Screws in hand painful while jamming

Has anyone had any experience jamming after having screws put in hand? A couple of months ago I crashed mountain biking and spiral fractured the index metacarpal in my left hand. Upon recommendation from an orthopedic surgeon I had screws placed in it to keep the finger from rotating. At the time I expressed concern that the screws would cause pain when crack climbing, and he said I shouldn't have any problem. I've been released to climb for several weeks and have no problem with sport climbing or bouldering (other than weakness from weeks of inactivity) but hand jams or stacks - anything that puts pressure on that bone - are really painful. If anyone had had a similar experience, I'd be interested to if this is something I should just get used to because there is hardware in my hand or if it will continue to heal around the screws and the pain will improve? I can deal with the pain if necessary but if waiting a bit longer will prevent it, that seems preferable. Secondly, would removing the screws be advisable to be able to climb pain free? Thanks!

My GF and I were involved in a bad car accident.
While I luckily did not sustain any injuires, she shattered her clavicle and needed several screws. We didn't climb for at least six months.

We've been climbing together now for about three months where she's been using a lot more of her upper body strength. I've heard her complain about it a lot but I think she's getting used to it that feeling of metal inside of you.

I suggest you keep off it for a little longer. Three weeks does not sound like enough time. You don't want to tear anything or risk damaging something not fully healed.

My 0.02

I would speak to your doctor about it. He's going to be the most qualified. Typically surgeons will only remove pins and screws if necessary, or if absolutely required for you to conduct the activity. Every time you go under there is always a risk of complications and a long healing period afterwards. Further, insurance companies are going to be very hesitant to pay tens of thousands if a procedure is not "medically necessary".

That said, when I had my leg surgery, my doctor told me that if I had significant problems running, I could come back and see him and he might be able to remove the pins in my leg. He mentioned that on occasion he will remove pins if they are causing lots of problems for the patient.

I just recently got metal outta my leg, which was used to repair shattered femur bone. I had discomfort, and sometimes severe pain, every day for 8 years. I'm active duty military, so getting medical work done isn't a financial concern. I exercised and stretched, determined to heal up quickly to get back onto the rock. I healed up SO quickly! I have little to no symptoms, now! And my leg can extend from flexion so much better, now! I'm a friggin' tank now! Heal up that hand and loose the screws, mang! Exercise and nutrients strengthens bone!

ambs8261 wrote:At the time I expressed concern that the screws would cause pain when crack climbing, and he said I shouldn't have any problem.

Talk to your surgeon immediately. Does your surgeon know what particular (and peculiar) stresses are involved in crack climbing, especially rattly hands? I'm thinking not, simply because it seems odd for a surgeon to give you the okay to hit your hand with high amounts of rotational torque when they suggested that a screw be placed to support a bone that already has a spiral fracture in it (aka already has marked rotational weakness). Tell him what you'll be doing specifically, bring a How-To-Crack-Climb book or pull up a Youtube video so he can see what forces will be acting on your hand.

In addition, while I'm only a 4th year med student, so ortho residents & attendings will have far more knowledge than me, my initial thought (prior to you seeing your surgeon, he trumps me by a long shot) is to put a serious hiatus (like 6mos - 1 yr) on crack climbing. You have fracture that was unstable enough to recommend putting a screw in, and now you're putting forces on that fracture in the worst way. You should be fine to pull on crimps to your heart's content - that places the stress in-line with the screw & takes the majority of the stress off your metacarpals and onto your phalanges & your surgeon has already given the okay.

You've only got one left hand. We're doing well on a bunch of artificial joints, but the hand is a ways off - it'd really suck to have serious longterm pain and/or limited mobility as a consequence & potentially have little/no recourse to alleviate it.

Final thought on pain - as a general rule, dull muscle pain, the type of pain that you notice more hours after the exercise & generally associate with working hard, is good pain. Sharp localized pain (pain that you can point to with one finger) is bad pain and can mean injury & you should stop whatever you're doing immediately.

He said the injury was a couple of months ago. The three weeks was since he's been cleared to climb. Not to argue with a med student, but I'd venture to say the bone healing is complete.

I love the line he told his doc: "Yo man, fix me up but don't F up my crack climbing now, be careful!" That's awesome.

I have screws in my right tibia, as a result of a skiing accident. (The binding didn't release.)

I'm pretty sure that if those screws were in my hand, it would be painful to have it compressed in a crack.

I agree with Paul Hutton (previous poster) (thanks for serving, Paul!). I have had pain at various times throughout the course of the screws existence in my body.

I'm sure your doctor has never had a screw in his hand or had it compressed by a crack.

If the screws can be removed, then that might help.

If they can't, then I'd consider padding. (Padding out my leg worked for entry into ski boots.)

Otherwise you might just need to find a different kind of climbing to enjoy.

Broke my hand last spring at the base of my thumb, had to have one screw put in. I was actually back to climbing in under 10 weeks. I had some residual pain originally, but working back into it slowly lead to a pretty successful recovery. There were certainly some moves that I had to be very careful with but I was back to climbing pretty much as hard as I was before the screw was put in.

About 4 months ago I injured another finger on that hand. Thought it was a badly torn pulley, but eventually progressed to thinking that it may have actually been a partially ruptured ligament/tendon in my finger. However, it was my middle finger and didn't have any affect on the previously injured area.

Finally got a point where I felt I could go climb at Denver Bouldering Club a couple weeks ago. Felt great to get a solid session in. By the end though, I was having some pain where the screw is in my hand. It tends to span the soft tissue between my thumb and pointer finger and travel up the inside of the pointer as well.

