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Topic split: PIP joint inflammation (Read 1732 times)

AMorris

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Topic split: PIP joint inflammation
September 09, 2022, 04:38:54 pm
Went off to a physio a month or so back to try to sort out the chronically inflamed PIP joint which has been plaguing me for over a year now. Turns out it is probably arthritis by this point, and is unlikely to ever heal, which shits all over any climbing goals I have for the future. He jabbed it with some corticosteroids which brought the inflammation and pain down a decent amount. I was quietly hoping would allow things to begin to heal, but it seems like it's all coming back again.

Anyone have any experience of PIP joint inflammation on this timescale? Is there any hope? My well of optimism has kind of dried up :lol:

MischaHY

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#1 Re: Topic split: PIP joint inflammation
September 10, 2022, 08:36:44 am
Went off to a physio a month or so back to try to sort out the chronically inflamed PIP joint which has been plaguing me for over a year now. Turns out it is probably arthritis by this point, and is unlikely to ever heal, which shits all over any climbing goals I have for the future. He jabbed it with some corticosteroids which brought the inflammation and pain down a decent amount. I was quietly hoping would allow things to begin to heal, but it seems like it's all coming back again.

Anyone have any experience of PIP joint inflammation on this timescale? Is there any hope? My well of optimism has kind of dried up :lol:

A climbing physio or a regular one? I know several people who have been misdiagnosed with arthritis when actually they were experiencing pretty normal climbing related inflammation which can be resolved.

abarro81

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#2 Re: Topic split: PIP joint inflammation
September 10, 2022, 10:42:43 am
This is a long topic for me... All comes with the caveat that I am not a doctor or physio and your problem may be different. No one has said I have arthritis... But as Misha said, my instinctive reaction is caution there - how did they diagnose? Did you have an MRI? You'd have to ask Huffy or James if it's viable to diagnose via ultrasound, it may be. I assume any diagnosis based on symptoms should be treated with a very heavy pinch of salt. I know the hand surgeon I've seen said you need the posh MRI (3T Vs 1.5T I think?) to get a good look in that joint (this was to check I'd not ripped up bits of cartilage or broken a bit of bone off or anything, basically to confirm there was nothing "wrong" with it other than swelling)

I still have chronic swelling in one of my PIP joints, I don't expect it to ever go away, but I can still do a lot on it with suitable choices of routes. For me monos are a no no, small crimps require low volume only, thin pinches require care, and I have to be careful how I train - I've accepted that trying things like Evo or Northern Lights is too risky so I mostly choose things that are steeper and on bigger holds; long steep onsights - fortunately my favourite style - work very well. In the right style I'm probably better than I've ever been, but the range of styles I can operate in has narrowed. Repeatedly pulling on the same holds is where things really get risky. This is also true for training, so I don't really do repeaters or foot on campus any more as the repetition can be very aggravating.

How many injections did you have? I had 2 from Volker (10 days apart), but think I went back to training, especially volume, too fast in the following months. I would advise sacrificing maybe 6 months after injections to gradually building back up if you really want to try it properly. They might help you reset to zero but by all accounts will dehydrate the cartilage and you'll still need to teach the affected cells not to be so sensitised to swelling. Volker was fairly adamant that a single injection very rarely worked well, you need 2-3 10 days apart each, no climbing for 10 days after any injection.

Nowadays I find that if I do almost anything my finger is slightly swollen, say 2-4/10, so it's not feasible to keep it totally unswollen. But then I can do a lot and it stays in that range. Only if I get reckless does it get very swollen... I.e. I can operate anywhere from say 5-85% of my capacity and it stays at maybe 3/10, so I just avoid that last 15% that really sends it over the edge e.g. monos, small crimps (arbitrary numbers but you get the point hopefully!)

