[mark]

Dear Auntie UKB,

Three weeks ago I fell out with my right hand ring finger. I took it for granted, flirting with a tricky problem in the biting cold without warming up properly.

The next time I climbed, it punished me, sending shooting pains around the base of the finger when I pulled open-handed. I think it might be either the A1 pulley or a ligament that I've offended. Since then I have been trying to make up by resting and giving it a daily treat of Glucosamine but it seems in no mood to forgive me.

Do you have any advice on how we can get our relationship going again? I want to be friends and take it out to play on the rocks but so far it shows no sign of forgiveness.

Yours sincerely,
Tweaked

[fatneck]

I'm not an expert, but common consensus seems to be that you need an initial rest, but that you shuold keep climbing as much as possible after this period. Just try and do stuff that doesn't hurt the injured finger. Good tape will offer some minimal but worthwhile support untill it's better.

Good luck :!:

P.S. Sorry I haven't continued in the amusing format you started in Mark....

[andy_e]

i have also had this problem with my left finger. were you pulling on a pocket? i kept climbing, but didn't climb stuff which would hurt that finger. try and make sure your finger isn't on the edge of your finger if you know what i mean, i.e make sure it's between two other fingers. take glucosamine and chondroitin as well as god liver oil and generally go easy on it.

[mark]

Thanks Fatneck.

i have also had this problem with my left finger. were you pulling on a pocket? i kept climbing, but didn't climb stuff which would hurt that finger. try and make sure your finger isn't on the edge of your finger if you know what i mean, i.e make sure it's between two other fingers. take glucosamine and chondroitin as well as god liver oil and generally go easy on it.

Yup, it was a shallow two-finger pocket that I slapped into. How long did it take before your finger was completely better?

[andy_e]

it still isn't 100%, but i'd say about two months ago is when it happened.

[Jim]

ibuprofen, tape and rest but not in that order. week off at least, tape for a month at least with light climbing building up slowly. the second you feel a tweak stop or climb summit easier that doesn't make it tweak. I taped for 6 months after tendon injury and still do occasionaly for certain things on that finger (eg mono's)

or

have finger surgically removed

the choice is yours

[andy_e]

have finger surgically removed

wouldn't that seriously reduce the strength of that finger?

[Jim]

depends if you put it in vinegar or not wouldn't it....

[dom]

yo, sounds like i've got the same problem.  Initially popped (audible popping sound) my tendon at the base of my left hand ring finger a couple years ago, rested it for a month or two til it got better.  But just a couple of weeks ago i re-injured the same finger from over-working it on some hard crimpin' projects.  I tried it again recently after 2 weeks rest but its still buggin.  How much longer should i rest it for.  And whats this glucosamine and chonondroitin stuff?  Is it expensive, can i get it at a pharmacy?   I'm already on the cod liver oil anyway, just casue i'm a bit homo.

[dom]

as well as god liver oil

shit man, that stuff sounds expensive

[mark]

yo, sounds like i've got the same problem.  Initially popped (audible popping sound) my tendon at the base of my left hand ring finger a couple years ago, rested it for a month or two til it got better.  But just a couple of weeks ago i re-injured the same finger from over-working it on some hard crimpin' projects.  I tried it again recently after 2 weeks rest but its still buggin.  How much longer should i rest it for.  And whats this glucosamine and chonondroitin stuff?  Is it expensive, can i get it at a pharmacy?   I'm already on the cod liver oil anyway, just casue i'm a bit homo.

There was no pop with mine and it only hurts when I'm open-handed. Broad pinches are the worst. Definitely getting better but I'm hesitant to climb on it yet in case I go straight back to the state it was in a couple of weeks ago.

Glucosamine was recommended to me by my physio the last time I saw him. He reckoned it was worth taking for anything tendon or ligament related. I got mine from Healthspan who do a range of Glucosamine stuff pretty cheap: http://www.healthspan.co.uk/shop/products.aspx?cat=GLUCOS&brandid=1

[Jim]

Tape it and climb on it. If it hurts - stop. go try a different type of problem.
2 weeks rest is plenty if your as psyched as me.
Just get out and move on rock people - its amazing

[mark]

Tape it and climb on it. If it hurts - stop. go try a different type of problem.
2 weeks rest is plenty if your as psyched as me.
Just get out and move on rock people - its amazing

Can't tape it as the pain's around the A1 pulley, i.e. within the hand.

