Pulley Tear Advice for Not a Climber

Firstly, I am not a climber, unless you count quasi bouldering while hiking. After a year of frustration, I finally got an MRI that diagnosed an A3 pulley tear on my middle finger. My hand was nearly torqued in half when a car door opened on me in the bike lane & caught my ring finger. I developed a very rare condition that ultimately required surgery in my palm. While I was dealing with that injury, the tendon on my middle finger shortened such that when I tried to do an open palm wall push-up, I felt a "twang" followed by swelling & bruising.

From cruising different climbing sites, I understand that pulley ruptures are usually audible but often fixable when treated promptly. Unfortunately, due to the other hand condition at the time, my PT thought it was just an adhesion that had broken loose so we splinted & taped while the swelling went down, then I was left with a finger that bows slightly to the outside but seemed otherwise functional. By then I was scheduled for surgery for the other condition.

It has been just shy of a year since that "twang" and I have had 2 doctors tell me to "just deal with it." It impairs my grip endurance and certain vibrations, like clapping, can cause it to wag like a guitar string, sometimes with excruciating pain.

My question to you fellow outdoor enthusiasts, is if any of you have had A3 pulley injuries, or if you've had other pulley injuries that did not heal, how are you "dealing with it?" I can't count the number of times I've wanted to cut it off!

Thank you so much for your help!!

Sadly, 2 doctors had the same opinion. Most recent one even told me you don't need the A3 (then why is it there?)

I'm probably a great case study for someone.

Bowing slightly to the outside (laterally) is not normal for a simple pulley rupture, that's why I think maybe they are wrong about the diagnosis (or there was other damage in addition).

You DON'T need your pulleys, especially if just one ruptures, a year later you should essentially have normal function and be pain free. Also, a complete isolated pulley rupture should cause your finger tendon to bowstring towards the palm when you flex the finger but should not bowstring or wag laterally. In looking at a diagram of A3 versus A2, maybe because it's closer to the joint, not having one causes worse instability?

I am not a hand surgeon, but have looked over the medical literature in detail when I ruptured mine. I don't think what you are experiencing is normal for a simple isolated pulley rupture.

I will stop commenting and maybe someone else can chime in. Good luck. I'd get a 3rd opinion from a hand surgeon who is recommended for climbing injuries.

From what I've researched, the A3 won't show signs of bowstringing. The lateral pull is the curious thing, I don't understand it either! Thanks for your insight!

If it was a full tear it will not heal on its own. How ever, I know with most tendons you can splice a tendon graft into the damaged one for a repair. I would imagine that this could be done with your A3 to repair it. But pulleys are a little different then most tendons.

Also your symptoms seem like more then just a torn pulley, did they mention any other injuries that might be able to cause this?

No other diagnoses, although I do wonder if the tendon is damaged. That may explain the chronic pain. All any doctors do is shrug & say "nerve pain" which isn't helpful, certainly doesn't feel like nerve.

Is it still painful to do a wall push up? I wonder if the real problem is not the A3 pull but rather the Flexor tendon. If the flexor had shortened it would apply extra pressure to the pulleys. If that is the case you could probably develop a program to lengthen the flexor tendon and perhaps relieving your symptoms.

When you clap does it hurt through out your arm or just in your hand?

What a drag
There is a person here who posts under the name J Q,
he has a strange cartoon Hefner-like guy Smoking from a holder. . .as an Avatar, thumbnail. .

His pictures and finger damage stay with me to this day,
check out the
Eric Sloan ethics thread, find
JQ. and look up his pictures. He seems a good egg.
Approachable, but Not one to suffer fools so have a clear understanding that he may at first think you are a Fake , what is called a troll. . .
Good luck with the hand, it is all connected .
I recommend the Hospital For Special Surgery in NYC.
The hand department is conservative, but among the best world wide.

"Is it still painful to do a wall push up? I wonder if the real problem is not the A3 pull but rather the Flexor tendon. If the flexor had shortened it would apply extra pressure to the pulleys. If that is the case you could probably develop a program to lengthen the flexor tendon and perhaps relieving your symptoms.

When you clap does it hurt through out your arm or just in your hand?"

Just tried a wall push-up again, strange not being on the knuckles! It was ok, maybe because I've been splinting again the past few days so it doesn't hurt. The initial condition (Saddle Syndrome) can cause tendon shortening and it was 8 months between the accident & surgery so I've been thinking that's what happened.

Clapping is just in the finger. It literally feels like a guitar string, a "free" tendon might fit that description.

Since the pain increases with prolonged use, maybe the tendon is getting aggravated. Or maybe it's pulling on the other pulleys and that's what's hurting? Does that happen?

Michael Schneider wrote:What a drag There is a person here who posts under the name J Q, he has a strange cartoon Hefner-like guy Smoking from a holder. . .as an Avatar, thumbnail. . His pictures and finger damage stay with me to this day, check out the Eric Sloan ethics thread, find JQ. and look up his pictures. He seems a good egg. Approachable, but Not one to suffer fools so have a clear understanding that he may at first think you are a Fake , what is called a troll. . . Good luck with the hand, it is all connected . I recommend the Hospital For Special Surgery in NYC. The hand department is conservative, but among the best world wide.

under the pulleys their is a special sheath that reduces the friction and should prevent aggravation. If that was damaged it would cause irritation and cause inflammation, tendinitis.

If you had a complete rupture of the A3 pulley you would have some room for the tendon to vibrate, and if it has shortened it could act as a string in an instrument and oscillate with a standing wave. If that is the case all you would have to do to stop the vibration and the pain would be change the tension on the tendon, say relax your hand.

But at this point we have far exceeded my medical knowledge. I wish you success in finding a solution to your injury. If you find one, I would love to see what you did.

Good Luck

Tendon shredding itself- that's the first thing that's made any sense!! Any idea if that would heal? Would a pulley heal this long after injury? Assuming it isn't a full rupture.

The vibration thing is sometimes helped by actually flexing the tendon, and shredding it more, or squeezing it next to the ring finger. So far a full splint is the only comfort I've found but giving the world the bird this long has gotten old.

Thanks very much for your insight!