What is this finger injury?

Climbing on 2-finger pockets 3 days ago, felt a bit of discomfort in ring finger while lowering off. Grip method on this route was primarily the bowling-ball style, with middle and ring fingers in the pocket and thumb finding something to make a pinch. Decided to cease climbing for the day.

Next morning discomfort was a little worse. Full range of movement produces little to no pain (0 to 1 out of 10), but specifically activating the ring finger by itself causes significant pain (3 to 5 out of 10) that extends just about from fingertip down through the wrist. Epicenter of pain almost feels just below the biggest knuckle at the base of the finger.

The other important detail, full crimp position on that hand produces no pain. It seems when the middle finger is also engaged, nothing hurts. What is this and should I steer clear of climbing/crimps for a while even though they don't necessarily hurt? Thanks for your advice!

EDIT W/ REHAB PROGRESSION:

Starting Day 3 squeezed theraputty 3x20 minutes a day, initially this felt nice but after a few days was bothering my finger so I switched to every other day. Did this with daily joint/cartilage supplements (glucosamine, L-proline, etc.) in case that would help. Did 0 climbing and kept clear of any other stuff that might bug it, kept on riding bikes and being generally active.

After 2 weeks, finger felt okay, still twinges of pain with some activities like shoetying, beltbuckling, etc. Tried some cautious hangboarding and discovered that my initial diagnosis was a little off; the ring finger hurts when loaded in isolation but most noticeably it hurts when the pinky is allowed to curl. I was able to hang on the smallest crimps in open hand and full crimp position with just a tiny bit of discomfort, but if my pinky slipped off I'd get a pretty good shock. Resumed climbing, feels pretty good but any kind of pockets are a huge no-no.

After 1 month of injury with gradual healing, visited PT. Was diagnosed as a flexor tendon tear. The "smoking gun" symptom was that it had become difficult for me to mobilize the last joint of my ring finger - e.g. I could not move the very tip of the finger when the rest of the finger was pinned down. Was told to do gentle exercises involving curling and uncurling the finger while loading with the other hand, 2 days on 1 day off, and to continue climbing as hard as I want provided I can always let go (i.e. no big run outs where I won't risk a fall). After an additional month of this (total 2 months since injury) I am still making progress, but not 100% yet.

no acute injury? no snap or pop?
no immediate weakness?
sounds like an intrinsic muscle strain or more likely a tendon strain .... be easy on it for a week or so. in general if it hurts dont do it... As soon as it starts to get worse Stop immediately and rest (probably for a few weeks).

Michael.P wrote: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. drjuliansaunders.com/ask-dr…

Yes, this, I've had it a couple of times, once it lasted about a week, another time it was more serious and lasted a couple of months. Basically just don't do anything that causes the pain. I found that for climbing, the easiest thing to do was to tape the offending finger to the one next to it so that I wouldn't accidentally split the fingers and all was well.

Thanks for everybody's responses! I did see that same Dr J article, and it seems like that could be the answer. The pain isn't really in my forearm though. In any case it seems like the consensus is pretty clear. I will update with my progress so that others finding this thread will have some conclusion...

How you can tell whether it's a flexor tendon strain and not a strain in the collateral ligaments of the PIP or MCP joints?

I had a similar injury at the beginning of last winter. I was crimping a bit too hard at the gym and felt some pain but no pop or tearing sound. I believe I had strained or slightly tore my A2 pulley tendon. Same epicenter of pain right below the largest knuckle on my ring finger. I had full range of motion without pain, but if I pushed on the area it was quite painful, as well as when using the hand to squeeze something or pull on anything. It took me roughly 2.5 months of not climbing at all and taking it easy to recover. Now I have no pain and can crimp again but I am still being cautious of overdoing it again.

Now that I've reread the OP, it does sound more like a pulley injury (which is technically a ligament, not a tendon, the pulley originates in the bone, goes around tendon, then connects back to the same bone - tendons connect muscle to bone).

Christian wrote:Now that I've reread the OP, it does sound more like a pulley injury (which is technically a ligament, not a tendon, the pulley originates in the bone, goes around tendon, then connects back to the same bone - tendons connect muscle to bone).