I am psyched but I'm also aware that if I do further damage then an injury which might heal completely in not a lot of time could drag on and become a chronic problem. Not that I always assume the worst, of course.

Went out this morning and had a glorious hour at the Plantation. Finger wasn't hurting though I definitely had the feeling that it wasn't 100%. But looks like it'll be fine. Fuckin' A.

[bigphil]

I think I've done this to my right hand ring finger today.  I get pain when I open hand or pinch.  I got it openhanding a small slopey crimp with three fingers.   :cry:

Does taking Glucosamine and Chondroitin work?

[Huffy]

Hey Mark,

A1 or A2 pulley from sounds of it.



Don't tape it up too early as this will interfere with the healing process. going on the principles of stages of healing i give pully injuries around 6 days of icing twice a day, anti inflamm and no climbing. Jim is right that you should climb on it at this will help get tensile strength back in the collagen fibres but if you climb too soon then you rick really messing the structure up which builds XS scar tissue.  

after 6 days i get an elastic band and *v-gently* do some light pain free resistance work, progressing the resistance for a week. Ice if swelling. Hot and cold is generally left until after 14-20 days.
After that you should be ready for climbing on it again, but avoid any sort of pocket like the plague! (papers have shown these put the most strain through the base of the finger)

Of course this is just an ideal regimen, if you seeing good physio and they have plan then stick to that if it's working.

The evidence for Glucosamine with Chonditin with Vitamin C with blah blah blah remains largely subjective. They've tried al sorts of tests, even injecting the stuff directly into the knee to see the effects and not found anyhting conclusive. I still take the stuff though cos Donnie does and he's a GP!

All the best with it mate.

For anyone psyched on understanding injuries then look this up http://www.electrotherapy.org/electro/healing/tissue.htm

Knowing the principles of healing is totally the key in managing any injury effectively!

Back to the essays....yawn.

[moose]

Glucosamine has never really done it for me, regardless of dose and MSR / chondritin additions. But that's not entirely surprising as it's mainly recommended for cartilage problems and arthritis.  

Anyone have any knowledge or experience re Bromelain?  From what little I know it might be more applicable to climber's tendon woes - it reputedly promotes tissue repair and cuts down inflamation.... my shoulder hurts and I need quackery......anyone got snake-oil for sale?!

[saltbeef]

Donnie does and he's a GP!.

that's not saying too much! Gp training involves painting things that mean alot to you and group hugs, oh and advanced slipper wearing classes...
i still take it though.

[bigphil]

I've started to take Glucosamine with Chondroitin following my recent finger injury because I guess it might help and it makes me feel like I'm actually doing something to promote healing, though after reading the website Huffy posted up I think I might take some general multivitamins and eat more meat as well.  Part of the problem with supplements though is that its really quite hard to actually notice whether its doing you any good or whether your wasting your money.

[cofe]

not really read the above but a good bit of knowledge i got off my mate who's in prison is to get a big bowl of ice cold water with ice in it (i.e. that's frozen water for all you gangstas out there...) and sit with ALL fingers in it for a half hour. this then sends shit loads of blood to the fingers and especially the bad one. apparently having all fingers in sends a stronger message to the brain even if only one finger is afflicted with cod. seems to work really well. scouse will back me up. huffy will probably tell me i'm deluded and to 'rest'.

[Jim]

how can scouse back you up. He's got more injuries than Nigela and JR put together

[saltbeef]

cofe. wrong. in the initial instance first week post injury you want to ice it, this is to decrease inflammation, second or third week yeah stick your hand in some iced water, after that stick it in hot water this will increase blood flow, and thus promote healing. why on earth would you put the other hand in except for sympathy pains? probably the reason your mates in jug, for giving out false information.

[Scouse D]

The ice bucket method truly is the business. Touch wood it has sorted my fingers out better than they've been for years. The full ice immersion increases blood flow massively and induces mild hot aches, you really feel the blood pumping- it IS GOOD KNOWLEDGE. Props to Kim Thompson for the knowledge and John for passing it on and to my mum and dad and my agent.

