Tenosynovitis / Trigger Finger right hand middle- and ringfinger

Hello everyone!

I have been dealing with an inflamed tendon sheath in my right middle- and ringfinger for over a year now (no trigger finger yet). Sometimes it was better, sometimes it was worse, but it never healed completely. I have done a lot of physio therapy and also had a cortisone injection.

I just came back from my surgeon and he told me that after such a long time, the only way to get rid of the inflamation and the injury is to cut open the A1 pulley in both fingers. As I see that as the very last option, I want to ask if someone already had this surgery? What are your experiences? How does climing feel without the A1 pulley? Can you still climb "hard" for example 5.12 with half or full crimps? Or is there still another possibility to get rid of the injury (laser treatment, acupuncture...?)

Thank you for the help, I am already desperate...
Chris

Hey Todd! Thank you, I will check it out. Maybe Ill book a private session.

Someone here who had the injury by himself? Or any experiences?

Maybe seek out another medical opinion. For me, a cortisone injection (or two (2 weeks apart), depending on the severity) together with religiously h-taping and base taping plus physical therapy (the best PT I found was actually someone specialized in treating golfers…) did the trick. 

Hey Mike,

nice to hear you got rid of it! I am always h-taping+base taping while climbing/bouldering as well. The cortisone injection also did some work, but I pulled too hard again a few weeks ago and the inflamation became worse again (dynamic move, open handed). May I ask which physical therapy exercises worked best for you and how long you suffered from the injury?

Hi Chris,

I had this twice so far (middle finger a few years ago, ring finger recovering right now). depending on severity my doc (Volker Schoeffl — I’m in Germany - look him up, he’s the one!) advises on the following protocol:

1. Rest, cool, tape, tar ointment (?) to “pull” the inflammation out of your finger… sulfur baths. PT.

2. If not better after 4-6 weeks —> cortisone shot. One, if it’s a slight case, two (2 weeks apart) in worse cases. Rest for two more weeks, then start climbing again. The finger may still be painful in this stage but pain will slowly subside during the next 6-8 weeks. You can climb at basically full strength by then (be a little more careful maybe, stop if it’s too painful, warm up religiously). 

My PT looked for reasons I’m getting this inflammation and worked on them. This is highly individual and in my case often upstream. My middle finger injury basically rooted in a slight scapular imbalance.

The current ring finger issue is probably due to tight extensors in the forearm and apparently some triceps issues (those also create trigger points in my pecs and around my scapula). I’m getting an hour of really painful massage and Mobilisation per week and it does wonders. Active work did nothing for me. Some stretching maybe but the big thing is a GOOD PT looking at you and your body, looking for the cause of your problems and addressing them.

Another word of caution: In my experience surgeons really like to cut something open. So maybe really seek out another opinion. 

Hey Mike!

Funny thing, I called Volker Schöffl earlier today and I can have an appointment mid September. He is kind of my "best, another opinion" and last hope.
Until then, I gonna try out your plan (which is similar to mine I have done in the past). Did you start doing icing + PT at the same moment? It's pretty bad right now, I feel pain when I press the base of my finger.

Regarding the cortisone injection: yeah, It felt similar to me after the one shot (fingers were painful first, slowly subsiding). But I never had the feeling I could go anywhere near to climbing at full strenght. Maybe I really need two of them 2 weeks apart...

Thanks a lot for your insights!

Good luck!
Are you in Frankenjura, too?

Volker Schoeffl will fix you! Trust him!
Don’t overrehab until your appointment. Focus on something else (core?) give your fingers some rest and you’ll be back climbing in no time!
Icing and rest may help, as well as does PT (I started PT after the first shot) but nothing beats a professional opinion and rehab plan.

I am in Austria and Dr. Schöffl is about 4 1/2 hours away by car... but I think its worth meeting him.

Yeah, I'll take it slow until then. Thanks Mike! Yeah, hopefully this time it works out and I will be fit by the end of this year (2 years of this injury+ soft climbing is enough)...

