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Ring finger A1 partial pully tear
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By Ben Griffin
From Durango, CO
Apr 12, 2012
Bitches get Stitchez, Golf Wall, Durango, CO
I felt a pop in my left ring finger about a month ago. Anyone got any suggestions on how long it takes these injuries to heal? I have been given a lot of tips and pointers on how to take care of this injury. I am curious to hear about other people's experiences with finger injuries. Thanks for sharing.

Ben

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By Dave Wachter
Apr 13, 2012
"Driftwood" direct V6/7. Also known as t...
Hey Ben,
Just rehabbing from an A4 injury myself. I've found this useful: onlineclimbingcoach.blogspot.c... onlineclimbingcoach.blogspot.c...

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By Ben Griffin
From Durango, CO
Apr 19, 2012
Bitches get Stitchez, Golf Wall, Durango, CO
Thanks that article was helpful and informative.

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By kennoyce
From Layton, UT
Apr 19, 2012
Climbing at the Gallery in Red Rocks
Ben Griffin wrote:
I felt a pop in my left ring finger about a month ago. Anyone got any suggestions on how long it takes these injuries to heal? I have been given a lot of tips and pointers on how to take care of this injury. I am curious to hear about other people's experiences with finger injuries. Thanks for sharing. Ben


A couple of things, If you felt a pop then it wasn't a partial tear, you completely tore your pully. with a partial tear, there won't be a pop. I once fully tore the A2 pully in the middle finger of my left hand, and it took at least 6 months (the first three months with no climbing) until I was completely healed (although to this day I still can't fully close that finger). Back on November 24, 2011 I partially tore my A2 pully in my right middle finger. Because it was a partial tear I haven't stopped climbing, just taken it easier (especially with that finger) but it still hurts a bit after climbing which means I'm not taking it easy enough, and it's not completely healed.

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By Omar Little
Apr 19, 2012
I feel your pain Ben. I either tweaked or tore my A2 pulley on the second day of an 8-month long climbing trip... Additionally, according to the x-ray of the finger I have a hairline fracture near my fist knuckle. I must have somehow pissed off the climbing gods.

I have scoured the internet for treatment tips and Dave MacLeod's seem to be the best informed.

I had a question of my own that I was hoping could get answered:
The pain has shifted from the finger itself to the base of the finger and into the palm. Is this common? If I lift something I will get sharp pains in my finger, but for the most part it is a throbbing pain in my palm.

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By bradyk
Apr 19, 2012
My left pointer finger took 3 months to heal. Then I re-injured it and took around 2 months off. Now I tape it and try not to crimp on it. Tendons always takes a long time to heal. Take a lesson from my mistakes and wait until your are completely healed. Nathaniel, pain in your palm is very common. It is a tendon that runs from your finger, through your palm, and up your arm. Deep massage in the forearm will sometimes help this pain. I found that acupuncture works wonders, but it can be expensive. If you have the money, do it.

Good luck on the fingers.

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By Christopher Barlow
Apr 19, 2012
kennoyce wrote:
A couple of things, If you felt a pop then it wasn't a partial tear, you completely tore your pully. with a partial tear, there won't be a pop.


This is very misleading and basically inaccurate. A "pop" sound has nothing to do with a diagnosis. It is equally possible to fully tear a pulley without hearing noise or feeling a pop or to hear a loud pop and do very little damage to real tendon structures. I've had both of these scenarios. I'm only mentioning this because, as someone who's had somewhere around five significant finger injuries, I've learned that we climbers are not particularly good at understanding the physiology of injuries. There's a lot of lore and not that much science out there.

If an injury really is a pulley strain (and that is a big "if"), then the best differential diagnosis between partial and full tear - aside from an MRI - is observable bowstringing. A partial tear won't show bowstringing while a full tear will. All of the information I've seen mentions how hard this can be, in some cases, to observe.

As to the question about pain in the palm, this is probably another facet of the injury, not a moving injury. One can also strain the entire tendon structure, including a pulley, the tendons themselves (or, more commonly, the tendon sheath), lumbrical muscles, and other supporting structures. There are several different injuries that are relatively specific to climbers; more than one can happen at the same time in one traumatic event. Getting a very good specialist (either MD or PT) to help with the diagnosis is very important.

Ben, we could talk in person if you want - I love talking shop about injuries. You know how to get a hold of me.

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By kennoyce
From Layton, UT
Apr 19, 2012
Climbing at the Gallery in Red Rocks
Christopher Barlow wrote:
If an injury really is a pulley strain (and that is a big "if"), then the best differential diagnosis between partial and full tear - aside from an MRI - is observable bowstringing. A partial tear won't show bowstringing while a full tear will.


