ROM exercises, joint manipulation and massage. I'd say they also helped, but the tape I think made the difference. I was advised to avoid the fingerboard, boards etc. and I chose to avoid the wall.

DavidM

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#22 Re: Painful DIP
March 20, 2023, 02:34:36 pm
Thanks i've been doing the Saunders stretches and climbing doctor joint mobilisation and then some ROM exercises after the ROM has been increased from the mobilisations. 

mrjonathanr

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#23 Re: Painful DIP
March 20, 2023, 04:58:02 pm
Hand putty comes in different densities, is pretty cheap and great for gently mobilising joints. By way of example- https://www.mobilitysmart.co.uk/patterson-medical-therapy-putty-super-soft-113g.html?ff=1&fp=22110

 

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