[Huffy]

Sounds like Scouse is training his frostbite tollerance

I use contrast baths when recovering and we've been taught to use it in practice. Despite this there is no single study in the scientific literature linking contrast baths with quicker recovery from injury as far as i can tell (would be difficult to assess objectively)

huffy will probably tell me i'm deluded and to 'rest'

hehe, we still injured by anychance?

[bedrock]

I've done the same finger injury-popped my 4th finger on a pocket. Rested for 3 weeks initially with light climbing once a week (to keep sane!!) but it was always twinging so rested it for one month then introduced light climbing and about to start pushing it now. Never taped it as that can hinder the healing process. General rule for tendons is rest until it stop hurting during normal everyday tasks and when you fully flex the tendon then rest the same time AFTEr that again and only then start climbing on it gently.
I take glucosamine and MSM, felt there was no need for chondroitin as thats for cartilage but I'm not too sure if thats a good idea???!!!

[cofe]

fuck no. as of 18:47 hrs on sunday i'm back in the game. the ice knowledge is the shit.

[andy_e]

Arse. I've re-injured my finger, on the very same pocket no less. Only this time it's more serious... out comes the ice...

[bedrock]

now that was silly going back to the offending pocket 

I managed to re-injure mine by getting kicked by a cow I was trying to roll.....DOH!

[andy_e]

Kicked by a cow as you were trying to roll? 

I nkow it was the same pocket, I REALLY do want to tick the problem though... the nemesissy bastard.

[bedrock]

yes...I was rolling it to get one of its stomachs back on the correct side as it had moved to the wrong side   

all in a days work experience at the vets 

[andy_e]

Ah, you see that makes sense. I thought you were trying to roll underneath the cow, or trying to tip it or something! 

[grimer]

I went to the 'Bodies' exhibition in London this weekend, where the German guy has peeled back the skin off cadavers to show our workings. Really struck by the tendons in the hand, those skinny little strings that we put under so much stress. No wonder they give up sometimes.

[Pemb]

Mine seem to be giving up all the time at the moment!

Since I started climbing again five months ago I've had five really bad A2 injuries, all in different fingers. As soon as I recover and can do some light climbing on one, another finger gets injured. I know these types of injuries are common in climbers but this is getting beyond a joke!

I warm up well, drink lots of water and take a Chondroitin and Glucosamine supplement. However, I have put on a few stone since I last climbed reguarly and my joints do hyperextend quite a lot. Could this be the problem or am I just climbing's Chris Kirkland?

And will all these injuries affect my finger strength long-term? I remember reading a bit of research on this by Steve Bollen or someone but can't remember the conclusion.

Cheers dudes

[lorentz]

Sigh....

Bloody crimpy sit starts! Common complaint it would seem. Got that freaky audible pop in my right annular (ring) finger yesterday - first section above the hand. Is this the legendary A2 strain I've been reading so much about?

 Because it didn't hurt at first I thought maybe it was a joint popping  thing and carried on with some tape until it did hurt. Schoolboy error... it's really sore today. So then

1) Rest followed by real light training/ theraband rehab and strapping once pain stops and swelling goes down - see how it goes.

2) Ice and potentially contrast baths further down the road.

3) Glucosamine.

4) Ibuprofen gel

5) STOP IF IT POPS!



Great knowledge in this thread, folks. It's good to know y'all been thru it too. Are you all fighting fit again now or does it still niggle? Anymore advice/knowledge yo? Why does it tend to be the ring finger? What causes the pop? Have I ruptured the tendon or merely strained it. Any knowledge about long term damage to finger strength also appreciated.

Sorry to resurrect an old thread, but new to this tendon injury thing.

Gutted because I warmed up well, and have been totally psyched recently. Just started to move my lazy ass of a grade plateau where I'd been stuck for a looong time.

Cheers. Out.

[fatdoc]

just wanna add some more therapies to the potential list for you all here

(BTW that piccie of the finger earlier on is the shit, nice one)

- cross frictioning whilst the finger is numbed by ice; best done by a sports physio type
- ultrasound again by the above (not in vogue at present - but helped me in the past)


- at last but not least is steriod injections!!!!! few drs can / will do them... you need a real experienced sports doc - they work, esp in cases that wont get better due to excessive scaring. - yes if repeated they can be dangerous, but refractory cases do occur and its that or an operation (that has a really low success rate). the only dr. i ever trusted to inject me  - i've had 3 - is now the dr. for a major premiere league FC....... if i had 4 months of banana finger again with severe pain i would travel the length of the country to see him!!!