This is very misleading and basically inaccurate. If you have a single pully tear it is highly unlikely that any bowstringing will be visible. Unless you tear at least two pully's even a trained doctor most likely isn't going to see any bowstringing, and really you won't see much bowstringing at all unless you tear three pully's.

You are correct that a "pop" isn't the best way to diagnose anything, but a partial pully tear will not cause a "pop", If you tear a pully and do hear a "pop" that is caused by the tendon pulling through the pully, then it will be a full pully tear, not a partial. Of course a "pop" could be caused by many things that have nothing to do with tearing a pully, but it is pretty common.

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By Omar Little
Apr 21, 2012
Good info here, thanks guys. I had another question or two... Is it worth spending the money to get an MRI? I know that if it it a torn tendon or a strained tendon the only option is rest, but are there other injuries that have similar symptoms that would require different recovery paths?

Also, I injured my tendon about 6 weeks ago. Since then it has steadily gotten worse. At this point it is still either getting slightly worse or not getting any better. Is this expected if I am actually resting it and not climbing (which I am).

Thanks guys

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By Christopher Barlow
Apr 21, 2012
Nathaniel Gustafson wrote:
I know that if it it a torn tendon or a strained tendon the only option is rest


Not necessarily. From the stuff I've read, fully torn tendon structures do need surgical treatment. The research is somewhat inconclusive about mostly torn structures and surgical v. conservative treatment. Partial tears ("strains") don't need surgery. Practically, full tears mean true loss of or abnormal function of hand movement while partial tears will maintain normal function with pain. Keep in mind that it's pretty rare to actually tear tendons as they are really strong. Usually, we tear pulleys, tendon sheaths, small muscles in the hand, and ligaments.

As far as the MRI goes, my doctors and PTs have told me that MRIs are a the turn onto the road toward surgery. For me, it's worth spending the money to see a really good sports medicine person, usually a PT who understands climbing and/or a hand specialist. They can do good examinations of hand function to decide the severity of the damage. I've always erred on conservative treatment (for fingers and other injuries) and have had - knock on wood - great success.

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By Christopher Barlow
Apr 21, 2012
I'll add that most types of injuries that are in the minor to moderate range will respond well to mostly similar treatments; it's just best to get a good understanding of what's wrong so that one doesn't do anything counterproductive.

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By Omar Little
Apr 21, 2012
Great, thanks Chris. I am trying to find a good sports doc... the last one I went to was terrible and told me 2 more weeks and I should be OK to climb.

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By Christopher Barlow
Apr 21, 2012
There is the possibility that 2 weeks could be plenty of time before returning to very easy climbing. The most recent rehab stuff says that low-level stressing of injuries once they're past the initial inflammatory stages is good to stimulate tissue growth. There's obviously a fine line here. I've talked with several folks - climbers and medical professionals - that seem to think climbers, while being relatively ignorant of the realities of sports injuries, often baby their injuries too much. At the same time, we tend to be bad at stressing them in the right way, too, making for a perfect storm of injuries and re-injuries and chronic problems.

Play-dough has been my saving grace in the last six months (3 separate, unrelated finger injuries in that time). It's cheap, and squeezing it provides a good amount of resistance to promote blood-flow and tissue growth. Now that I'm climbing hard again, it's the first part of my warm up. I try to put my fingers in the position that hurts when I'm squeezing it. I've also done a few different things to increase blood flow. One is cool water therapy (immersing your hand in cool water for 30 mins), and the other is contrast baths (15 secs of ice water and 45 secs of hot-as-you-can-stand-it for 5-10 minutes).

Looking back to your first post, about pain in your palm, were you pulling on a pocket or were your fingers in some way significantly uneven when you hurt it? Is the pain between the bones in your palm, almost as if you can push on it from the back of your hand as much as the palm? If these are the case, it could be a lumbrical tear, another injury that is very uncommon in anyone except rock climbers.

A worsening injury like this over 6 weeks of rest might be an indication of scarring. Blood flow and tissue stimulation (really light to start) will be your best bet. If it gets worse with this, then you know that you need to do something different.

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By Omar Little
Apr 22, 2012
Yeah, I just can't see much improvement in 2 weeks the way it is feeling now.

Thanks for all the advice. I have been doing the contrast baths, and I just got some of the soft power putty.

When I hurt it I had my pointer and middle finger in one pocket and my ring finger in a different pocket that was slightly higher than the other. My fingers were fairly even, but I was not pulling THAT hard. The pain in the palm is generally just a dull, unlocalized pain with sharp pains in between the bones. Maybe I should look into lumbrical tears...

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