So you’re feeling strong. You’re trying a lot harder routes than usual. You throw for that hold feeling confident. Crank down on it hard and then… SNAP!
Something bad just happened but you don’t know what. You start to feel the pain with certain angles of pressure on your finger.
What did you injure? What caused it? Should you keep climbing? What can be done to help prevent it in the future? So many questions! Yet all you’re really thinking about is, “How am i going to send this route?”
Finger injuries, unless properly addressed, are hard to resolve
It’s so common to find people climbing regardless of finger injuries. “Maybe if I ignore it, it will go away?” Finger injuries, unless properly addressed, are hard to resolve. Have you experienced the same finger getting hurt again and again? Continue to ignore it and something worse may eventually happen. This post will talks about the ways to diagnose your finger injury and explore common finger injuries that are out there.
There will be future posts to go in depth with each injury. For now, just the big picture.
Common Methods to Diagnose Finger Injuries
Radiographs: An X-ray will be able to rule out fractures or osseous tears of the fibrocartilago palmaris. Chronic overuse, atraumatic epiphyseal fracture of an adolescent rock climbers can also be ruled out. You don’t want to mess around with fractures. Make sure you get that cleared.
MRI: Magnetic Resonance Imaging. Giant magnetic currents run through your body giving very detailed images. This is the Gold Standard to diagnosing finger injuries PROS: Accurate, high resolution image CONS: Expensive. Time consuming. Unless there is severe loss of function in your finger, MRI is not very practical.
Diagnostic Ultrasound Imaging: This uses high frequency sound waves producing an image where trained clinicians are able to see inside your body PROS: Less expensive. For diagnosing pulley injuries, Sensitivity 98%, Specificity 100%. This means 98 out of 100 times you will be able to correctly rule OUT an A2 pulley injury. And 100 out of 100 times you will be able to correctly rule IN that same diagnosis. Pretty darn accurate. CONS: It’s still costly and time consuming. At the end of the day, you gain some medical knowledge but no practical advice. You’re still itching to climb.
Clinical Diagnosis — Your physical therapist or occupational therapist can rule in/out certain injuries. They’ll pull on your finger, bend it one way or another and will ask you to resist in certain angles. Highly trained PTs or OTs are able to diagnose your condition at a fairly accurate rate. PROS: Cost effective. Get your finger diagnosed, learn how to rehab it and most importantly learn how to climb safely! It is all about education and injury prevention. CONS: There may still be an underlying issue that your therapist could have missed. If treatment is not helping after 4–6 weeks, I would voice your concerns and they may refer you to a specialist.
Common Types of Finger Injuries
1. Flexor tendon pulley injury, commonly A2 pulley
This is said to be the most common climbing injury. It typically occurs with persistent closed hand crimping.
The proximal interphalangeal joint is flexed past 90 degrees, the distal interphalangeal joint is hyperextended and this places 3–4 times more stress on the A2 pulley than at the fingertip. The A2 pulley cannot bear the stress and you may hear and feel a pop. There will be tenderness to the base of yor finger and possible swelling. Good news is that even a full rupture of a single pulley is generally managed non surgically.
2. Tenosynovitis, Irritated Tendon, Tendinopathy
This is the second most common injury. You may end up feeling an ache to your entire finger down to your forearm. It will be broad across multiple joints and possibly even down to your elbow. This normally occurs when someone is climbing for the first time and does not give enough rest in between days of climbing. They continue to climb hard on a daily basis and the tendon does not have ample time to recover. While your muscles are able to have increased muscle output quickly, tendons and ligaments take more time to adapt and tolerate the stress applied to them.
3. FDP tendon & FDS tendon Strain
Straining your FDP (Flexor Digitorum Profundus) or FDS (Flexor Digitorum Superficialis) will result in significant weakness in isolated finger strength. Depending on which tendon is injured, you will have pain and weakness with different angles of resistance. You may also feel pain down by your elbow because your FDP and FDS travel and connect to the inside of your elbow.
4. Lumbrical Strain
The lumbrical is a unique muscle group that does not attach to bone. It originates from the Flexor Digitorum Profundus and attaches to the extensor expansion. Basically this muscle allows you to bend at your knuckles while keeping your fingers straight (see picture above). With one or two finger pocket holds, the FDP cause the lumbricals to be positioned in a certain way that could strain those muscles. You will feel pain when palpating the palm of your hand. It may even hurt to fully flex your fingers while extending your MCP joint.
5. PIP Synovitis
Joint inflammation is also very common in climbing. You want to start climbing routes that are above what your body can tolerate and the joints get irritated. Muscles have a high source of blood flow and therefore are able to recover and get stronger in a shorter period of time. Tendons, ligaments, and joint capsules are a different story. There is a lot less blood flow to these tissues and they need time to catch up to how strong your muscles become. Climbing strong every single time will not allow those connective tissues to recover fast enough. They break down and send a warning sign to your brain to pace yourself. Or else more damage will follow. Listen to your pain. Pace yourself and let your tissues catch up to you.
6. Flexor tendon sheath ganglion cyst
Occasionally there may come a time when the tendon sheath or a joint capsule becomes irritated to the point of leaking. The synovial fluid leaks into the surround tissue and forms a fluid filled sack. Most of the time this will resolve on its own, give it 6–10 years. Or a physician can drain the cyst with a needle. Unless the sack begins to push on a nerve and causes pain, it is harmless. But if you are concerned go see your medical practitioner. Back in the day this was also known as a bible bump because people would use a big bible or a book of similar mass and whack the cyst in order to rupture it and reduce the bump. Not a good idea.
All content within this column is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. Lee Physical Therapy is not responsible or liable for any diagnosis made by a user based on the content of this site.