[Monolith]

Oh Bollocks. I've finally arrived at part of the forum I swore never to have to visit.

Fell off at Ysgo, took a bit of tumble and my middle finger got some sort of crushing amid the chaos. I should see a doctor, but haven't yet. I can't bend my middle finger, so that the fingernail section touches the base of the finger. It feels a very strange, stiff sort of pain and feels worrying (maybe because I never really get injured and dont know the pains some seem to encounter often).

Should I follow the icing protocol outlined within the thread, or just get off my arse and see a doctor? I've been told by a nurse I met that it wasn't broken, and hence thought I'd seek some info from the tendon bashing brigade. Is swelling around the knuckle coupled with the aforementioned inability to touch the base of the finger indicative of a tendon problem?

Thanks in advance.

[fatdoc]

you do not have a clear mechanism of injury here.

twated, crushed by your falling mass (meant non weightist), twisted on landing, hyperextended, hyperflexed or plain old normal *ping* either on a pocket or an edge (will usually be a differne tpart of the pulley mechanism )..... rarely a full on tendon in the forearm rupture

can tell me were the pain is and what exactly happened??

I had sooooo many finger injuries I reckon wothout seeing it i'll still be able to confer some informal advice

[Monolith]

Good to have a resident doc fatdoc!

I sort of slipped off the mat backwards and was a bit too busy trying to protect my head. I think i just put my hand out and a lot of weight was transferred through to it. Is it possible I have just bruised the digit? I bloody hope so, the injury department terrifies me!
Try as I might, I just cannot get the finger tip to meet base of finger. About 1 and a halfcm from doing so. And not neccessarily because of pain, I just can't physically do it.

Hmmm, what to do doc?

[cofe]

I use contrast baths

that's good enough for me.

[fatdoc]

OK


forget the usual bouldering / climbing induced over use pulley strains... cos you've not done that.

Most likely is a hyerextension injury (TOO far back), less so the hyper flexion (crushed into your palm).

if it really doesnt hurt much then you've not got a hairline fracture.... that's obvious really


BUT



if its truly *stuck* you could have a button hole fracture, where the *slips* either side of any of the fingerr interphalangeal joints "pop" leaving an irriducible fracture...


so, is really painless on forced movement??  if so IMO (which is supposition i.e; i'm not medically tied to this diagnosis professionally - truly sorry- it's the medicolegal world we live in) you just twated it. hard.

if it hurts on forced movement...... go to A&E before work in the morning (shortest wait) and you'll end up with an xray.... any bother and shout the house down that you're a national class climber and you bloody want it sorting

If A&E either not needed or negative then:regular analgesics, rest.... err.... quite a lot of rest actually..... and if peristantly swollen in 1 week cold therapy time. no resolution in 2 weeks = sports physio.


hyperextension injuries are most often seen in cricket. average time to get back to the crease is









at least 4 weeks.





sorry.... is that explanation OK??

[Monolith]

Fantastic, thanks doc. It does hurt when I try to get it to meet, so I'll nip down to A&E in the morning before anyone has chance to hurt themselves. I'll try the ice pack and rest too. Taping neccessary at any stage or best left alone? It's been a week tomorrow that I did it, so maybe time for ice?

Thanks once more

[fatdoc]

taping seems to have gone out of vogue in my (4 year) abscene from climbing.

there is no evidence for this as far as i can find...

i tape my middle 2 fingers, figure of eight pattern (so both pulleys covered) all the time - well you know - when climbing. If you dont understand can you remember how richie P used to tape?? - like that..

i cut it off, not peel... my tendons are a bit achey after a session and it hurts to pull on them; i'm old and massively injured in days gone by...

A&E will most likely be negative - but you need to be sure mate  - good luck.

[Monolith]

A&E will most likely be negative.

A negative response? Thanks hombre, I appreciate the advice.

[fatdoc]

negative as in no button hole fracture..... remember the NHS knows nothing about musculoskeleto disorders from sport... but if you have a fracture you will be sorted out...

