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Pulley Injury - Need To Understand MRI Report
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perecrimp


Aug 9, 2010, 4:40 PM
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Pulley Injury - Need To Understand MRI Report
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Hi,

I went to the sport medicine doctor to review the results of a MRI test he added ordered following a injury that felt to involve the A2 pulley of my annular finger. I am not sure the doctor understood what the report was saying to be honest...That`s why he`s referred me to a hand specialist (which will take anywhere from 2 to 4 months).


In the meantime, I was hoping someone could make sense of the following impression by the radiologist who reviewed the MRI. It goes like this:

1. Small focal defect along the ulnar aspect of the A2 pulley of the fourth digit. (1 mm)
2. Periosteal lifting at the volar plate attachment without evidence of volar plate injury. (10 mm)

Hope this is enough. If not I could always type in the full paragraph.

Ultimately I would like to know:

1. Is this MRI conclusive as to what I have
2. If so, is it good or bad news...
3. Can I start climbing on it (easy)

Thank you


onceahardman


Aug 11, 2010, 3:16 PM
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Re: [perecrimp] Pulley Injury - Need To Understand MRI Report [In reply to]
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perecrimp wrote:
Hi,

I went to the sport medicine doctor to review the results of a MRI test he added ordered following a injury that felt to involve the A2 pulley of my annular finger. I am not sure the doctor understood what the report was saying to be honest...That`s why he`s referred me to a hand specialist (which will take anywhere from 2 to 4 months).


In the meantime, I was hoping someone could make sense of the following impression by the radiologist who reviewed the MRI. It goes like this:

1. Small focal defect along the ulnar aspect of the A2 pulley of the fourth digit. (1 mm)
2. Periosteal lifting at the volar plate attachment without evidence of volar plate injury. (10 mm)

Hope this is enough. If not I could always type in the full paragraph.

Ultimately I would like to know:

1. Is this MRI conclusive as to what I have
2. If so, is it good or bad news...
3. Can I start climbing on it (easy)

Thank you

I don't know if you are confused, or if it's a misprint, but you don't have an "annular finger". The "A" in "A2 pulley" stands for annular, though.

In reply to:
1. Small focal defect along the ulnar aspect of the A2 pulley of the fourth digit. (1 mm)

This is a tear of the A2 pulley, toward the ulnar (or pinky) side of the pulley. The tear may or may not be full thickness, as this is not expressly stated.

In reply to:
2. Periosteal lifting at the volar plate attachment without evidence of volar plate injury. (10 mm)

This is damage to a bony attachment of the volar plate, where it attaches to the bone. Purely in terms of size, this is a larger (10 mm vs 1 mm) injury.

http://www.learningradiology.com/...s/volarplatepage.htm

Regarding your questions:

1) MRIs are good, but nothing is ever truly "conclusive" until a surgeon cuts it open and looks at it. Even then, there will be competent experts who disagree.

2) Good or bad news...well, it would be better if you did not have a small focal defect in your A2 pulley, or a periosteal detachment of your volar plate. On the other hand (no pun intended), it's not cancer or a progressive neurological disorder.

3) Whether you climb on it or not is (clearly) up to you. I would rehab it, and be prepared to not climb for 6 months, if this was my injury. On the other hand, I have no doubt that others here (perhaps including myself) have pulled down pretty hard (with pain) despite similar injury.


miklaw


Aug 11, 2010, 3:35 PM
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Re: [perecrimp] Pulley Injury - Need To Understand MRI Report [In reply to]
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as my wife has ruptured (totally, not just torn) A4 pulleys 5 times now, I suggest doing what she did, rest for 2 months and start climbing again. Avoid surgeons, if you are keen read all the finger injury papers by schoffli


onceahardman


Aug 11, 2010, 3:51 PM
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Re: [miklaw] Pulley Injury - Need To Understand MRI Report [In reply to]
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miklaw wrote:
as my wife has ruptured (totally, not just torn) A4 pulleys 5 times now, I suggest doing what she did, rest for 2 months and start climbing again. Avoid surgeons, if you are keen read all the finger injury papers by schoffli

I'm not sure, and I don't necessarily disagree, but I'm wondering why we should follow your wife's course of treatment, when she has ruptured her pulleys 5X?