Last summer I took 6 weeks off to try a "factory reset" but it came straight back when I started breaking things back in again. Not worrying so much about it and just being strategic with my problem, route and training choices has worked well for the last year. Its comfort zone is definitely expanding, just very slowly.. who knows, if this carries on another few years maybe I can do hard crimp routes again? For me this thing is definitely a long game - it's like standard rehab (find what you can do, do that, gradually do more) but over the course of years not weeks or months. Again for me this means it's not feasible to just rehab on a fingerboard or by avoiding climbing outside as the timescale is too long, it's about making season-long choices about your objectives and seeing where you get to.

Oh, I X tape every session and leave the tape on for 1-2 hrs after the session to help suppress swelling

But of a brain fart there but hopefully something useful or encouraging!

Liamhutch89

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#3 Re: Topic split: PIP joint inflammation
September 10, 2022, 11:48:12 am
Alex, did you always have pain with the swelling? I've had swollen knuckles around the pip joint on my index and middle fingers on both hands for ages, but not pain. Not sure if it's something I should be concerned with or not. I say swelling but it's actually very hard, giving the impression of bone growth around the joint.

Sorry for the slight hijack.

abarro81

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#4 Re: Topic split: PIP joint inflammation
September 10, 2022, 12:56:08 pm
Yeah, I have some pain, although often maybe discomfort would be a better description than pain - it's duller than the sharp pain of pulling on an injured pulley, for example. But whatever word you use, I can certainly feel the joint objecting when I do things it doesn't like!

AMorris

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#5 Re: Topic split: PIP joint inflammation
September 10, 2022, 05:34:45 pm
Hi all, cheers for the replies, some very useful info in here!

The physio was not a climbing specific one, nor was he a climber. He did seem to be aware of the kind of injuries sustained during climbing, but was certainly not a specialist. I think the arthritis suggestion was a result of the longevity, limited RoM, and the fact that there is a bit of a crunching if I hold the knuckle up to my ear and flex the joint under light load. He did ultrasound it, but that was to guide the injection, and said that diagnosis from ultrasound was not possible. Though again, he is not a specialist so this might not be entirely accurate.

I had a single injection, then took 2 weeks completely off. It reduced the swelling by about 80% and the pain under load by probably a bit more. Now, however, the swelling is back and never really drops below about 50% of how it is post session. I have tried two month blocks of time off, with the same "factory reset" logic as you, a couple of times over the last year or so, but like yours mine came back pretty quickly.

Have you adjusted your climbing to utilise drag/chisel more?

That is all very helpful information, thank you for taking the time to reply! It's extremely frustrating, and it's hard to know what approach to take with it, since everything I have done has not seemed to have had much effect. It is encouraging to hear that you have managed to continue to develop your climbing despite this injury. I have been road cycling a lot, since suffering up filthy hills scratches a similar itch, but I don't want to become "just another injured ex-climber on a bike" :lol:

abarro81

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#6 Re: Topic split: PIP joint inflammation
September 10, 2022, 06:15:29 pm
With the same caveat about not being a professional, my guess is you're like me - stuck in a cycle of inflammation with a joint that is very sensitised and so respond to even small perceived threats by swelling. I wouldn't put too much weight on the arthritis suggestion.

I don't crimp much nowadays, especially in that hand. For me it's a lot safer to be a little more half crimp whenever possible. F3 drag is my safest grip so that's my go to for sessions where I want to train
but not stress the joint too hard, e.g. fir about 2 years I only really used that grip on hangs as everything else felt too aggravating.. now I'm back to some half crimp but I can't imagine ever being able to train on micros properly. When I do crimp I wouldn't want to try the same move too many times in a row, and wouldn't want to climb fingery stuff lots of days in a week.

For me at least, I feel like I've kind of tried everything now, so it's about management. I can still climb lots of stuff, and still love it, so it's mostly accepting my limitations in what I can try and how I can train, and working around those. Strangely enough, giving up on trying to "fix" it has actually been very liberating mentally. Of course it's hard to know how much my experience might map to yours though, I guess it will depend on just how swollen and sore yours is!