[Turboman]

Hi fatdoc,

I managed to bend my fingers backward in a big way last Thursday (hyperextension?).  Ironically I got them caught in a door handle at the Foundry. I've been following the usual ice, ibuprofen, no climbing routine and I'm a serial abuser of glucosomine/chrondroitin and cod liver oil.

Five days later things are going OK but If I try hard to extend my ring finger without assistance I get a pain in top of the first finger joint.

Any idea what the damage is?  Is it a ligament/tendon thing or could I have damaged the cartilage? What's typical in hyperextension cases?

[Timatron]

Haven't a clue how to quote stuff, but fatdoc said:  "remember the NHS knows nothing about musculoskeleto disorders from sport"

I'm an NHS physio, and myself and most of my colleagues are highly knowledgable about sports injuries.  Also, especially these days because of the current jobs crisis in physiotherapy, most physios have already graduated from previous higher education qualifications that are usually sport related.

[fatdoc]

Haven't a clue how to quote stuff, but fatdoc said:  "remember the NHS knows nothing about musculoskeleto disorders from sport"

I'm an NHS physio, and myself and most of my colleagues are highly knowledgable about sports injuries.  Also, especially these days because of the current jobs crisis in physiotherapy, most physios have already graduated from previous higher education qualifications that are usually sport related.

fair that you are trained. i have no axe to grind here at all........ and those physios interested in sports injuries are on the whole multiple educated.... how much funding does your PCT give the secondary healthcare provider to get the prompt (< one week referral) to give rapid, timely and much needed treatment??


SFA i imagine. it's not a funding priority. If you pay for sports physio / sports massage / sports docs on the whole you get a damn good service.

there are the trained personel, esp in physio...... but the NHS does not fund the whole concept in any way as to call it a national service.

getting an appt 6 weeks after spraining your ankle is not the way to run a sport service, i'm sure we agree on that....... a 7 day new patient wait is the longest that I would consider acceptable.

If you work in a trust that has that facility let us all know... with patient choice we'll be be asap!

Hi fatdoc,

I managed to bend my fingers backward in a big way last Thursday (hyperextension?).  Ironically I got them caught in a door handle at the Foundry. I've been following the usual ice, ibuprofen, no climbing routine and I'm a serial abuser of glucosomine/chrondroitin and cod liver oil.

Five days later things are going OK but If I try hard to extend my ring finger without assistance I get a pain in top of the first finger joint.

Any idea what the damage is?  Is it a ligament/tendon thing or could I have damaged the cartilage? What's typical in hyperextension cases?

Again medical advice over the web is usually a disaster....... and as such this a general recommenadtion not de facto medical advice:

if you cant actively move through the whole range of the finger's movement with that mechanisism of injury you need to get it seen to......... one of the 2 extensor tendons that pass over and insert in that joint could have been stretched to failure. It's an A&E job i'm afriad. If you are local to sheff and there is a possibility of such occuring the northern general has a plastics dept. that is very good with hand stuff.
(go the the northern A&E earl in the day - you will be classed as low priority and have to wait bloody ages i'm afraid)

[Monolith]

Went to A&E this afternoon. Very fast turnaround and the x-ray showed no break or fracture. Apparently its just an ibru and ice jobby and its the swelling preventing the full tip to palm movement. Thanks for your quality advice fatdoc.

[fatdoc]

that's bloody good news mate 

should be a minor layoff only then!

[Monolith]

I ope so! Any idea on how long it takes for swelling to go down? Been a week and no improvement really. Maybe another two weeks off before resuming climbing activity?

[Timatron]

No offence was taken fatdoc, I was just a bit taken aback by the statement that's all.  I totally appreciate your comments, and it's true regards to priorty.  I think the turn around in my outpatient's department (I work in orthopeadics inaptients at the moment) can be as fast as 7 days, however, you've got to remember that thousands of people get treated every year, so sometimes there's a back log.

The basic role of NHS physiotherapy is to get people back to where they were prior to their 'present complaint'.  Obviously, with sports people (and remember I'm one of them so I do understand) the work required would often be so intense and time consuming that it is best left to the patient finding a specialist.

Also, in my experience, many sports people expect a quick fix, which a physio (or anyone else) just can't provide.  Most of the time the answer really is rest, rest and more rest.  Sometimes with a bit of cryotherapy etc. thrown in for good measure, although none of these things are actually 'proven' to speed up recovery times.  So, often getting a quick appointment won't make any difference anyway.

