Return to climbing after sagittal band repair

I'll try to keep this short. About 5 weeks ago I ruptured the sagittal band on my ring finger while slamming the rock during an uncoordinated dyno attempt at a local crag. This resulted in a lot of pain and an extensor tendon that didn't want to stay in place at all. I (luckily) managed to get in for a consult and surgery within 2 weeks for the repair and am now about 3 weeks out from surgery. I should begin PT in a week or two. I have a few questions:

1. Has anyone else even heard of another climber getting a sagittal band injury? It's normally a boxing injury, and not something I was even really aware of.

2. Has anyone come back to climbing after this type of injury? I'm optimistic since it's not really climbing specific, but I'm also worried that I could tweak the repair if I'm not careful.

3. I've never really done any aid climbing and I'm wondering if it would be stupid at this point to go out and aid some climbs on TR solo while only using my pointer and middle finger on the left hand. Is that do-able? Would I be able to keep any/all strain off of my ring finger safely?

Thanks in advance.

I have no personal experience with this injury but...

2.  It's an extensor injury.  You should be fine with regards to climbing if you allow it to heal correctly.  

3.  This seems like a bad idea to me.  Seems like it would be easy enough to pinch or tweak that finger if you're messing around with a bunch of aid gear, especially if you're not a seasoned aid climber.  Just allow it to heal correctly.  I feel like you're just asking for a setback if you try to push it too early.  3 weeks for a soft tissue injury of the finger is nothing.  Follow the advice of your PT/OT.

I also ruptured my sagittal band 3 weeks ago.  Middle finger.  Right hand.  I don't even want to say how I did it because  it was so stupid.  Anyway, my doc splinted it for 6 weeks and said no surgery and that most heal on their own.  3 weeks later its still swollen.  What went into your docs decision to go straight to surgery?  I am really nervous that mine will not heal and I will have a long term injury and then have another 6 to 8 weeks in a splint after surgery.  Pulling down on something is not painful, but its straightening my fingers in an upward direction that leads to the extensor subluxing into the gutter between my knuckles.  Kinda gross and painful.  Is that what yours did?

Claudine, that is exactly what mine was doing. My doc said there was research suggesting that conservative care could work and that it might heal on its own, but that the surgery was reliable. I made the decision to have it surgically repaired since I'm a teacher and I knew that in the case that conservative treatment failed, I would be way more inconvenienced having the surgery during the regular semester than if I had it during summer (which I did). I'm about 7 weeks out from surgery now and I'm at the point where I'm out of the splint and I basically have full range of motion back. I'm about to begin strengthening, and I'm also about to begin teaching again. The surgery was expensive, but luckily I had built up enough in my HSA to cover all of the costs. I feel good about the surgery, but the recovery has been a little more intense than expected (initially there was a huge reduction in range of motion, but I've been able to gain it all back). I was definitely wary of conservative treatment since I knew that I'd be stressing it in unusual ways with climbing. The surgery was quick and relatively convenient (I wasn't put under and there was only a local anesthetic). I'm confident that I'll basically be back to normal in a few months. If I wasn't so busy with all of the changes because of COVID-19 (converting all of my courses into an online format) then I'd probably already be out aid climbing. I think I'll be climbing again by the end of fall. I definitely trust the surgery in that I don't feel like the extensor tendon will subluxate unless I do something really stupid - the knuckle feels really solid now, and I have a lot of confidence in the repair. 

Another reason I'm glad that I had the surgery so quickly is that even in the two weeks between injury and surgery the fascia on the opposite side of the injury had enough time to contract (because there was no opposing force from the damaged side) that after surgery it took a lot of rehab to get it stretched back out. At first, I couldn't bend at the knuckle at all! Range of motion came back really quickly, and my doc told me that if I'd waited that it would have taken much longer to regain range of motion and that there was no guarantee that I'd get the full range of motion back. 

Thanks for your response, David.  That is scary about the range of motion.  I actually just had my hip replaced (and I fell three days after the surgery- getting out of my daughter's bed of all things).  I really wanted to rehab both at the same time so i was not doing one and THEN the other - just more time sidelined frankly at a time when outdoor exercise is critical to my mental health.  I can understand the inconvenience while teaching.  I work on a computer and the splinting is difficult to type with.  Another 8 weeks of this will be super frustrating.  2 docs have now recommended the conservative path and I continue to remain skeptical.  My gut tells me you probably made the right choice and I will wind up there- just far more slowly.  At the same time, I have had several surgeries in my life, so I was not rushing into another one.  Keep me posted on your progress if you don't mind.  I am really interested in how it holds up once you start pulling on it by climbing.  My hope is that due to its function it may not be too impacted by climbing.  

