Possible FDS tendon injury

Hello all,
First: I am headed in to a sports medicine PT office today to have this evaluated. I found a similar thread that described my symptoms accurately and someone suggested a tear of the flexor digitorum superficialis. The discussion stopped there so I hoped to spark more discussion and see if the masses agree with this possible diagnosis.

The incident:
Towards the end of my warm-up I grabbed the starting holds of a problem. The left grip was a vertical sidepull crimp and the right grip, a horizontal edge. My left hand was in an open crimp position and the movement was upward with the right hand to a sloper. While somewhat dynamically moving upward, I felt a pop and tear in my left forearm and what I would describe as a weakening of the ring finger. (the finger felt like it opened up slightly). I dropped off and initially had a hard time telling what had just happened. The pop and tear were not audible, but the sensation felt in the muscle or tendon connected to the finger mid forearm. I stopped climbing immediately, and began icing my forearm and palm, unsure of where the injury had taken place.

Sensations:
Immediate: After the adrenaline subsided, I began feeling the ache in my forearm, base of the palm and base of the ring finger. Resisting the flexion of the finger produces sharp pain in middle of the forearm with regards to distance from wrist to elbow. Slight numbness in the finger, but no discoloration, temperature difference, or swelling. Range of motion in tact, but noticeable ache when moved in the base of the finger, base of palm and mid-forearm.

(icing on and off all evening, with regular doses of ibuprofen 400mg)

Following morning(today):Any resistance in flexion of ring finger produces sharp pain mid forearm. Palpation at the point of pain during flexion resistance produces little to no pain. Slight numbness in finger. Range of motion in tact, but slight resistance noticeable during flexion and extension. No observable inflammation in finger, palm or forearm (hard to tell with chronically swollen forearms :) ) All other fingers function and appear normal.

(continued icing and ibuprofen)

Questions:
Is this a tear to some degree of the flexor digitorum superficialis?
If not, what do you suspect has happened?
What would be the ideal short term treatment/care plan?
Has anyone else experienced this, and what were your short term and long term experiences?

Sorry for being long winded, but I figure too much info is better than too little. Again, I am seeing a PT in 1.5 hours, but I would enjoy hearing from the masses as well.

Thank you.

Michael Engelstad

'Hard to tell' has been the problem.

I went to a general sports PT office and they suspected a certain muscle tendon junction, but suggested I go to a hand & arm specialist. I did and a series of specific isolation tests, she suspected the same thing to a lesser severity. (sorry I don't remember the exact muscle tendon junction). Both checked off the FDS as OK. The problem was: with both visits the pain was very inconsistent in both intensity and location. Both also made the comment that because of the lack of intensity and the ROM still being present, the injury is likely not severe.

Now that I have had two weeks since the injury, I think I could more accurately describe the location. I first thought the pop-tear sensation occurred closer to my elbow, but now realize it was actually closer to my wrist(right where the FDS tendon attaches to the FDS Muscles in the anatomy diagrams!). The majority of the pain is now in the base of my palm. I attempted to climb yesterday at a very low intensity and realized that in an open crimp position, I felt the most severe pain in the base/center of my palm. In a closed crimp position, there was considerably less pain.

At this point, I think I will give it another two weeks of zero climbing, tons of massage, scraping and perhaps a cold laser therapy session or two. If more progress is not made, I'll get an MRI.

It seems to be healing, although slowly, on it's own.

Thanks for the follow-up!

Sorry for reviving an old thread, but I just had the same symptoms start today after making a move to a two finger pocket. Any final diagnosis/outcome?

Ryan M Moore wrote:Sorry for reviving an old thread, but I just had the same symptoms start today after making a move to a two finger pocket. Any final diagnosis/outcome?

For what it's worth: I had this injury last summer. Was lay-backing when I had a sharp pain shoot through my forearm and an immediate loss of strength in my ring finger. Went to a climbing familiar othro and made sure nothing was torn. Just like Michael, producing the pain was inconsistent, but the most consistent way to was to lay my hand on a hard surface palm up; Have someone apply pressure to the middle section of your finger then one of you apply pressure on the finger tip while trying to curl the top of your finger up off the surface. This almost always produced pain and was also a good gauge of how it was doing during recovery.

I had hurt it pretty bad, but there was no tearing visible in x-rays. I took, and needed, 2 full months off with an initial 2 weeks of nSAIDs then heat/ice cycles for the 2 months. Came back slow, but was climbing stronger than before within a few months.

Just don't rush back and do be aware of any moves that may put pressure on this tendon (I still do today on slopers in particular). Also, it may just be anecdotal, but one of the squeeze/extend balls really seemed to allow me to work the tendon slowly since you can closely adjust how much pressure you're putting on the fingertip.

Michael E this also sounds super similar to a problem I've had off and on. Pain that exists in the middle of the forearm and also wrist pain. Hurts when I grip hard.