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#7 Re: Topic split: PIP joint inflammation
September 10, 2022, 06:56:43 pm
Hello

I have not had PIP joint inflammation, but had DIP joint inflammation and pain for about a year. I was also concerned about arthritis and had various blood tests and a consultation with rheumatologist. Blood came back normal and the rheumatologist said it would be exceptionally unusual for arthritis to appear in the DIP with no other joints affect - not sure if this is the same for the PIP. So at this point I was sure it was simply a sports injury so I had an ultrasound which revealed a tear in the ulnar collateral ligament. By my understanding, the blood flow to this structure is incredibly poor which means the healing process takes a very long time. I eventually had some shockwave therapy from John Ostrovkis in Sheffield which I think sped up the healing process. After about 12-18 months I was back to full crimping power.

In summary, my first port of call would be to rule out arthritis by getting a consultation, took me a while on NHS but was worth it in the end. At the same time get an ultrasound to find out if any soft tissue damage has occured - preferably from a climber physio - I would recommend John who I mentioned above if you are anywhere near Sheffield.

PS: non-painful climbing probably also helped the recovery but hard to say for certain.

abarro81

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#8 Re: Topic split: PIP joint inflammation
September 10, 2022, 07:36:05 pm
The rheumatology consultant was presumably looking for rheumatoid arthritis, psoriatic arthritis etc not osteoarthritis? I took the OP to be referring to the latter not the former.

I don't think shockwave would be likely to work for osteoarthritis or standard chronic inflammation but I may be wrong (I did actually try it, it didn't help, but there's no real reason why it would for chronic inflammation issues AFAIK)

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#9 Re: Topic split: PIP joint inflammation
September 13, 2022, 10:45:36 am
Very interested in this. I went years ago to a hand 'specialist' consultant with swollen PIP and DIP in different fingers. Had an ultrasound, sent off to a hand therapist who said early onset arthritis, nothing I could do except a FODMAP low inflammatory diet. Which frankly cut out so many things I like eating I wasn't willing to go with it, so just settled for trying to avoid things that cause my fingers to flare up - for me it seems to be pocket pulling and open handing that causes problems as much as savage crimping.

However, fast forward 5 years and I'm currently suffering a bit on three fingers on my left hand (swollen PIPs) and one on my right (swollen PIP and DIP). I think it's not arthritis and something is going on with ligaments, joint stability, maybe synovitis. Doesn't really hurt to climb most of the time, more if I knock them, particularly sideways. Want to go back to a specialist but need a very different one with more expertise.

What's sad for me is I am getting these problems a number grade before other people seem to get issues, doesn't bode well for my long term climbing success :(

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#10 Re: Topic split: PIP joint inflammation
September 13, 2022, 12:10:33 pm
Alex, did you always have pain with the swelling? I've had swollen knuckles around the pip joint on my index and middle fingers on both hands for ages, but not pain. Not sure if it's something I should be concerned with or not. I say swelling but it's actually very hard, giving the impression of bone growth around the joint.

If size doesn;t increase or decrease with exercise and there is no pain I would not call that swelling, just development of ligaments and tendons as a result of loading (and maybe some scar tissue).  After 30 or so years of climbing at moderately high effort mine look the same, and most older climbers i know have hands that look similar.

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#11 Re: Topic split: PIP joint inflammation
September 13, 2022, 12:41:31 pm
Tangentially related - I've been growing a nice wee bump roughly where the A2 inserts on the bone for the last couple of years. Hurts to press but I've never felt it during climbing. Tried to "massage" it away before to no avail.

In the last month of climbing in Canada it's basically disappeared. Point being - don't let one diagnosis / issue convince you you're bust! Things do clear up.

I do, however, think I'm getting big toe DIP joint pain a bit too often. New TC pros seem to help but it doesn't seem great. I'll maybe drag up an old toe pain thread and ask some Qs there.

 

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