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Finger injury...not one that I've heard of before...
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altelis


Mar 9, 2011, 5:16 AM
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Finger injury...not one that I've heard of before...
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Ok, so I have a finger injury that I really can't figure out, and don't think I've seen anything like it on these boards...

I'll start with the summer of '05. This may or not be relevant, I'll let ya'll figure it out. I was leading a course in Alaska, and while backpacking a slip on a talus field led to a subluxed PIP joint in my middle finger. Ever since that joint is about twice as large as one on my right hand, and feels like a boney nodule, not soft. It doesn't cause me pain or limit my ROM. Just large.

I've climbed plenty since then with no problem. After a couple month of hiatus from climbing trying to get through last semester in school, I started up again in the gym a few months ago. I don't remember any particular injury or moment where I felt something happen. But at the end of a day that involved a fair amount of crimping, my DIP joints in my second, third and fourth digits were a little sore.

Well, next day hand felt fine except the middle finger. It actually hurt to flex, primarily in the PIP joint, immediately after getting up. After about 5 minutes of going about my morning, flexing the finger, the pain will be mostly gone, and doesn't come back till the next morning. I'm climbing about twice a week, and the pain comes back pretty much every morning, at about the same intensity, regardless if I climbed that morning or not.

Interestingly, my proximal phalangeal is tender to palpation on the volar side, but not the lateral sides. I can really isolate it to the volar side by putting my hand on a desk and pushing on each side rather than "pinching" the digit. The pain is pretty concentrated over the area immediately distal to the MCP joint. The joint itself is non-tender. The PIP, DIP and 2 distal phalanges are NOT tender to palpation (despite the DIP being the joint that hurts to flex in the mornings).

There is no swelling or bruising anywhere.

Any ideas?!?!


gblauer
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Mar 9, 2011, 5:35 AM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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Arthritis? YOu many want to google "tendon gliding exercises", that's what my hand therapist has me doing 30+ times per day. Is it making a difference with respect to my pain level? No, but, they tell me it helps distribute the synovial fluid (bathe the tendons etc) and that's good for my fingers.


altelis


Mar 9, 2011, 5:39 AM
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Re: [gblauer] Finger injury...not one that I've heard of before... [In reply to]
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gblauer wrote:
Arthritis? YOu many want to google "tendon gliding exercises", that's what my hand therapist has me doing 30+ times per day. Is it making a difference with respect to my pain level? No, but, they tell me it helps distribute the synovial fluid (bathe the tendons etc) and that's good for my fingers.

We just finished our Ortho/MSK module. "Rheumatoid arthritis" floats through my head every morning. Well, ok the phrases "morning stiffness" and "pain improving with activity" are what float through my head, but that just makes me think RA Unsure


gblauer
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Mar 9, 2011, 5:49 AM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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I was thinking osteoarthritis...degenerative wear and tear.


altelis


Mar 9, 2011, 6:12 AM
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Re: [gblauer] Finger injury...not one that I've heard of before... [In reply to]
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gblauer wrote:
I was thinking osteoarthritis...degenerative wear and tear.

I know... I was joking (mostly) about RA. It's not RA, its medschoolitis. Less damage, harder to treat Angelic


gblauer
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Mar 9, 2011, 6:18 AM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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I have an appointment with the rheumatologist today. I have widespread joint pain and I need to figure out what's going on. Feet (toes), fingers, elbows and jaw. It so sucks to grow old...


UPDATE: I do indeed have OA of fingers, feet and now my neck. (who knew? My neck doesn't bother me!!)

Interestingly, the doc told me to keep on doing all that I do. Keep lifting weights, hiking, skiing, climbing, etc. She told me that the more muscle I build around the joints, the more stable my joints will be.

No cures for OA, just pain management.


(This post was edited by gblauer on Mar 9, 2011, 12:19 PM)


rokdoc


Mar 9, 2011, 6:52 AM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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Chill young padawan. Classically, the morning stiffness in RA lasts at least 45 minutes and generally over an hour. Single joint involvement is less common. The fact that you injured this joint before makes OA or ligamentous injury many times more likely—welcome to the club. While you can always find exceptions, common presentations are common.

