[Paul B]

Has anyone suffered from an A4 injury?

Recently I've had some discomfort just below the end joint on my middle finger, initially I thought it was probably just a 'crush' injury of some sort but it doesn't seem to be going away, its nowhere near as painful as the A2 injuries I've had previously, I also didn't feel it much when climbing last night (apart from on the odd hold that dug in), however I'm very aware that by climbing I may be making it worse (As per some previous injuries). I've had a look on climbinginjuries.com and cannot see anything about A4 injuries so any information is much appreciated.

 

[Danny]

Tricky. I don't really know for sure, but I suppose, due to the position of the A4, it isn't subject to the same kind of leverage as the A2 - so its most likely to be, as you thought, a crush injury. I suppose the way to find out is to see which hurts / hurts more:

Crimping in such a way as to put leverage on the a4; ie very small crimps and pebbles which require an arched, rather than buckled crimp grip.

or

pockets / edges which pressurize at the a4 joint through contact.

However, this could be utter shite; it is merely supposition 

[fatdoc]

i've got the "one move too many book"


i'll flick through it for you, give me a day or so though.

in the interim - go for the usual..... if it hurts, stop! i know you know this - but sometines you need someone else to help you see the light!!

[Paul B]

cheers that would be great. I'm thinking its probably just a bad crush as I was on some pretty small crimps last night and it was fine and not any more aggrivated afterwards.

[Somebody's Fool]

Has anyone suffered from an A4 injury?

I think Jim's money clip might have done.  I'll ask him next time I see him.

[Ru]

in the interim - go for the usual..... if it hurts, stop!

Is there actually any more to dealing with any finger injury that doesn't require surgical treatment than this? With one nagging tweak I was tempted to get an mri to diagnose it, but then I realised what a waste of time this would be. It obviously didn't need an operation as nothing had snapped, and regardless of whatever was wrong with it the only possible solution was not to injure it any further (ie stop if it hurts) then hope it goes away. So basically it doesn't matter whether it's the A4, A3, join etc etc if theres nothing more you can do about it than what you would do anyway.

[fatdoc]

nothin specific to A4 in the book.

lots of nic piccies of pulleys etc... usual rest / rehab rules apply.

have to say even i havent got an mri of my fingers in my collection! (which is extensive, at least 20 xrays, CT back and mri of spastic foot)

take it steady and hopefully it's just a bit or a crush injury.

[Paul B]

Thanks for taking a look anyway.

Ru: No I guess not, I hadn't ever really thought about that.

Pretty sure its either a Grade I or II A4 injury now, it seemed ok at the works but a session on the board and it feels very aggrivated this morning. Oh well....pull-ups only for a couple of weeks I guess, these things always come at the worst times.

[account_inactive]

in the interim - go for the usual..... if it hurts, stop!

Is there actually any more to dealing with any finger injury that doesn't require surgical treatment than this? With one nagging tweak I was tempted to get an mri to diagnose it, but then I realised what a waste of time this would be. It obviously didn't need an operation as nothing had snapped, and regardless of whatever was wrong with it the only possible solution was not to injure it any further (ie stop if it hurts) then hope it goes away. So basically it doesn't matter whether it's the A4, A3, join etc etc if theres nothing more you can do about it than what you would do anyway.

Despite this being incredible annoying, it is also probably very true

[dave]

Has anyone suffered from an A4 injury?

I once got a paper cut. stung like fuck. i'm pretty sure it was from a sheet of A4.

[Tricky]

laminated tab at the castle went under my right hand middle finger nail  ouch

[bob]

hows the a4 now? i slipped onto a fully boned down mono crimp at the weekend and heard what sounded like a carrot snapping but think ive only got a partial a4 pulley tear . currently icing and massaging but anything more than gentle pressure hurts but from what ive read a4 injuries seem to incapacitate less than a2, hoping not to be out for months and was wondering how you're getting along.


oh and if anyone can recomend a good physio in north wales i might treat myself.

[Paul B]

Sorry I can't really be much help because about a month after posting I had a 5 month break from climbing...

[Teaboy]

Bob, you pretty much describe what happened to me (although in my case it was a mono undercut which was held quite open handed rather than crimped). After a couple of weeks I started climbing on it, it wasn't to sore but did seem to inhbit me a bit. After a few more weeks it got so sore I couldn't climb on it one day and just decded to give up for a few weeks. 8 weeks rest and now I'm back climbing, it hurts at the start of the session, and at the end but is ok in between but does seem very weak in as much as i can't pull as ahrd on it as I did. During my rest i considered doing bar work and weights but these just put pressure on the affected area and in some ways seem worse than climbing, same goes for using big holds at the wall.

My conclusion is that there are no conclusions, I reckon I could have climbed on it throughout but at a lower grade. I didn't ice it frequently or consistently enough to know whether that helps. Another couple of weeks and I'll have an ide as to whether 8 weeks was sufficeint rest.