Big points from the OP that make it pretty obvious it's not a pulley injury:

- full crimp position on that hand produces no pain.
- specifically activating the ring finger by itself causes significant pain (3 to 5 out of 10) that extends just about from fingertip down through the wrist
- Full range of movement produces little to no pain (0 to 1 out of 10)
- It seems when the middle finger is also engaged, nothing hurts

With a pulley injury none of the above would be the case.

kennoyce wrote: Big points from the OP that make it pretty obvious it's not a pulley injury: - full crimp position on that hand produces no pain. - specifically activating the ring finger by itself causes significant pain (3 to 5 out of 10) that extends just about from fingertip down through the wrist - Full range of movement produces little to no pain (0 to 1 out of 10) - It seems when the middle finger is also engaged, nothing hurts With a pulley injury none of the above would be the case.

Thanks, just wondering because I have zero pain at the base of the (middle) finger where the A2 is and where he says the "epicenter" of the pain is, but some pain when bending the finger towards the palm and significant but very short-lasting pain when I accidentally hit it in a lateral movement.

Maybe I'm answering my own question about diagnosing a collateral ligament vs flexor tendon strain?

Christian wrote: Thanks, just wondering because I have zero pain at the base of the (middle) finger where the A2 is and where he says the "epicenter" of the pain is, but some pain when bending the finger towards the palm and significant but very short-lasting pain when I accidentally hit it in a lateral movement. Maybe I'm answering my own question about diagnosing a collateral ligament vs flexor tendon strain?

For what it's worth, pain is only induced by forceful flexion (moving the finger toward the palm, against resistance). Lateral movements and extension are painless.

BrendanP wrote: For what it's worth, pain is only induced by forceful flexion (moving the finger toward the palm, against resistance). Lateral movements and extension are painless.

Got it; we definitely have different issues.

The only time it really hurts for me while climbing is pulling up rope to clip against resistance (rope drag, being short roped, etc)

The weight bearing down laterally on my middle finger (hand is thumbs up so weight is towards pinky side) can get fairly painful.

Zero pain with buddy taping to ring finger, but I have a feeling I won't be able to climb anything hard with my fingers taped like that?

I'm far from being a medical doctor, but it does sound like OP has a pulley tear (maybe A2/A1)? FWIW, I've had those (pretty mild) from campusing & it doesn't really hurt w/ full crimp. Half crimp is the worst (well, besides pockets). And big incut holds on steep wall are also really annoying.

Christian wrote: Zero pain with buddy taping to ring finger, but I have a feeling I won't be able to climb anything hard with my fingers taped like that?

You can climb plenty hard as long as the hold configuration allows, but unfortunately, there seem to be little info on actively rehab the injury (i.e. pulley). I had one on a middle finger (on the lateral side). The joint felt loose for quite a while & eventually (over several years) feels as stable as other fingers, but the knuckle ended up being a lot bigger.

reboot wrote: but unfortunately, there seem to be little info on actively rehab the injury (i.e. pulley). I had one on a middle finger (on the lateral side). The joint felt loose for quite a while & eventually (over several years) feels as stable as other fingers, but the knuckle ended up being a lot bigger.

This is exactly what is going on with my R middle finger. Knuckle feels a little lax, crimping doesn't hurt AT ALL. Climbing actually doesn't hurt generally AT ALL. What actually hurts me the most is a totally open grip on slopers and when I hyperflex my PIP with my other hand. Still climbing my limit on it.

Some thing I am doing to actively rehab: the best thing actually has been to do some actual climbing on it, massage and stretching with the finger flat.

This video has good footage for palm on the floor stretches which have helped: youtube.com/watch?v=GXE-VXB…

The power web has been helpful with finger extensor exercises and flexion at the knuckle with a totally straight DIP and PIP:
pwrwebintl.com/

An ice sleeve similar to this one is also nice:
torexhealth.com/cold-therap…

Accupressure rings feel nice and maybe help break up scar tissue, probably doesn't do much:
amazon.com/Goda-Acupressure…*Version*=1&*entries*=0

I had the same type of pain in my hand through my wrist. Looks like you have already gotten some good advice, but buddy taping to my ring finger worked just fine for me. I could climb just as hard as long as I avoided pockets with that hand. It fully healed up after about 3 weeks.

I got some theraputty from a local medical supply and I've been loving it. Hard to say for sure if it's helping but my finger feels warm and happy after 20 minutes or so of squeezing it. Already starting to feel like it's healing but I haven't climbed on it yet. Interestingly, the daily task that seems to hurt most is tying my shoes.

Look up Lumbrical muscle tear! i had the same thing happen to me. I have since told lots of people about it, and many have said they think it's exactly what they experienced.

