injury to pinky finger--ice climbing--UPDATE

OK, this goes out to all the ice climbers, all the climbers in general managing finger injuries, and, of course, all the physical therapists, doctors, amateur sleuths, and so on. 

Injury to pinky finger.  No obvious cause.  Just started to hurt during a pitch leading ice, and by the top it was quite painful.  Swollen around base of finger.  A little bruising for first few days.  I have satisfactory range of motion.  I can flex and extend my finger.  There is some resistance because of the swelling, but there is good strength in that direction.  I can also spread my fingers laterally open and closed, but with any resistance on either side of my finger, it really hurts.  It seems to be the part of my finger closest to my hand.  When I press on my knuckle joint, that hurts a lot, and when I press on my first finger joint, closest to my hand, that hurts a a lot too.  I can't really isolate it to the bone or the joints.  I've tried carefully working my way down the finger, comparing to other side, but I can't determine any deformities, slipping, looseness, instability, and so on. Just a whole lot of pain when the finger is loaded side to side, and some persistent swelling and pain around the knuckle and first joint.  

It hasn't really gotten better in two weeks, but there are days when it somehow feels better, and other moments, sometimes at night, when, man, it hurts.  

Now, I should say, I could have just smashed my knuckle and finger against the ice at some point--but I haven't really smashed my hands into the ice for 5-8 years, maybe?  Ever since I switchted from straight shaft tools to offset tools.  And I have no joint or finger pain on the other hand.  

I almost feel like I dislocated my finger when I pulled down on the ice tool, and then it moved back into place, but I feel like that would have been a sharp pain.  Tear of a collateral ligament?  Fracture of that first finger bone?  Some kind of damage to the joint capsule/s???

Weird injury.   I guess I should schedule a doctor's visit for an X-ray to rule out a fracture and then...MRI?

I did go climbing today :)  I put on my gloves, buddy taped my fingers, and swung and climbed holding my ice tool with my remaining three fingers.  Ice season only comes once a year!  Not ready to throw in the towel yet.  

Any help appreciated. 

B

ideas????  Bump.

If it's primarily resisted lateral movements that cause pain, it sounds like a joint capsule or collateral ligament injury. Do you feel pain if you squeeze the bone without creating any joint forces? Check the metacarpal too. Pain from bone compression suggests fracture. Point tenderness on a bone surface, likely a muscle or ligament attachment is torn. If the pain comes from pressing into or manipulating the joint, we're back to joint capsule or collateral ligament. If the pain was resisted movement in one direction only, I would think muscle or tendon, but you say both lateral directions.

Has the swelling been getting better? Is it red and warm, or normal color/temp? Does it bother you in daily life, or just if you provoke it? Do you feel like you need to protect it from injuring it further?

Conservative treatment is going to be rest, judicious analgesics and/or ice, possibly splint or buddy tape it for protection.

Hi Kevin, 

Thanks for your response!

Mobility--I can flex and extend my finger, for example, opening and closing my fist, without much problem.  This is somewhat limited by swelling around the base of the finger.  I can move my pinky from side to side, with clear, distinct, movements, in both directions. This would lead me to believe that the muscle and tendon attachment points are at least somewhat intact. 

Resistance/strength--As above, I can resist force in all directions, flexing and extending, and side to side, in both directions. Resisting movement in flexion/extension does cause some pain, maybe, 3-4 on a 1-10 scale.  Resisiting movement side-to-side hurts more, maybe 5-6.  It does hurt on both directions side to side, but I would even say that it hurts more when I press on the outside of my finger and resist that force (in line with a classic "karate chop" motion)  then when I press on the inside of my finger. The pain seems localized to the base of the first bone in pinky and/or the joint between my pinky and my hand. 

Pain-Walking my fingers down my injured pinky, I have basically no pain at all, in the bones, or in the joints, until I reach the first bone in my finger, where it meets the knuckle joint. There is some pain when I press directly on that bone, from top-to-bottom, and side-to-side. If I reach further down, and squeeze on my first knuckle joint, I don't have  much pain.  Where the pain really seems the most is the base of the first finger bone, where it meets the knuckle. That's really painfull, in all directions, from the top, bottom, and both side, although the most pain is probably from the outside, and from the palm side, in both cases, right at the base of the finger bone, where it meets the joint.  

Swelling/color--It is still swollen around the base of the finger, and into my palm. It was a little blue for the first few days, but not anymore. 