Hey Chris,

I developed tenosynovitis (in my pinky - without triggering/locking) about two years ago. When it became painful enough to prevent me from climbing (and in fact many normal life activities), I saw a hand specialist who advised a steroid injection as a more conservative approach to surgery. I did this and had almost immediate relief and was back to climbing 5.12+/5.13- within a few weeks.

This relief lasted about 6 months then the pain started coming back. Again, I dealt with it as long as I could before going back to the doctor for a second injection. The doctor cautioned me that sometimes the steroid will clear things up, but often it is a matter of diminishing returns, and regardless one is limited to three injections before one risks permanent damage to the tendons.

The second injection provided the same relief but this time only lasted me about 4 months before the pain returned. I eventually went in for my third and final injection which again provided relief but, predictably, only for 2 or so months this time.

Reluctantly I scheduled surgery - the doctor assured me that I would see no loss of strength or mobility even as a climber (and humored my nuanced explanations of and concerns over finger locks and mono’s) but despite his belief that I’d have no problems with the surgery I was still concerned so I got a second opinion. The second doctor said the exact same thing and encouraged me to "just do it" - saying I’d feel so much better and be climbing again in no time.

I had the surgery and was climbing again (very easy stuff at first while the wound healed) a little over two weeks later. Now, two months post-op, I've worked up to 5.12a/b. The pain is largely gone (though there are some different pains which I hope are temporary post-op things). I am very much still in the recovery process and am not pushing things too hard yet, but I do not think the lack of an intact A1 pulley will hold me back in the long run.

I would prefer to take a conservative approach and would recommend against surgery if at all possible, but neither PT nor rest helped my finger and I was unwilling to take an extended period of time off (6 months to a year or more) when my shorter breaks (up to two months) provided absolutely no relief. If you’d like I can post another update in a month or two on how my hand is feeling. Good luck.

Hey Josh,

yes, please update!
Luckily my condition did not return (yet…) after the steroid shot.
Good to hear that surgery seems to work as an ultimate means.
About the condition returning: I had multiple PTs (also “climbing specialists”…) that all had more or less the same ideas. Some massage, some stretching, some strengthening. Did not reply work. I finally discovered someone who seems to find the reasons for the injury occurring in the first place and also being able to address this. Guy cured my golfers elbow in four weeks and so far I have no recurring finger issues.
What I’m trying to say is that imho there are a lot of PTs doing the standard protocol and sometimes it works and sometimes it doesn’t. But there are also PTs that seem to have a greater understanding of biomechanics and whatsoever and therefore be able to really help you. Sorry, but I’m totally sold on my guy, it’s really magical… 

Josh Janes wrote:

Hey Chris,

I developed tenosynovitis (in my pinky - without triggering/locking) about two years ago. When it became painful enough to prevent me from climbing (and in fact many normal life activities), I saw a hand specialist who advised a steroid injection as a more conservative approach to surgery. I did this and had almost immediate relief and was back to climbing 5.12+/5.13- within a few weeks.

This relief lasted about 6 months then the pain started coming back. Again, I dealt with it as long as I could before going back to the doctor for a second injection. The doctor cautioned me that sometimes the steroid will clear things up, but often it is a matter of diminishing returns, and regardless one is limited to three injections before one risks permanent damage to the tendons.

The second injection provided the same relief but this time only lasted me about 4 months before the pain returned. I eventually went in for my third and final injection which again provided relief but, predictably, only for 2 or so months this time.

Reluctantly I scheduled surgery - the doctor assured me that I would see no loss of strength or mobility even as a climber (and humored my nuanced explanations of and concerns over finger locks and mono’s) but despite his belief that I’d have no problems with the surgery I was still concerned so I got a second opinion. The second doctor said the exact same thing and encouraged me to "just do it" - saying I’d feel so much better and be climbing again in no time.

I had the surgery and was climbing again (very easy stuff at first while the wound healed) a little over two weeks later. Now, two months post-op, I've worked up to 5.12a/b. The pain is largely gone (though there are some different pains which I hope are temporary post-op things). I am very much still in the recovery process and am not pushing things too hard yet, but I do not think the lack of an intact A1 pulley will hold me back in the long run.