I'm seriously asking, and not trying to be a wise ass.


miklaw


Aug 11, 2010, 4:02 PM
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Re: [onceahardman] Pulley Injury - Need To Understand MRI Report [In reply to]
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She ruptured them on mostly different fingers (she is way strong, fairly well built, but has little hands and tiny fingers), I think one injury was a repeat.

She showed full 'bow-stringing' where the pulley was totally gone, light taping and rest for about 6 weeks allowed repair, then there was another 6 weeks or so before she could climb without pain.

Diagnosis was always difficult, the general message from the small number of knowledgable health professionals I saw was to avoid surgery (one study I read showed the utcomes for surgery and for doing nothing was about the same)

If you hunt arround there is a lot of info on this climbing injury. If you email me on mlx at ansto.gov.au I could send you some of it.


onceahardman


Aug 11, 2010, 4:12 PM
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Re: [miklaw] Pulley Injury - Need To Understand MRI Report [In reply to]
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Thanks! That makes more sense.

I agree about avoiding surgery, by the way. I have generally seen longer turnarounds for these than 6-12 weeks, but I'm glad your wife has done well.


miklaw


Aug 11, 2010, 4:15 PM
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Re: [onceahardman] Pulley Injury - Need To Understand MRI Report [In reply to]
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She normally took about 12 weeks to start easy climbing, then about the same for full strengthening.


perecrimp


Aug 11, 2010, 6:06 PM
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Re: [onceahardman] Pulley Injury - Need To Understand MRI Report [In reply to]
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In reply to:
3) Whether you climb on it or not is (clearly) up to you. I would rehab it, and be prepared to not climb for 6 months, if this was my injury. On the other hand, I have no doubt that others here (perhaps including myself) have pulled down pretty hard (with pain) despite similar injury.

Well I should probably have mentionned that this injury happened just about six months ago. I will start climbing slowly on it. Thanks for the advice.

Cheers


onceahardman


Aug 13, 2010, 4:00 PM
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Have you been rehabbing it for 6 months, or just resting?

I'm interested in your outcome.


perecrimp


Aug 13, 2010, 5:20 PM
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Following my injury in January, I did some physio for 6 weeks (10 session in total) prior to departing for Kalymnos in hope that things would improve. I did not climb prior to Kalymnos. I also tried to ice my hand as often as possible approx. 3 to 4 times a week. In Kalymnos, it became clear that things were not back to were they were so I belayed my girlfriend for most of the trip. I quit the physio because it was costing me a chunk of change but most noticeably because I did not trust him anymore at that point. From March to May, I rested. In May, I started doing Gripmaster exercises without pain but with a mild discomfort.
Another symptom that still persists to this day is the triggering of the same finger. Its been happening ever since my finger popped while holding a two-finger pocket. This does not seem to be a common cause of trigger finger as I understand this condition is mostly related to overuse over a period of time...I am still trying to understand if its the 1 mm or 10 mm defect that`s causing this or a mix of both...I noticed that when I apply pressure on the 1 mm area (ulnar aspect), the triggering seems to decrease.

As for the icing, I have not been very steady of late though...

On the positive side, I have been jogging/running/ playing soccer three times a week at a good pace which should have helped blood circulation and tissue repair.

Thanks for your interest!

I will definitely let this forum know as things evolve although the access to a hand specialist here in Ontario-Québec can be difficult...

Merci!


Shawn.rodriges


Oct 6, 2010, 4:59 AM
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In the meantime, I was hoping someone could make sense of the following impression by the radiologist who reviewed the MRI. It goes like this:

1. Small focal defect along the ulnar aspect of the A2 pulley of the fourth digit. (1 mm)
2. Periosteal lifting at the volar plate attachment without evidence of volar plate injury. (10 mm)


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livinonasandbar


Oct 6, 2010, 5:45 AM
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Re: [Shawn.rodriges] Pulley Injury - Need To Understand MRI Report [In reply to]
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