Update:

I am 14 weeks post op and have my full range of motion back. The knuckle has healed up nicely and there is only a small amount of residual swelling left. I still am not back to full strength, but I have been doing pull ups and some kettlebell exercises. I was planning to go do some V0 bouldering this week, but unfortunately I sprained my ankle very badly last night while I was trail running. I'm in a boot and on crutches for the foreseeable future. Long story short, knuckle good, ankle bad.  

Thanks for starting this post! This is not directly related but this is the only thread I have found on the whole wide interwebs dealing with saggital band injury rehab for climbers so I will share my story in hopes that it may benefit others. Long story short is that I have been dealing with weirdly recurring SB symptoms on my right index finger for about the last year. The annoying thing is that they have gone away for months at a time during which time I have been able to train and climb at pretty much full capacity, then they will just come back full force, usually after a day of trying hard that involves either hard pinching in a sideways position or else hard finger locking or cupped hands. I have had 3 "flare ups" in the last year separated by 3-4 months each. Symptoms are the classic saggital band injury symptoms - doesn't hurt when I flex or pull straight down but my finger will "catch" and snap audibly, sometimes painfully, when I extend the index finger from a flexed position. Swelling/ inflammation at the MCP joint and an overall feeling of instability (like I want to pop the knuckle frequently). 

I saw a hand ortho about it after the first time I hurt it almost a year ago and they were frustratingly dismissive - they basically said "yea there's a bunch of stuff it could be so just take it easy for a while and it should be fine." They prescribed me a topical anti-inflammatory ointment. At my coaxing they ordered an MRI but my insurance denied it so I never got one. After my most recent flare up about 6 weeks ago (which as far as I can tell started the morning after I was trying a route that had a strenuous thumbs down index finger lock) I was able to speak to another specialist who is way more focused on climbers and he ordered an MRI which my insurance approved! The imaging confirmed a tear to the saggital band and partial extensor tendon subluxation. There is also a bunch of related inflammation/ arthritic-type scarring going on in the surrounding area (which is not terribly surprising since I'm 38 and have been climbing for over 25 years). My new doctor (who shall remain unnamed until I get his permission to share) said he actually felt that this was "good news" compared to a pulley or tendon injury and has expressed confidence that I will be able to heal it conservatively (i.e., sans surgery). He has told me to splint the finger during day to day use but to continue loading it in a controlled manner fairly frequently (4 times a week). 

The finger rehab portion consists of doing 3-4 hangboard sessions a week where I am doing 2 rounds of 2-3 sets of hangs to failure (30-45 sec) on good size edges (20-30mm) using open hand and half crimp positions plus two short climbing sessions a week (on same day as HB) where I am focusing on climbing more or less 100% statically with complete control of hand positioning and avoiding weird or tweaky grip positions. I am also allowed to continue weight lifting/ cross-training with a bar and kettlebells carefully and at low volume. I have been doing this program now for about a month (he actually prescribed this before I had the MRI based on an initial consultation but has kept me on it after confirming my diagnosis) and have noticed a slight decrease in swelling and a reduction in the frequency of symptoms. That being said, it does still get "snappy" occasionally (usually on rest days) and there is still noticeable swelling at the MCP joint, particularly in the mornings when I wake up. Basically, I can't really tell if it's getting better or just not getting worse, but of course I am only part way through the total expected rehab time, which he said will likely be another month or so (until I can start grabbing holds "with velocity" and adding load in hangboarding). Anyways, I just wanted to share where I am at with this conservative course of treatment - I will post again in a month or so with another progress report.  Really hoping this works because I am also 9 months out from ORIF surgery on my heal and am reaaaally not looking for another surgery/ rehab. Fingers crossed (carefully).

I wanted to share that I took a very conservative course of treatment. No surgery. I splinted for a long time and did the rehab. I have zero pain now and no signs of any recurring injury. Frankly it was nothing shirt of amazing. I was really skeptical but it worked! I hope you both are ok. 

I will add I was really diligent about the splinting. 

Chandler Van Schaack wrote:

Thanks for starting this post! This is not directly related but this is the only thread I have found on the whole wide interwebs dealing with saggital band injury rehab for climbers so I will share my story in hopes that it may benefit others. Long story short is that I have been dealing with weirdly recurring SB symptoms on my right index finger for about the last year. The annoying thing is that they have gone away for months at a time during which time I have been able to train and climb at pretty much full capacity, then they will just come back full force, usually after a day of trying hard that involves either hard pinching in a sideways position or else hard finger locking or cupped hands. I have had 3 "flare ups" in the last year separated by 3-4 months each. Symptoms are the classic saggital band injury symptoms - doesn't hurt when I flex or pull straight down but my finger will "catch" and snap audibly, sometimes painfully, when I extend the index finger from a flexed position. Swelling/ inflammation at the MCP joint and an overall feeling of instability (like I want to pop the knuckle frequently). 