In terms of the pain you are experiencing right now, I would say it will probably decrease as time goes on. However, if any of the screws are on a pressure point that you stack on in a crack or use for a specific move repeatedly, it may take a long time to develop a tolerance to a point where it won't affect your climbing.

On the idea of getting the screws out...I would definitely consult an orthopedic surgeon again. I had this conversation before I even got the screw put it my hand and my doc was immediately apprehensive. He said that if it heals well with the screw in, I would have a very hard time convincing him that I would be even better off without it. Especially when it comes to the hand, there is already somewhat of a scar tissue buildup due to the initial surgery. Another surgery to remove the screw would actually be more invasive than the first, and because it is right near the joint of my thumb, there is potential that more scar tissue could begin to affect the functionality of the joint.

I know the long, slow recovery process sucks when all you want to do is climb, but in the end it is worth it. If the pain you are having is just part of your hand healing, take it easy and let the healing process run its course. If it is sharp or excruciating pain that doesn't subside over time, definitely do not climb on it and go see a doctor to see what your options are. I thought that my injury might forever affect my climbing but I had a hell of a surgeon and my body happens to have almost miraculous healing powers. Best of luck man.

Paul Hutton wrote:I just recently got metal outta my leg, which was used to repair shattered femur gone. I had discomfort, and sometimes severe pain, every day for 8 years. I'm active duty military, so getting medical work done isn't a financial concern. I exercised and stretched, determined to heal up quickly to get back onto the rock. I healed up SO quickly! I have little to no symptoms, now! And my leg can extend from flexion so much better, now! I'm a friggin' tank now! Heal up that hand and loose the screws, mang! Exercise and nutrients strengthens bone!

Removing hardware from hands is a much different story. So many bones, tendons and ligaments in such a small space. The potential effect of scar tissue on the functionality of the hand is a major concern. The surgery for the removal is often more invasive than the initial procedure, and unless you had a real bad accident, the recovery can more painful.

However, it is pretty common to have hardware removed from leg injuries. My dad has 3 bolts in his knee from a car accident. They bothered him for some time, got them removed and he couldn't believe how much better it felt afterwards.

Thanks for the thoughtful responses (this is my wife's hand)
Also I'd like to add that she really love OW climbing so pusing through the pain is not the queation. The question is...

If she is causing more scar tissue to build up and if that scar tissue will cause more long term pain. She's fine with taking a break from crack climbing and doing sport. But eventually she's going to get back in an OW. I have a bit more info as well:

I see 2 arguments for removing the screwsand would appreciate any prof opinion as to these arguments versus risk of going back under the knife.

There is severe pain when she bumps her hand. Often she says that it is something under the skin getting caught on the screws. Feom a physical systems standpoint I looked at the xray. They used capped Phillips head screw. You can actuality feel them under the skin.

Another point is that screws are designed to take certain stresses, but if too much torque is places on them in the axial direction (such as done with wrist locks, and most other crack moves) then I would expect that the screws would become increasingly loose.

If the screws loosen, I'm sure she will have some kinesthetic and visual evidence. That would merit additional surgery.

Surgery short of that is a choice, and depending on the actual injury, there might be good reason or no reason.

Interview Ortho's until you find one that understand's climbing and visualizes you climbing as you want and better.
Get their opinion.
I always have as much metal removed as possible, however, I only seem to pound my lower body.

I am in a similar position. I have 8 screws in my left hand, they were placed back in March 15... At the time I discussed it ALOT with my ortho, how it was going to affect crack climbing, etc. He always lobbied to keep them in unless it they came loose/were eroding, etc.

My hand has healed significantly since, but I don't have that much ROM at the MCP joint, and my hand is significantly "fatter" (ie, sucks to fit in tight hands). I have jammed a bit, and it was painful, but doable.

The ortho that did the surgery was in Boulder, CO. They see a lot of climbers. Still, I think he saw the surgery as a success b/c my bone was healed, and my hand was usable... unfortunately, he did not seem to understand how important being able to climb normally was to me (i expected differently in Boulder).

I have since moved to Texas (military), and saw an ortho here... he was even less interested in a second surgery to improve my rock climbing. Seemed kind of annoyed I asked.

For now I will give it a year and see how it goes. I'd love to hear what others experiences are.

Lee Runyon wrote: Another point is that screws are designed to take certain stresses, but if too much torque is places on them in the axial direction (such as done with wrist locks, and most other crack moves) then I would expect that the screws would become increasingly loose.

Loose hardware is definitely an indication for a second surgery. This in pretty much universal.

I also had concerns that the screws would weaken the bone, seems that with 8 screws in there that is a lot of bone matrix missing... I know the screws are in there, but it does not contain collagen fibers that link with rest of the bone in the same way....so we'll see. I am sure there is not much research in this particular area....

PS: I am an MD, but not an Ortho. I defer decisions to experts in the field. Obviously there are practice differences doctor to doctor. I am sure you could find one that would take them out if you wished... but as you mentioned before, there are risks to every surgery... and you may not benefit as much as you think you will.

Give it more time. Bones remodel slowly. Yes, the bone is healed (the fracture lines are closed), but the bone will remodel over time as you stress it while climbing. It may get better to the point you don't care, or you may decide you want surgery. Either way, my vote is give it more time.

Lee Runyon wrote: If she is causing more scar tissue to build up and if that scar tissue will cause more long term pain.

Another significant part of my procedure I didn't mention was that it included debridement. Upon examination of the CT scan, my doctor said he saw a good amount of scar tissue that he could clean out. He said he'd scope my knee during the procedure to look for any structural flaws. He seemed very confident, prior to the surgery. I love my results!