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can't extend finger (not mallet finger, different knuckle)
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bertrand


Oct 14, 2008, 11:48 AM
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can't extend finger (not mallet finger, different knuckle)
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I was hoping somebody could help me categorize this injury:

**The pain started 4 days ago after topping out on a 13 pitch mid-grade climb..and it was COLD, we expected 80 degree weather, but it snowed on us and I was constantly blowing on my hands to keep from going numb. **The pain is at the middle (proximal knuckle) and ONLY when I extend my finger, not flex.

Any idea? flexor and pulley injuries hurt only when you curl your finger, not extend, right? Many thanks to anybody who can comment.


onceahardman


Oct 14, 2008, 12:03 PM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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bertrand wrote:
I was hoping somebody could help me categorize this injury:

**The pain started 4 days ago after topping out on a 13 pitch mid-grade climb..and it was COLD, we expected 80 degree weather, but it snowed on us and I was constantly blowing on my hands to keep from going numb. **The pain is at the middle (proximal knuckle) and ONLY when I extend my finger, not flex.

Any idea? flexor and pulley injuries hurt only when you curl your finger, not extend, right? Many thanks to anybody who can comment.

Hmmm...can you passively extend the PIP (proximal interphalangeal joint) using the other hand? Or is it "stuck"? Or just limited by pain?

If you can extend passively, is there a difference in the pain when trying to extend actively, vs. passively?


bertrand


Oct 15, 2008, 12:31 AM
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Re: [onceahardman] can't extend finger (not mallet finger, different knuckle) [In reply to]
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good question...I can extend it without help from the other hand, but it hurts when I do it. when I extend it with the other hand, it hurts less. thanks.


onceahardman


Oct 15, 2008, 11:15 AM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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bertrand wrote:
good question...I can extend it without help from the other hand, but it hurts when I do it. when I extend it with the other hand, it hurts less. thanks.

OK, good. That rules out lots of stuff. Can't be a full tear of the extensor tendon, or you could not actively extend. Also rules out a major internal derangement of the joint.

Could still be tendinitis or a minor injury to the extensor, since it is more painful to actively extend, could also be a capsule injury, or an injury to the joint surface. (you get compression on the joint surfaces when you contract a muscle which crosses that joint.)

What happens when you do repeated active extension?

-Sit at rest. Is there any pain? How much?

-Do 20 reps of active finger extension This will hurt, as you've told me. When you finish, sit in the same resting position. Does the finger NOW remain worse? Or is it still the same as it was before? Or is it better?

If worse, stop. If the same, try another 20. If better, do 100 reps.

Let me know what happens.


bertrand


Oct 16, 2008, 12:54 PM
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Re: [onceahardman] can't extend finger (not mallet finger, different knuckle) [In reply to]
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ohm, you are great...thanks for taking the interest.

so yesterday I took off the tape brace I had made, and I resumed doing most things pretty normal.

When I do the extension exercise, it hurts increasingly with each rep...but only during the motion. When I stop, everything is fine. I can start another set in a couple minutes with no worse pain than the first set.

sound like tendonitis? is that something for which I have to take a break from climbing, lest suffer chronic probs? my climbing calendar is pretty full this season. THANKS AGAIN


onceahardman


Oct 16, 2008, 4:14 PM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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Too soon for a reliable assessment of tendinitis, but it's still in play.

No pain at rest, only with motion, tends to rule out inflammatory conditions, and rule in mechanical conditions. ie tends to rule out acute tendinitis, but maybe rule in an internal derangement of the joint, or a mild strain of the tendon.

This is middle finger (3rd digit), right? Try this:

Grasp the middle phalanx (between PIP and DIP) of the offending finger, using the opposite hand. Apply an axial force, that is, try to compress the PIP a tiny bit using the middle phalanx. While maintaining this pressure, fully extend the joint into the offending motion of full extension.

-It that worse than normal extension (whether passive or active?)

-Any crepitus (joint sounds, cracking, popping?)

IF (and only if) you have no pain (or greatly reduced pain) when performing this technique, repeat it about 5 times. If it's painful, don't repeat it.

Let me know.


bertrand


Oct 16, 2008, 6:51 PM
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onceahardman wrote:
Apply an axial force, that is, try to compress the PIP a tiny bit using the middle phalanx.