I Didn't have too much pain, just the sensation of cracking knuckles somewhere in my wrist/palm/forearm when it happened. So here's to hoping nothing is torn.

drjuliansaunders.com/resour…

see pocket trauma

Thanks Jon, also found this about lumbrical tears which just about exactly sums up circumstances and symptoms. klatring.no/LinkClick.aspx?…
At least it doesn't sound like a torn ligament or tendon.

Here's my two cents, ice is for dead people. It's great for preserving things in its current state. However that's not what you want in healing an injury. To reduce swelling elevate, use compression clothing and NSAIDs. After swelling reduces in a few days start using heat. Heat helps blood flow which helps promote healing along with PT. Tendons have limited blood flow so the healing process takes a long time no matter how you treat it. Ice certainly doesn't help it heal faster.

Of course see a doctor first to diagnose how severe the injury is and exactly what caused it.

Well I've been buddy taping it and its feeling much better. Haven't tried any small hold/sloper boulder problems yet, but have had no problem or pain on the routes I normally warm up. Pretty confident it's a lumbrical tear.

That's good to hear! If it was a lumbrical muscle in your hand it should fully heal quickly. Depending on how torn the muscle is. When I pulled a flexor tendon in my forearm it took a solid 3 weeks before I could squeeze anything without feeling pain. I took about another month before I regained full strength.

Sorry for reviving an old thread again, but I just had the EXACT same thing happen a few days ago. I was holding the 3 finger pocket on a beastmaker just doing my normal training, nothing crazy. I felt a pop in my left forearm about 1/3rd of the way down going toward my elbow (so closer to my wrist). I felt tingling in my palm and ring finger immediately after. As time went, no swelling, no bruising, full ROM. I can put full pressure on every finger except my ring finger. If I put ANY flexion pressure on my finger tip, it's very painful in my forearm where I felt the pop initially. However, I can hold on jugs all day. 

I saw my ortho the day after it happened and she couldn't confirm exact what had happened (granted I'm her only patient who climbs with any regularity) but suggested FDS. Definitely not pulley related since there's no bowstringing or anything, and likely not a full rupture since I still have full ROM and no bruising/swelling. So, her orders are to double up on vitamins and BCAAs, NSAIDs as needed, and no more climbing of any kind for a solid 4 weeks. I'll also be seeing a sport med therapist in a week to see what he thinks, but based on this thread and everything else I've read, it really sounds like time will be the best medicine for this.

Try the test described in this article

POCKET TRAUMA

I had pain about halfway down my forearm on the biggest and outermost tendon that connects in the middle right at the base of the palm. I think it happened after hanging too hard on my middle and ring fingers. I used to wrap tape around my wrist when I climbed, and that seemed to help a bit (since I couldn’t dream of resting it for months!). It would hurt both during and after climbing, and I don’t think it swelled. The pain is gone now, but I’m wondering if it will come back after an especially difficult climb, or if I start getting into crack climbing, and in that event what I should do?

PAUL BLUMER DETROIT, MICHIGAN

 

Oh, another good one. Though I see it often, I have never seen this injury documented and, if I knew exactly what it was, I’d name it!

Unless you carry very heavy shopping bags with one finger, this is 100 percent a climber’s injury. And even better, although it feels sharply debilitating, you can climb as much as you want. Here’s the deal.

The two prime movers of grip force are flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP). FDP is the stronger of the two. Each muscle differentiates anatomically and functionally into four separate slips, each attaching to the end of a finger. Hence you can control each finger with varying force. When you split your fingers under heavy load, the trouble begins. Mostly that involves the ring and middle finger in either one- or two finger pockets.

Let’s take a standard pocket using the middle two fingers. Once you start pulling, the little and first fingers curl into your palm. Now the middle two slips are long and pulling hard, and the outer two have contracted, are hence considerably shorter, and are also pulling hard. This creates a tearing force at the junction of the little- and ring-finger slips, and the middle- and first-finger slips. Typically I see tears at the former rather than the latter sites in my climber patients, but I am not sure of the pathomechanics involved. My experience suggests that the tear usually occurs in FDP, but without a lot of expensive imaging, the site of trauma and biomechanics involved in your case are an educated guess.

To test for this injury (hereafter known as the Dr. J test), pull on each finger (gently!), curling the other fingers into your palm. Pain that exists in the mid forearm when the finger is pulled on separately, but not when accompanied by a neighboring finger, is virtually pathognomonic for this injury.

Splitting your fingers in the next few weeks will be like pissing into the wind—not only are you doing yourself a disservice, it will get messy. Avoid it and you can probably climb as much as you want. Silly as it may sound, avoid pain! Split them and you will squeal. Taping can be simultaneously very helpful and very bothersome. Where possible, if you need to pull on a pocket, don’t curl your unloaded digits into your palm. The force summation will feel less, but so will your propensity for injury.

All the usual shenanigans like heat, massage, ice cream and shagging will facilitate the healing process.

http://drjuliansaunders.com/ask-dr-j-issue-172/