PIP joint injury (pain on extension???)

A few months back I injured the PIP joint on my middle finger while half-crimping. It was a gradual onset while working a particular move, or at least I don’t think it was a sudden injury and definitely no popping. It became very painful and swollen, but both symptoms gradually eased over the next few days.

I took two weeks off and over the next few weeks I backed off volume and difficulty but the pain and swelling are still present, though very, very mild. Even after a second two-week break I still had some mild pain (to touch). Yesterday I tried crimping a little harder and more significant pain and swelling returned after the session (though not during).

Interestingly, I was able to crank hard finger cracks with the injury with no irritation, which leads me to believe the injury is not a collateral ligament.

The pain is on the top of my knuckle just distal to the joint and it really hurts on resisted extension which I think is bizarre since I injured it half-crimping.

Any ideas what this might be? Has anyone had a similar injury? If so, any good rehab protocols besides rest, massage, range of motion exercises?

I'm in the same boat with you. I just found this today and going to give it a shot.

https://www.reddit.com/r/climbharder/comments/dwdhyg/synovitis_cured/

Hand therapist here.  My first thought is a strain of the lumbrical muscle. My other thought is one of the slips of the FDS tendon. Could also be a strain of the joint or one of the little collateral ligaments. 

Need more info.  Where exactly is the pain during extension?  Do you have full range of motion? 

dino74 wrote:

I'm in the same boat with you. I just found this today and going to give it a shot.

https://www.reddit.com/r/climbharder/comments/dwdhyg/synovitis_cured/

Thanks. I will read up on this.

F Wheeler wrote:

Hand therapist here.  My first thought is a strain of the lumbrical muscle. My other thought is one of the slips of the FDS tendon. Could also be a strain of the joint or one of the little collateral ligaments. 

Need more info.  Where exactly is the pain during extension?  Do you have full range of motion? 

I have full range of motion (full extension and I can touch my palm with my fingertips in flexion) when the swelling subsides. 

Post injury, and after I've climbed since the injury, there's some swelling and it will feel stiff, and I'll have full extension but reduced flexion. 

The pain during resisted extension is directly over the top (dorsal point) of the knuckle (PIP joint) and close to the surface. It is sensitive to palpation at the same spot at all times. I don't have pain on unresisted extension, and minimal pain when crimping (resisted flexion), but I haven't really pushed it hard since the injury. It did hurt while crimping at the time of the initial injury. 

Thank you in advance for your help - I'm in Bend, maybe I should come see you!

I did more research today and have a suspicion that this may be what's going on: Extensor Hood Syndrome—Osteophytic Irritation of Digital Extensor Tendons in Rock Climbers

Josh Janes wrote:

I have full range of motion (full extension and I can touch my palm with my fingertips in flexion) when the swelling subsides. 

Post injury, and after I've climbed since the injury, there's some swelling and it will feel stiff, and I'll have full extension but reduced flexion. 

The pain during resisted extension is directly over the top (dorsal point) of the knuckle (PIP joint) and close to the surface. It is sensitive to palpation at the same spot at all times. I don't have pain on unresisted extension, and minimal pain when crimping (resisted flexion), but I haven't really pushed it hard since the injury. It did hurt while crimping at the time of the initial injury. 

Thank you in advance for your help - I'm in Bend, maybe I should come see you!

I did more research today and have a suspicion that this may be what's going on: Extensor Hood Syndrome—Osteophytic Irritation of Digital Extensor Tendons in Rock Climbers

Very interesting article!  It could definitely be that.  People have different natural end ranges in their joints and crimping stresses the end range in more than one direction.  

I’m on the post-surgery OT side of the house so I don’t get too many chances to see non-machinery or knife injuries.  You wouldn’t believe how many people slice their flexor tendons while carving pumpkins though.  Pumpkin slime + kitchen knife = grip slide.  Separating frozen burger patties is also a surprising common one.

You sound pretty well versed so I’m sure you already know this, but an x-ray can show joint changes, and any hand doc worth their salt should order one.  Also, if you do decide to see a doc, make sure it’s a hand doc.  Anyone else is just going to tell you it isn’t broken and to rest it.

There may something helpful here 

https://www.camp4humanperformance.com/blog-2/pip-joint