I didn't quite understand this. what I did was pinch the offending finger (its my index finger) between the PIP and DIP, and apply pressure toward the joint as I extended and flexed. no discernable pain.

...your patience w/ me is astonishing...THANKS AGAIN.


bertrand


Oct 16, 2008, 6:56 PM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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oh ya, and no popping noises or anything like that either... it's all just mildy irritating w/ motion. Hopefully that means its totally minor...I'm probably overly concerned, but it is my finger...and I am a climber,,etc. better safe than sorry.


onceahardman


Oct 16, 2008, 7:22 PM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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OK, good. It sounds like you did the technique correctly.

I'm unsure of something. First you said there was no discernable pain, but then said, "mildly irritating with motion".

If there is NO pain durng the compression technique, then repeat that 5-10 times daily. Don't overdo it.

Is it your sense that the finger is improving since the injury?

I don't think you have anything to worry about. I suspect a mild injury to the capsule (synovium) or a minor internal derangement of the joint, like a bit of damage to the articular cartilage. In general, keep the joint moving, lots of AROM, but take a brief break from climbing, especially fingery stuff. Tape might be helpful when you return.

An axial force, is a compressive force through the long axis of a bone or series of bones. Pushing down on the head is an axial force applied to the spine. Discs are especially strong in resisting axial loading.


jakedatc


Oct 16, 2008, 7:33 PM
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Re: [bertrand] can't extend finger (not mallet finger, different knuckle) [In reply to]
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axial force is pushing straight in on the tip of your finger. like if you were to point at a wall then walk straight into it with your finger.

holy crap Hardman.. .this is a normal guy not anatomy class :)

this might help PIP is Proximal interphalangeal..aka 2nd knuckle in, DIP is distal aka furthest out knuckle.



onceahardman


Oct 16, 2008, 8:21 PM
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Thanks jake.

I think he did OK thoughCrazy...

but I could be wrong, my wife says I often am.Sly


jakedatc


Oct 16, 2008, 8:33 PM
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I'm just sayin... if you're going to try to explain special tests over the internet using less medically specific terms... especially not abbreviations might be a bit easier to understand :)

in my medical opinion.. he wont die :)


bertrand


Oct 16, 2008, 9:02 PM
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Re: [jakedatc] can't extend finger (not mallet finger, different knuckle) [In reply to]
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Thanks again gentlemen, I appreciate the specificity in your comments...remarkable for an open blog site.

The finger has been getting gradually better with increased use. (maybe it was a mistake to tape splint it the first couple days)...still doesn't feel quite 100% so I'll practice aiding and jugging this weekend. That's instead of my original plans for Serenity Crack!

Now I know who to PM for hand/finger issues!


onceahardman


Oct 17, 2008, 7:48 AM
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Re: [jakedatc] can't extend finger (not mallet finger, different knuckle) [In reply to]
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jakedatc wrote:
I'm just sayin... if you're going to try to explain special tests over the internet using less medically specific terms... especially not abbreviations might be a bit easier to understand :)

in my medical opinion.. he wont die :)

Jake, I slept on it, just so I wouldn't react in a hostile manner.

The OP clearly understood proximal/distal/PIP/DIP.

His only confusion was axial force, nonetheless, his description indicates he did the technique correctly.

I try to be helpful here. If you have seen my posts, I think you'd agree that I generally have been successful.

If you see specific confusion, by all means, help out. In my opinion, while I recognize your criticism, I don't think it was warranted. A simple compression test is not a "special test" like a ligamentous stress test would be. The OP has almost certainly put more dangerous forces on his finger in the last few days just living a normal life.

I try to pick my shots here, patiently explaining things to people who seem smart enough, and interested enough, to really try to understand what is going on.

Thanks for your concern.


clumbsyclimber


Jul 25, 2011, 7:53 AM
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Re: [onceahardman] can't extend finger (not mallet finger, different knuckle) [In reply to]
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Thanks for the advice/comments, I seem to have nearly the exact same problem. However, it happened when I was repelling and in short got the rope wrapped around my hand and I heard a pop. It didn't feel like a break (I've broken the pinky before) but I could tell something wasn't right. You think its a ligament issue?


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