Finally, we work with some seriously 'f*cked up' people who often will be suffering in ways you just can't imagine, for the rest of their lives.  When you see people unable to walk, wash, breath on their own after an accident it kind of puts a finger strain/sprain into perspective.  That's not to say we don't care, I have a finger strain at the moment and it's driving me round the bend, and I'd always do my best to help someone with a similar problem.  However, you must be able to see why most NHS physios aren't going to lose any sleep over a climber's gammy finger.

That's my perspective anyway.  I'm not trying to diminish any climber's suffering as a result of injury. When it's a big part of your life, it's really hard, and scary when you can't do it.  I just thought it might be interesting to see the other side of the coin.  Any feedback would be interesting.  Don't ask me any advice, because all I'll tell you to do is exactly what I'm doing - REST.  You can always train other things like the other hand, the unaffected fingers, pull up strength, front levers etc. etc.

Oh yeah, and there are some really sh*t physio's out there too.  I remember, before I trained, I went to see one (a sports physio ironically enough) and she was hopeless.  Told me my shoulder injury was all down to my posture!!  She didn't even ask how I'd done it!!  If she'd known it had happened while cranking out some one arm chin-ups she might have realised that posture was nothing to do with it!!

Adios!!

[fatdoc]

i appreciate the NHs workoad..... and the *precious* mind set of sports people; and the huge swathe of really disabled folk that also need physio just to carry out activities of daily living. with such a diverse group of presenting complaints one can fully understand the relative lack of empathy over a finger sprain.

one could agrue many facets here ; self inflicted, the NHS is about whole population fitness and ability to work (= then be a functioning taxpayer in society), but what about the smokers / piss heads twated in a fight / morbidly obese...... do they warrent = care to others??.......not easy to draw lines in the sand

The blair govment will effectively destroy the NHS for all with the free poimts of care concept already going fast... it's fatal blow was with the introduction of payment by results and agenda for change has devalued the staff to a level that is horrendous.

end of the day my ethos is: pay for prompt service for sports injuries - lets face it - it's your recreation time, climbing is p8ss cheap, you want back into the climbing and could get there faster by spending not a great deal.... just go get treatment!!

Monolith mate: by some new video games... it's a prolonged rest period i'm afraid

[Timatron]

That's a very good point fatdoc, bouldering is seriously cheap, so why not pay for private treatment?

I'm one of these old fashioned people who still believes in some socialist NHS principles, but hey, maybe in 5 years you might see my private practice opening up at the bottom of Stanage.

[Simon S]

 

Plus Its often worth paying for a more expensive physio rather than the cheapest. I spent £85 on a 45 minute session and was correctly diagnosed and sorted. That was after 4 x £25 with another physio, plus 2 GP appointments and 1 hospital visit-all resulting in SFA. Sometimes spending more works out cheaper in the long run!

[Turboman]

Just to add to the general advice on here....

I found Dave Mcleods site a massive help with my recent injury. 

http://www.davemacleod.com/articles/pullyinjuries.html

Dave explains in detail the ice water therapy some have mentioned earlier on here. 

Very Cold Water = Reduced Inflammation
Moderately Cold water = increased blood flow to fingers aiding the healing process. 

The following is pulled from the above site.

"Ice therapy

Increasing the blood flow to the area helps to speed healing greatly. Gentle climbing or exercise is an obvious way of achieving this. A little used, but massively effective method of increasing blood flow is ice therapy. If significant cold is applied to the skin, the blood vessels in the nearby area (in this case the hand) constrict to reduce blood flow and prevent cooling of the blood. However, when moderate cold is applied there is an initial reduction in blood flow followed by significant dilation of the blood vessels and subsequent increase in blood flow of up to 500%. This is called the ‘Lewis reaction’. The cycle of blood vessel constriction and dilation takes around 30 minutes and thus the cold application should last this long. Place your injured hand in a pot or small bucket of cold water with a few (roughly 5) ice cubes added. Leave your hand in the water for the length of the treatment. If your hand hasn’t gone pink and feels flushed with blood after ten minutes, the water is too icy. Try to use the ice at least once or twice a day. Don’t use this treatment on a freshly injured finger where there is significant inflammation!

Get the water temp just right and this works a treat!