Some advice. Put your mind at ease: see a doctor, get an exam looking for synovitis, get a one view x-ray of your hand and don’t get any blood work for autoimmune disease unless you are having other symptoms you have not mentioned (you are more likely to get a false positive test than to have RA or lupus or reactive arthritis or you get the point).


spikeddem


Mar 9, 2011, 6:56 AM
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Re: [rokdoc] Finger injury...not one that I've heard of before... [In reply to]
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I've had issues with morning stiffness.


chadnsc


Mar 9, 2011, 8:07 AM
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Re: [spikeddem] Finger injury...not one that I've heard of before... [In reply to]
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spikeddem wrote:
I've had issues with morning stiffness.

No you haven't. You're a flaccid as wet noodle and about as potent.


altelis


Mar 9, 2011, 12:15 PM
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Re: [rokdoc] Finger injury...not one that I've heard of before... [In reply to]
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rokdoc wrote:
Chill young padawan. Classically, the morning stiffness in RA lasts at least 45 minutes and generally over an hour. Single joint involvement is less common. The fact that you injured this joint before makes OA or ligamentous injury many times more likely—welcome to the club. While you can always find exceptions, common presentations are common.

Some advice. Put your mind at ease: see a doctor, get an exam looking for synovitis, get a one view x-ray of your hand and don’t get any blood work for autoimmune disease unless you are having other symptoms you have not mentioned (you are more likely to get a false positive test than to have RA or lupus or reactive arthritis or you get the point).

Like I said above, I don't really have a fear that I have RA, and considering we just yesterday had a lecture pretty much all about how we should never get autoimmune Ab test in healthy pts, I wasn't going to go that route.

The thing that confuses me is just the DIP hurts in the morning, and the volar side of the proximal phalange is tender to palpation throughout the day...distal flexor tendonitis? I most likely will see a doc, but here i really have access to inactive city dwelling school health center providers...not always the most confidence inspiring...


onceahardman


Mar 9, 2011, 3:32 PM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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You can't really sublux a joint without doing at least some damage to the passive restraints (ligaments, capsule) of that joint.

You apparently did some permanent damage.

Probably no big deal, maybe a volar plate injury or something like that. It'll never be perfect, but it will be good enough.

It will help you to discuss issues with your pts. There's a reason for everything.


altelis


Mar 9, 2011, 4:14 PM
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Re: [onceahardman] Finger injury...not one that I've heard of before... [In reply to]
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onceahardman wrote:
It will help you to discuss issues with your pts. There's a reason for everything.

I like it, thanks.

And, yea, I figured it was something like that. In your opinion (without, of course, having seen it, etc) do you think no climbing or easier routes is a better idea? Need to be seen, or wait before going in?


onceahardman


Mar 9, 2011, 4:28 PM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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Based on what you've said, I'd probably tape it and go easy, but I bear no responsibility for what you do.

Good luck, let me know how it goes.


altelis


Mar 9, 2011, 4:29 PM
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onceahardman wrote:
Based on what you've said, I'd probably tape it and go easy, but I bear no responsibility for what you do.

Good luck, let me know how it goes.

But of course! And I have mandatory rest next week- going to SLC for spring break, and only brining the ski gear Cool


altelis


Apr 27, 2011, 6:51 AM
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Re: [altelis] Finger injury...not one that I've heard of before... [In reply to]
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For anybody who may be interested, here's what's happened:

So I taped it, and went easy. Really easy. It was actually really good for my form- just concentrated on movement, footwork, etc.

While it actually felt really good while climbing, it just wasn't getting better, and the pain above my DIP was getting more sharp in the mornings, so I saw a hand-specialist. He actually knew a thing or two about climbing. Not a climber himself, but at least had a working understanding of different forms of climbing, crimping, slopers, etc.

He wasn't sure what was going on, thought it might be a mixture of stuff, so ordered an MRI. Turns out I have a partial tear of the A2 pulley and "an odd looking lesion in the extensor tendon, right over the dorsal aspect of the DIP". He, nor the radiologist at Georgetown who specializes in orthopedic radiology, were really sure what it was, but the anatomy of the lesion matches pretty well with my pain, so we figure the lesion represents whatever is causing me pain.

Gonna go see a PT who specializes in hands, get a splint for 1 wk, then PT & splint for 2, then go back to ortho...


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