Guarding--I definitely feel like I have to guard it.  If I bang it or move it wrong during the day, man, that hurts.  Generally, I've been buddy taping it.  It hurts less in the morning, more by evening, and sometimes at night, it wakes me up with throbbing.  

It's been two weeks, with essentially no change.  

Yes, yes, I know--see a doctor.  I have an appointment this week.  I thought it was something I could manage, but I apear to have been wrong :(

If you have any more ideas, please let me know, otherwise, I'll post back after I see the doctor, so others with similar injuries might benefit. 

B

I’ve taken to calling it “Leashless Finger” for a more legit, clinical sounding name like Tennis Elbow….and to support my disability claim, lol  

My theory is it’s main cause is the bending and pressure the pinkie sees over the bottom edge of the pommel.  

I was just thinking about this last night as I put my daughter to bed, and noticed “Dang - my pinky finger is sure tender”      It’s not from hitting ice like in the old days.   Generally it seems to clear up by each weekend, but after 4 in a row it seems to linger longer.  Gonna experiment with ergo tweaks to the pommel/pinky rest — like a little more rounded edge radius, and maybe softer to better distribute the load and reduce such a consistent smaller pressure point.  

@ Mark--Leashless Finger...that make sense.  That is what I thought it was at first, just pressure from pulling down on the tool, with my pinky bent over the pommel.  The duration/severity of the pain, however, makes me fear Leashless Finger has progressed to Leashless Rupture or Leashless Fracture.  I'm seeing my orthopedist tomorrow, a woman hand specialist, who has operated on this hand/wrist twice before.  I tell her my left hand is her best customer.  

More interesting, as often occurs, this injury lead to some adaptation and some evolution.  I went ice climbing this weekend.  I put on my gloves, and buddy taped the fingers (last two fingers) over the gloves.  Putting the tape over the skin and using a mitten was also an option, but didn't feel as secure.

I also tilted my X-Dream to the Dry position, and installed the large upper trigger finger, so that my remaining three good fingers could get better position and grip.  The bottom two fingers weren't really doing anything, other than causing minor jabs of pain!

It actually wasn't so bad.  Once I adapted my swing, I could use my injured hand somewhat.  I wouldn't want to lead near my limit like that, but it was OK to follow, or climb on top rope, even on quite steep routes.  

Also, swinging from the trigger finger (the only way I could swing with my injured hand) was a bit of an eye opener.  I've always been a "pinky pommel swinger" but I found that I could snap the tool pretty well from the trigger finger, so much so that I started doing with my good hand as well, just for fun.  It works!  For me, it seemed like I had perhaps less power swinging from the trigger finger, but maybe a little more accuracy, and a more circular arc or snap of the tool.  I could actually see incorporating a swing like that into regular climbing, keeping the pinky pommel swing for long reaches and more powerful swings. 

Anyway, as I close in on 50, I'm sure it will just be injury after injury. 

All best, B

OK folks, I went to the doc today, and it turns out...I broke my pinky.  Base fracture of proximal end of fifth finger.  Broke just above the joint, sort of a V shape, all the way through.  The doctor was surprised by the range of motion and stability, considering the break. 

How did this happen?  Well, I though it was from hanging off leashless tools (see above) but now I think it was from a small chunk of ice (a little smaller than a tennis ball?) that bounced sideways and hit my hand as I was belaying.  It was a short, sharp hit, and it hurt, but I didn't think it would break a finger.  The stance was decent, protected from the big stuff, but falling ice can do weird things. 

The take away from me is to be more aware of even the small bits of ice.  Also, even though this wasn't directly relevant to my mechanism of injury, it's cool to adapt to and experiment with a different style of swing, from index finger and not the pinky.  

All the best.

Well there you go! Mystery solved. Is it a Level 1 break that just needs to heal?

Hi Anna, yes, I think it is a level 1 break, maybe somewhat level two?  Can a break be "between" levels.  The doctor described it as "sort of a v shaped break" and also said that it was "outside the joint."  There does not seem to be any displacement or instability. Treatment is just a splint.  That said, I am planning on going ice climbing next weekend...I won't tell the doctor, of course, and then, after that, I have promised myself I will behave.  Climbing with ony three fingers on my left hand is a new challenge.  Why am I still doing things like this at 49 yrs. old???

Ha! Thanks the update. I'm 48 myself.