That's what I was self diagnosed as having, sounds the same as yours. Same symptoms, same method of injury.

Updated the OP with rehab progression, for those of you Googling your way here and looking for some concrete results...

Hey Brendan, can you please tell me, how the healing process went on?

Pretty sure i have the same injury. stopped climbing for 3 weeks then continued and it never got any better or worse. its now 16 weeks since the pocket-pull.. i stopped climbing a week ago and now its getting worse. i`ve seen 2 doctors but they didn`t really help me.. " ... just rest ... ". Well that`s what i am doing now, but i would really like to know how your injury healed and how long it took. I somehow have the feeling it won`t get any better without some kind of medication/surgery.

regards Tscha

Brendan Moran wrote: Climbing on 2-finger pockets 3 days ago, felt a bit of discomfort in ring finger while lowering off. Grip method on this route was primarily the bowling-ball style, with middle and ring fingers in the pocket and thumb finding something to make a pinch. Decided to cease climbing for the day. Next morning discomfort was a little worse. Full range of movement produces little to no pain (0 to 1 out of 10), but specifically activating the ring finger by itself causes significant pain (3 to 5 out of 10) that extends just about from fingertip down through the wrist. Epicenter of pain almost feels just below the biggest knuckle at the base of the finger. The other important detail, full crimp position on that hand produces no pain. It seems when the middle finger is also engaged, nothing hurts. What is this and should I steer clear of climbing/crimps for a while even though they don't necessarily hurt? Thanks for your advice! EDIT W/ REHAB PROGRESSION: Starting Day 3 squeezed theraputty 3x20 minutes a day, initially this felt nice but after a few days was bothering my finger so I switched to every other day. Did this with daily joint/cartilage supplements (glucosamine, L-proline, etc.) in case that would help. Did 0 climbing and kept clear of any other stuff that might bug it, kept on riding bikes and being generally active. After 2 weeks, finger felt okay, still twinges of pain with some activities like shoetying, beltbuckling, etc. Tried some cautious hangboarding and discovered that my initial diagnosis was a little off; the ring finger hurts when loaded in isolation but most noticeably it hurts when the pinky is allowed to curl. I was able to hang on the smallest crimps in open hand and full crimp position with just a tiny bit of discomfort, but if my pinky slipped off I'd get a pretty good shock. Resumed climbing, feels pretty good but any kind of pockets are a huge no-no. After 1 month of injury with gradual healing, visited PT. Was diagnosed as a flexor tendon tear. The "smoking gun" symptom was that it had become difficult for me to mobilize the last joint of my ring finger - e.g. I could not move the very tip of the finger when the rest of the finger was pinned down. Was told to do gentle exercises involving curling and uncurling the finger while loading with the other hand, 2 days on 1 day off, and to continue climbing as hard as I want provided I can always let go (i.e. no big run outs where I won't risk a fall). After an additional month of this (total 2 months since injury) I am still making progress, but not 100% yet.

I had a very similar (and severe) injury in my right ring and middle finger on a pocket almost 2 years ago now. Still can’t do some moves/right-hand pockets. Would love to get in contact and hear more about your healing process. I still experience popping in the wrist and popping/pain in the same spots you described — through the photon half of the finger to the wrist, with the epicenter being at the top of the middle hand, just below the large knuckles.

I really want to rehab this and I hope it’s not too late. My fear is that it healed wrong and I need surgery. I still can climb hard; like V6 crimps no problem, open hand or closed crimps, but when i curl pinky down with open hand pockets that’s a huge no-no.

Desperately need some help.  I’m thinking our injuries are the same; I have a ligament problem. Not sure exactly what that is but yes I heard like 3-4 distinct pops at the time of the injury.

I’d love to hear back:

Jason:

750-445-8939

jdawgbeals@gmail.com

This is 99% a lumbrical tear, I have had 2 now and the symptoms match exactly. It happened to me over a year ago and I was able to return to climbing quickly by buddy taping the finger. Long term I have still felt discomfort in this position, but have changed my approach to 2 finger pockets. Try to keep the non engaged fingers flat against the rock versus curled and you can generate similar amounts of power without discomfort. Keeping the non engaged fingers in a straight position keeps the lumbrical from being strained as the injury is caused from a shearing force. Over time training 3 and 2 finger pockets by gradually adding weight on a hangboard (starting with a rubber band etc) has helped get my fingers trained up to where I can curl the non engaged finger again.