I saw a hand ortho about it after the first time I hurt it almost a year ago and they were frustratingly dismissive - they basically said "yea there's a bunch of stuff it could be so just take it easy for a while and it should be fine." They prescribed me a topical anti-inflammatory ointment. At my coaxing they ordered an MRI but my insurance denied it so I never got one. After my most recent flare up about 6 weeks ago (which as far as I can tell started the morning after I was trying a route that had a strenuous thumbs down index finger lock) I was able to speak to another specialist who is way more focused on climbers and he ordered an MRI which my insurance approved! The imaging confirmed a tear to the saggital band and partial extensor tendon subluxation. There is also a bunch of related inflammation/ arthritic-type scarring going on in the surrounding area (which is not terribly surprising since I'm 38 and have been climbing for over 25 years). My new doctor (who shall remain unnamed until I get his permission to share) said he actually felt that this was "good news" compared to a pulley or tendon injury and has expressed confidence that I will be able to heal it conservatively (i.e., sans surgery). He has told me to splint the finger during day to day use but to continue loading it in a controlled manner fairly frequently (4 times a week). 

The finger rehab portion consists of doing 3-4 hangboard sessions a week where I am doing 2 rounds of 2-3 sets of hangs to failure (30-45 sec) on good size edges (20-30mm) using open hand and half crimp positions plus two short climbing sessions a week (on same day as HB) where I am focusing on climbing more or less 100% statically with complete control of hand positioning and avoiding weird or tweaky grip positions. I am also allowed to continue weight lifting/ cross-training with a bar and kettlebells carefully and at low volume. I have been doing this program now for about a month (he actually prescribed this before I had the MRI based on an initial consultation but has kept me on it after confirming my diagnosis) and have noticed a slight decrease in swelling and a reduction in the frequency of symptoms. That being said, it does still get "snappy" occasionally (usually on rest days) and there is still noticeable swelling at the MCP joint, particularly in the mornings when I wake up. Basically, I can't really tell if it's getting better or just not getting worse, but of course I am only part way through the total expected rehab time, which he said will likely be another month or so (until I can start grabbing holds "with velocity" and adding load in hangboarding). Anyways, I just wanted to share where I am at with this conservative course of treatment - I will post again in a month or so with another progress report.  Really hoping this works because I am also 9 months out from ORIF surgery on my heal and am reaaaally not looking for another surgery/ rehab. Fingers crossed (carefully).

Hey Chandler,

How'd the conservative approach end up?

Did the MRI show a complete tear to the saggital band?

I'm having similar issues that you described. I'll get an MRI next week. 

Hope you fully recovered.

N

I know that you didn't ask me, but I thought I'd give an update. 

My surgery was 100% successful and the knuckle is now completely normal (the scar is even basically gone). I am back to climbing stronger than I was prior to this injury. 

If you have the money and/or good health insurance then I would totally recommend sagittal band repair.  

In Response to NM's post above, I will provide a quick update. My MRI showed a Type 2 saggital band tear in my index finger, so yes it was torn but not all the way through. It's basically a year later now and the finger is pretty much symptom-free and I am able to train/ climb at 100% intensity (have been able to for at least 6 months now). The conservative approach seems to have done the trick. It took about 4 months of slow and systematic progression, following protocols provided by Dr. Tyler Nelson, for symptoms to go away. I highly recommend contacting him if you are looking for non-surgical options. He really helped me both in terms of creating a plan for recovery as well as with the mental side of things, i.e., realizing that some recurrence of symptoms during recovery did not necessarily mean that my finger was not healing. The program was a mix of hangboarding (lots of PIMA, or Pulling Isometric Muscle Action to start, with gradual increases in volume, intensity and speed) and climbing, with pretty much as much antagonist/ general strength training as I wanted to include. It was actually pretty eye-opening - as someone who has pretty much always been a practitioner of weighted hangboarding, I was pleasantly surprised that after 4 months of no weighted hangs at all that I came back bouldering at more or less 100% pre-injury levels. Dr. Nelson knows his stuff. Talk to him before deciding on surgery. Hope this helps.  

Thanks guys for replying and giving your experiences with both. Those in the future (and myself) appreciate it!

David, what was the grade of your tear?

Thanks guys, I'll post about the results to my MRI on Monday and hopefully contribute something useful to this thread.

My tear was a bad grade 2. There was one small bit at the bottom that was still hanging on, but any pressure/tension in the finger caused subluxation of the tendon. I actually got to see it during surgery.