Finger Fixes

Three common digit injuries and how to treat them

What climbers fear most isn’t heights, falls, or mangled toes—it’s finger injuries. And with good reason: While climbing is a full-body exercise, fingers make the most contact with the rock, thus taking more abuse than other limbs, especially from pockets.

INJURIES

The three finger injuries that climbers frequently experience are an A2 pulley strain or rupture, a flexor tendon tear, or a collateral ligament strain.

A2 Pulley Injury

The most common problem is an injury to an A2 pulley—bands of fibers that hold tendons flush to the bone, located in the meaty area between the base of the finger and the middle knuckle. Such injuries often happen when you’re crimping and a foot slips, putting unexpected force on the hand. Climbers may hear an audible “pop” and feel immediate pain, followed by swelling and possibly bruising later. The pain is usually localized to the base of the finger. An A2 pulley injury is the least serious of these three, as it usually doesn’t affect your strength significantly. It’s not recommended to have surgery even with a full rupture. However, you’ll likely always have to tape the finger after a rupture for support.

Flexor Tendon Tears

These tendons run from the inside of the elbow, down the forearm, and into the fingers, passing beneath the pulleys. They connect muscles and bones, allowing you to bend your hand and flex your fingers. When a tear or stretch occurs, pain is usually felt between the palm and wrist. You might experience an inability to bend one or more joints in a finger, and tenderness or numbness in the finger. If it’s a complete rupture, it likely will not heal without surgery.

Collateral Ligament Strains

The third injury occurs in the collateral ligaments, which surround each finger joint. Trauma here usually happens with sideways loading, such as when you’re gastoning or sidepulling with one hand and throwing up and out to a hold with the other. Pain will be felt at the side of the joint—usually the middle joint of the middle finger. This is another injury that might require surgery if severe enough.

TREATMENT

First, stop climbing immediately. If you can’t see a doctor right away, physical therapist and climber Aimee Roseborrough recommends assessing your hand for the next several days to determine how severe the injury might be. Meanwhile, she recommends combining ice baths (10 minutes, three to five times a day) with active range-of-motion exercises (gentle stretching and flexing) for the affected finger. The first 72 hours are most critical with icing, and you should continue the ice baths as long as there is pain with movement.

If bruising occurs, or if your joint is unstable and moving more than normal, see a doctor. If no bruising occurs, but there’s no improvement after resting and icing for five to seven days, make an appointment. The doctor might perform an MRI or diagnostic ultrasound to identify the problem, and will then make a treatment plan.

Recovery times vary depending on severity, but four to six weeks is a baseline guide for healing. A graduated approach— easy routes, big holds—is the best way to ease back into climbing once the pain is gone.


Comments

I just saw a patient the other day who had been competing internationally and for the last year, according to her doctors--should just give up climbing because even though ruptures healed, there was alot of scar tissue leaving irritation and inflammation. After one session of herbal liniment use and Tui Na massage, there was significant improvement that she could hold without the same pain. I don't bring this up to tell you it will be a miracle instant fix, but I do not see any information here on Chinese Medicine. As a licensed provider, I would suggest herbal liniment, Tui Na, moxabustion, and possibly Acupuncture to heal climbing related injuries. After a year off climbing, my patient had no advice from her doctors and was basically looking at giving up climbing for life. God willing, I am confident she will see improvement. Search for a legitimate provider on the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) website by filling any field: http://mx.nccaom.org/FindAPractitioner/FindaCertifiedPractitioner.aspx

Ali Sherbiny, Dipl.O.M. - 11/28/2014 7:35:08

+1 useless. Any evidence to back up pockets being more dangerous than any other type of hold??

tony danza - 09/22/2014 9:31:59

FYI: I work in a laboratory and we use DMSO. This is one chemical we are advised to double-glove when using...in other words - don't let it touch your skin! Here is a link to the MSDS for DMSO http://www.sciencelab.com/msds.php?msdsId=9927347 Granted, the products you buy will likely be a lesser % of DMSO, but there is definitely potential for side effects.

Jaimie - 08/04/2014 2:09:33

So I had flexor tenosynovitis (or fluid around the a2 pully) about 8 months ago, took phsiyo, been to doctors/ultrasound and I'm still dealing with a lot of problems. I now believe that I have a case where all 3 of the listed problems have happend. Now, this is 8-9 months. There no reason for me to still be injured. Does anyone have any insight? It doesn't hurt to close my hand or pull my fingers straight. But when I accidentally pull sideways I'm usually forced to deal with soreness for a while. What should I do? How can I fix this? Is my next step to go to a specialist who deals with nerves/tendons and hands specifically? Anyone I have been to didn't know angthing,.

Rob Seymour - 07/04/2014 4:52:35

I mostly boulder, nothing above a V3 and train at home lately and I am 63. My finger joints feel fat and I can't make a fist unless I stop for a week or two. I tape my two middle fingers on each hand. Treatment? Long term damage? About DMSO: A chemist told me it is a solvent and a carrier. Whatever is on your skin will be carried into your body. Would you want WD-40 floating around in your system?

Vadim - 02/18/2014 7:21:02

any tips on trigger thumbs from climbing, which is a form of tendinitis

joanne - 02/18/2014 4:48:26

This is a useless article. Check out climbinginjuries.com for better.

Me - 02/16/2014 8:26:08

I've found that DMSO works great for finger injuries.

Jamie - 02/15/2014 6:58:23

Any tips on taping an injured A2? Pain isnt too bad and i'd like to keep climbing regularly.

Brian - 01/30/2014 12:26:57

thanks ! that is helpful

Linda - 11/11/2012 11:33:07

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