Slow onset of pain following a finger tweak

I seem to have tweaked by left ring finger while climbing on plastic two days ago. The specifics of the tweak seem a bit odd, however. I spent a session bouldering in the gym on Friday, and nothing was amiss throughout a ~2 hour session. Went to the gym at noon, warmed up properly, and then was climbing on crimpy problems. No pops, no pain, no signs of any problems during the session. Stopped when I got tired, and went home early/mid afternoon. Still, all was fine. Around 9 pm that night (Friday), a diffuse soreness began to set in at the base of my left ring finger (A2 or perhaps A1 region), as well as a more mild and also diffuse soreness in the little finger next to it (A2 or A3 pulley regions). Soreness continued on Saturday, and into this morning (Sunday).

Here are the specific symptoms: There is no bruising, no swelling, no bowstringing. No loss of mobility, although the inside of the finger feels just a little stiff when making a fist.. The main time that there is pain is if I squeeze my hand into a tight fist, which produces a twinge at the base of the ring finger. Grasping an object with a fairly open hand (like a coffee mug) causes no discomfort, but pinching something small with a fairly closed hand (like picking up a laundry bag) causes a twinge. Pain is at most a 1.5 out of 10 (when it twinges because something irritated it), and most of the time it is a zero out of 10.

I've been climbing for >10 years, and by some stroke of luck this is the first finger injury I've had in over 9 years, so I don't have a whole lot of experience with these things. I'm assuming that it is some minor, partial damage to the A1 or A2 pulley. However, the symptoms, especially the slow onset, seem a bit different than the typical literature on these injury. So, what's the deal? Has anyone had a similar experience, where the sensation of it being tweaked does not set in until hours later?

With regard to treatment, I'm taking the standard conservative approach of ice and rest until it doesn't hurt anymore, and then will reassess. However, I really have no sense of how severe an injury it actually is. It feels like a very minor tweak, but all the reading I've done about A2 injuries has me quite concerned. How worried should I be? From those who have had similar experiences, does this sound like a take-a-week-off until it doesn't hurt sort of thing, or a sidelined for a longer time sort of thing? Just trying to get a sense of basic prognosis, how long to take off before trying to climb on it, and how seriously to take said tweak.

Finally, as a preemptive strike against unhelpful comments: Yes, I have searched the forums and the googles and read a bit about these sorts of things. And no, I'm not going to go see a medical professional about a finger tweak, especially when all they'll tell me is to not climb on it until it stops hurting; this I already know to do.

Bump

Based on your 5.13b sport climbing ability as professed in your profile, I am seriously surprised that this is your first finger issue. Sounds to me like a partial tearing of the pulleys of the A2 (think guides on a fishing rod). The open hand grasping a coffee mug with no pain; but pain pinching a thinner object concerns me. The ring finger is much more concerning than the pinky finer, if that is what finger you mean. Crimpy holds and especially gym boulder problems absolutely injure the ring A2 all the time in my case and other guys I have known.

One of my best friends is a 15 year V10 climber who is an exceptional orthopedic spinal surgeon, but he knows more about climbing specific finger injuries than almost anyone in the world. I consult him on these issues, and have had him examine my issues in the past. I have had at least 4 similar injuries to the left ring finger, mostly on my non-dominant hand (around ten A2 pulley tears on all fingers, not counting the A1 or A3).

I always did the week or two rest thing. I hate to be the harbinger of bad news, but 4-6 weeks is optimal. 8 weeks is best, but may be overkill. It will only get worse, and I am proof of that. You know your body best. Do easy stuff, easy for you but hard for most (think 5.10 no tweaky holds). See how it feels. Any pain, absolutely stop, go home and be done with it. Even a twinge of pain once. I am coming off of a pulley injury in my non dominant pointer finger palm and it is the same sort of thing. I am going to be out for a while, just to be safe, and that is why I am posting so much on this website!

And yes, I usually have delayed onset of pain in this type of injury. My full A2 tear with bowstringing was completely different. None of my partial pulley tears have ever produced a pop and 'you must come down now' feeling. Plus, it would be difficult to find a specalist who understands what activities you engage in and the specific injuries it commonly produces. I have seen three different hand specialists who had no idea of the injury or how to treat it. In my experience, they were used to on-the-job multiple finger crushing or partial sawing thought the finger thing.

Best of luck, do not listen to just me though. Question, are you right handed by chance? As in this is your non-dominant hand?

skinny legs and all wrote:Based on your 5.13b sport climbing ability as professed in your profile, I am seriously surprised that this is your first finger issue.