I would prefer to take a conservative approach and would recommend against surgery if at all possible, but neither PT nor rest helped my finger and I was unwilling to take an extended period of time off (6 months to a year or more) when my shorter breaks (up to two months) provided absolutely no relief. If you’d like I can post another update in a month or two on how my hand is feeling. Good luck.

Hey Josh,

what a detailed answer, thank you so much! I totally see myself having the same history (and future) with this injury like you do. It looks like it is time for the 2nd and maybe 3rd cortisone injection before thinking about the surgery again...
I am happy to hear that your recovery process works out and you will be able to climb hard again in the future! The only things that concern me is that post-op, we are putting more pressure on the A2 and its more likely to blow up. + I have the problems in my mid- and ring finger which are exposed to higher forces while climbing (rather than the pinky??)

Please keep us updated!

Chris K wrote:

Hey Josh,

The only things that concern me is that post-op, we are putting more pressure on the A2 and its more likely to blow up. + I have the problems in my mid- and ring finger which are exposed to higher forces while climbing (rather than the pinky??)

Please keep us updated!

Yes, the doctor I got the second opinion from mentioned that this could conceivably happen but he felt it was very unlikely.

For me, other than the stress of thumbs-up finger locks, I’m not too worried - especially since I’ve never strained a pulley and have no plans to climb 5.14 in this lifetime. But I understand your apprehension being that it is in your middle/ring fingers.

I’m definitely not advocating surgery (who knows what could happen and there’s no going back) - I just wanted to share what seems like a success story (thus far) to help you stay positive and informed. I’ll keep you posted.

You all should read Dave McClouds book “make or break” There is a ton of good information in there about climbing related injuries, how to heal and prevent them. A very large amount of injuries are poor technique related. You injured your self most likely because you were using poor technique. This book helped me with some elbow issues I was having for about a year. I used the information and suggested methods by Dave and it cleared the issue up. Read his books you’ll thank me later 

(Bumping this thread due to its relevance and excellent posts instead of starting my own).

Chris and Josh, how is your recovery progressing? Thanks for sharing such detailed information of your journey thus far.

I'm having related issues that perhaps Dr. Hivemind, MP, can chime in on. Yes, IGD. 

I just got back from six days of moderate climbing in Red Rock and am experiencing some symptoms that appear congruent with tenosynovitis. Specifically, I'll feeling a grinding / grating / frictiony sensation in my right pinky when I flex it individually or make a fist. It's also audible, which is especially unnerving.

It started on day two (Ginger Cracks to Blade Runner). There were no moves that felt strenuous or tweaky on my hands. The length of the route shouldn't have been an issue, since I had just done my birthday challenge the month before and got 1700' of 5.10 or harder in a day without issue. Perhaps it was from pulling rope - I led every pitch and belayed with a Munter.

Regardless of what caused it, I experienced swelling and tenderness around my fifth metacarpal, and the grinding sensation. Of course, I climbed on it for the rest of the trip (which again was low-intensity high-volume, only max efforts were on Running Man and cleaning a stuck Totem on Epi, har har).

I found this article very helpful about tenosynovitis and feel ready to begin the "Mobility" or "Strength" segments described therein. My question is whether doing tendon glides and pen rolling is a good idea right now since it actively creates the grating sensation. It's not painful but feels weird.

TLDR: My current tenosynovitis-y symptoms don't cause pain and don't inhibit my climbing. If I return to my normal training program (power endurance) and climb through it, will I be shooting myself in the foot (or palm, rather) down the road?

Background: I've successfully rehabbed medial epicondylitis by adopting an antagonist muscle training regimen, and my recent A2 sprains have mostly healed.

Thanks for whatever you can throw my way.

/gote

Eddie Purcell wrote:

You all should read Dave McClouds book “make or break” There is a ton of good information in there about climbing related injuries, how to heal and prevent them. A very large amount of injuries are poor technique related. You injured your self most likely because you were using poor technique. This book helped me with some elbow issues I was having for about a year. I used the information and suggested methods by Dave and it cleared the issue up. Read his books you’ll thank me later 

This is a great book that I bought specifically hoping he would address tenosynovitis, but unfortunately the actual rehab part on this tenosynovitis is very short and he basically says to see a hand specialist if rest doesn't help. 