[Paul B]

8 weeks seems far too long to me... Did you ice for a while then do contrasts etc? I'm really suprised that after all that time it hasn't gone away.

[pete D]

I've got a bit of experience with A4 injuries, having had 2.  They've both been on the middle fingers but different hands.  Interestingly, I don't seem to get much trouble with A2 injuries or the ring fingers, which seem more common.

The first injury occured on the mono of Poverty and was accompanied by the carrot snapping sound Bob describes.  I think it was either a partial or complete rupture of the pulley.  It was properly swollen, so I stopped climbing completely for about 3 weeks and then climbed routes (only trad at first) for a few months with it taped .  It didn't hurt but felt weak.  It took atleast 6 months for it to feel 100% again.

The 2nd occured this summer bouldering at the Tor and was only a minor sprain i.e. no popping sound and I wasn't aware which move/hold triggered it.  Unusually for me, I took 4 weeks of complete rest.  It still felt weak when I started climbing again, so I taped it but after 8 weeks it was 100% again.  I put this one down to climbing when I was tired and dehydrated.

The length of time for it to heal will depend how bad the initial injury was but I'd expect 6 weeks minimum for it to feel 100% again.  I'd take 2 weeks off completely and then start climbing again with it taped but avoid hard bouldering at first.  With an A4 injury, you can pull on a lot of holds with no pain or weakness except for first joint holds for 3 fingers or less, which I'd avoid. I don't think the pain you feel on a pull up bar or jugs, which is due to pressure on the affected area causes any additional damage.  From these and other injuries I've had, the healing time seems consistent with the severity of the injury regardless of whether you climb on it or not, so I don't think climbing is necessarily harmful once the swelling has gone away.  Your body does a pretty good job of telling you what you should and shouldn't pull on.

But I'm not a doctor, so what do I know!

[SA Chris]

I tore a pulley crimping a shallow pocket on a 45 degree wall. It plagued me for ages as i would give it a 2 week rest and then it would hurt as soon as I climbed on it, so would rest for another two weeks, and so on. After about 8 weeks I mentioned it to a friend who had had physio for a similar injury, and he said it had probably healed, but the scar tissue was causing the pain, and recommedend friction massage in order to break down the scar tissue. I did this daily, and was climbing pain free in about two weeks. It's painful, but definitely beneficial.

[Nigel]

What Chris says is very true. If you've been resting an injury for 8 weeks, then like as not its healed (unless you did something extremely severe). However, it will still hurt because it will be ragged full of scar tissue. The downsides of this are that its stiff and weak, so when you start to climb again it'll still feel like its injured, even though its not.

Massage, icing, all that bollocks is great for breaking down scar tissue and lining it all back up into useful stuff again.

The best thing is not to rest completely for 8 weeks, but take 2/3 then start doing gentle stuff on it again. This avoids the problem but takes great discipline and lots of tape for cross taping over your knuckles. Bon chance!

[bob]

okay so i'm back doing gentle stuff at the wall lightly taped and everything feels fine, however the morning after my finger is really stiff and swollen and and painful to move. Gradually over the course of the next day it loosens up and returns to its pre-session state.

so is this normal or am I pushing things to quickly? to be honest I don't think its damaging anything but thought i'd check that i'm not slowing down full recovery.

[SA Chris]

I dont think the stiffness in the morning is much of an issue (i get stiff fingers after most sessiosn these days), but the swelling IMO definitely is. As far as I know, swelling means there is definitely still injured tissue? I would say you are pushing it a bit.

I could be talking bollocks though.

[Paul B]

mine's being doing that from time to time, do you ice after your session if not then do! just rubbing one ice cube over the injured area seems to do the trick.
My injury is currently improving (well I think it is) and i've experienced what you have said above after sessions that I forgot to ice after.

[jimacp]

i've been rcovering from a strain of a collateral ligament.  Took a good deal of time off (about 6 weeks), taped and rested.  When i started trying back again i was disappointed that the joint would hurt and swell the next day - in fact it started to react badly to minor diy work.  couldn't understand why after 6 weeks the joint was more fragile than before.

Went back to the physio who confirmed that the ligament had healed fine and the pain i was experience was due to the de-trained supportive small muscles in the back of the hand.  She told me to get on the climbs straight away, and to do finger extensions with an elastic band to strangthen opposing muscles.  this has helped enormously, a week later the finger feels 90% better.

Just take it slow, i've found that climbing 3hrs at moderate level does more harm than 1 hr of fairly normal climbing.  i'm planning on hanging on my finger board  or climbing every few days, a grade or two below normal.  Also finger extensions every day.  Going leave the wall while still fresh and not climb again till any swelling/pain has subsided again.  So far the strategy is working well!

hope this helps!