Yeah, good luck thus far. I have had various other injuries (knee, shoulder, etc), but my fingers have mostly stayed healthy.

skinny legs and all wrote: Question, are you right handed by chance? As in this is your non-dominant hand?

Correct.

That is what I thought. Out non-dominant pulleys and tendons are weaker than those in our dominant hand. Hey, good on you, you are lucky. I am dealing with a torn right bicep with tendinosis and left bicep tendinosis in the same spot and I'm in physical therapy. All of that hard work sucks. It is even harder to not climb, I mean that is what we do!

An A2 partial tearing in the ring finger accompanied by an A3 lesser partial tear on my pinky is what I had once in my non-dominant (left) hand six or seven years ago. That is simply because the pinky is so much shorter than your three longer fingers. I would not really worry about the pinky too much though. One puts so much less force on it than the other fingers.

State College, Pennsylvania is where the Doctor practices. I know you are in Colorado, but information can only help. He even did a one year internship specializing in hand surgery in Switzerland after he had done all of the things to practice in any other area of orthopedic surgery.

I am by no means an expert, I have only lived it, so take my advice with a grain of salt, and hell, pour yourself a cold one!

So, another day of poking an prodding, along with some more research, suggests to me that the affected pulley is actually the A1 (a less common injury), not the A2. Is there any notable difference dealing with an A1 tweak versus an A2?

Hey JCM. What you described for your injury matches very closely to something that I am now experiencing in my left ring finger, although that slight feeling of discomfort seems to be coming more from the A3 region (the very top of my middle finger knuckle).

I've noticed that the only time I feel a slight pain is if I am doing a front three finger half crimp position, four finger half crimp feels fine, same with front three open hand. This tempts me to keep climbing lightly with only a three finger open hand grip, but I am sure that just resting for a few weeks until the pain stops is the winning ticket.

Anyways, just curious on how progress has been for you. Have you been climbing? Has the pain stopped? How long did you have to rest for? I have been climbing around 7 years and up until this point have had no injuries at all. Although the discomfort that I have noticed is probably a 1 or 2 out of 10, I am trying to do as much reading on the subject as possible to get a good idea of other peoples experience in a similar situation.

Joel R wrote: Anyways, just curious on how progress has been for you. Have you been climbing? Has the pain stopped? How long did you have to rest for?

The finger is doing very well. Took 3 weeks off then started climbing again on non-crimpy climbing (Rifle; steep jugs and slopers) about 3 weeks ago. I probably could have even climbed sooner, but final exams (school) meant that I had not time for climbing anyway. No limitations with regard to climbing in steep/juggy style; I can try as hard as I like. Am still a bit cautious around crimps or two finger pockets; I'm going to hold off of doing any crimpy bouldering for a while.

This sounds very similar to an injury I am recovering from. After a month off it was still sore, so I went to the doc. Here is the test he did to diagnose it. With the hand in a generally open and relaxed position use your other hand to move the ring finger to a closed position and then pull the tip (while closed) sideways towards the pinkie. This will put a lot of pressure on the knuckle. I had sharp pain when he did this in the knuckle region, and it was diagnosed as a ligament strain/partial tear.

303scott wrote:This sounds very similar to an injury I am recovering from. After a month off it was still sore, so I went to the doc. Here is the test he did to diagnose it. With the hand in a generally open and relaxed position use your other hand to move the ring finger to a closed position and then pull the tip (while closed) sideways towards the pinkie. This will put a lot of pressure on the knuckle. I had sharp pain when he did this in the knuckle region, and it was diagnosed as a ligament strain/partial tear.

Good to know. I just tried this and didn't have any pain whatsoever going to either side. Obviously I'm not going to take this as there is nothing wrong and should get right back on my projects again, but it definitely makes me worry some what less, so thanks!

JCM wrote:The finger is doing very well. Took 3 weeks off then started climbing again on non-crimpy climbing (Rifle; steep jugs and slopers) about 3 weeks ago. I probably could have even climbed sooner, but final exams (school) meant that I had not time for climbing anyway. No limitations with regard to climbing in steep/juggy style; I can try as hard as I like. Am still a bit cautious around crimps or two finger pockets; I'm going to hold off of doing any crimpy bouldering for a while.

Glad to hear it's doing better. I'll probably end up playing it safe and rest for 1-2 weeks, whatever feels right. Will be a tough adjustment though because I have a bouldering trip coming up in 8 weeks and I have to adjust my training plan accordingly.

Thanks for the info guys.