Hey guys,

sorry for my late reply but I am happy to hear you find this article useful! Here is my update:

I have had Tenosynovitis now for two years. After two cortisone injections and at least 1,5 years of physio therapy (daily finger exercises like tendon glides, pen rolls, putty suqeezing, antagonists, stretching, hot/cold packs, taping...) I could not get rid of it. Sometimes it was better and I felt it is almost gone but after bouldering too hard and too often it became worse again.

So now, after a long time I accepted that I have to live with it: I reduced the amount of bouldering/climbing (from 4-5 times per week to 2 times per week) and the grades (indoor bouldering up to 7c to 6b). That is because I don't want to get pain again in daily life + I am just too exhausted to keep on doing all the physio stuff. It's just my way, even it is not absolutely necessary:

My doctor (hand specialist, specialised on climbing for over decades, not Volker Schöffl) says: I can climb as much as I want and as hard as I want because tenosynovitis is not dangerous and is not damaging nearby areas. If it gets worse and causes pain in daily life again or the finger starts snapping, we will do one more cortisone injection. If that doesn't help, surgery is an option. He says, surgery (cut open the A1) is a small intervention and that the A1 will even grow together after some time again (just not that tight anymore). In daily life, I would not notice the cut open A1 and also (hard) climbing should't be a problem at all!

So here are my learnings (maybe also helpful for F r i t z's post above): Multiple doctors/physio therapists told me that tenosynovitis results from too little rest combined with too intensive climbing. If you feel symptoms, try to get rid of them as soon as possible: If the symptoms occour for the first time: stop climbing, seek a physio therapist specialised for climbing and If the symptoms won't dissapear after about 6 weeks, get your cortisone injection(s). I SUGGEST anyone to not try to climb over it. In the worst case, you will end kind of like me and you will have problems for years. It's much much worse than taking a break once. If the symptoms persist for a long time: Its not helpful to rest. I had the best recovery results with light climbing including a well warm up + physio therapy. And don't pull too hard, even one wrong move can throw you back to the start again.

I hope, that was useful!
Chris

Edit: @Josh Janes: how are you doing with your pinky?

Chris K wrote:

@Josh Janes: how are you doing with your pinky?

Now coming up on a year post-op and I’m climbing solid 5.12 trad and sport (and would probably be climbing harder if not for some issues unrelated to the finger). I do notice some lingering pain at the site of the trigger finger nodule - mostly when I stretch that finger (pinky). The pain is totally manageable and in no way do I feel that my tenosynovitis nor the A1 release surgery hinders my climbing or holds me back in any way.

TLDR version: One year out and I consider the surgery to be a success.

PS: This is a personal choice but given the alternative of cutting back from 4-5 days per week of climbing to 2 days per week I’d be getting that third injection and/or scheduling surgery. But good on you for being kind to your body!

Chris K wrote:

Hello everyone!

I have been dealing with an inflamed tendon sheath in my right middle- and ringfinger for over a year now (no trigger finger yet). Sometimes it was better, sometimes it was worse, but it never healed completely. I have done a lot of physio therapy and also had a cortisone injection.

I just came back from my surgeon and he told me that after such a long time, the only way to get rid of the inflamation and the injury is to cut open the A1 pulley in both fingers. As I see that as the very last option, I want to ask if someone already had this surgery? What are your experiences? How does climing feel without the A1 pulley? Can you still climb "hard" for example 5.12 with half or full crimps? Or is there still another possibility to get rid of the injury (laser treatment, acupuncture...?)

Thank you for the help, I am already desperate...
Chris

Exact same problem with the trigger finger - got so bad my hand looked like a golf ball where the middle knuckle is. Tried cortisone- nothing. Tried PRP - magic bullet. Get PRP injection into joint probably yearly for last 4 years and don’t even have a hint of the issue