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yet another finger problem I haven't seen described
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procyonlotor


May 13, 2011, 5:28 PM
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yet another finger problem I haven't seen described
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I've got a PIP joint on my ring finger that is not swollen, but stiff and tender to pressure on the palm side of the joint, from the joint to about a third of the way down the middle phalanx. I hurt it bouldering a couple of months ago. It wasn't a sudden injury... it came up overnight.
The finger is basically full strength, so I have been climbing fine, mostly sticking to more moderate routes and both x and buddy taping it in an attempt to get it better (it hasn't really gotten worse or better). I stretch it regularly, massage it crosswise, and regularly move it through its range of motion during the day. This type of injury is getting annoying, given that I got the same thing in a different finger last summer and it lasted 6 months until ice climbing cured me (less finger intensive).

Anyone else had this or know what's going on in there? Summer break's about to start, so this is not an ideal time to stop climbing for a month and then ease back in, but I don't want to turn this into something permanent. (And even if I fix it, I'm worried I'll get another one like it.)

Any feedback on what it is or how to handle it would be great! Thanks!


altelis


May 14, 2011, 4:46 AM
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Re: [procyonlotor] yet another finger problem I haven't seen described [In reply to]
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You seem to be describing a pretty textbook case of a partial A2 pulley tear. If you are really worried about it, go to an orthopedist- they are pretty straight-forward to diagnose with ultrasound, and many offices can do the ultrasound there.

That said, treatment for a pulley tear is pretty straight-forward as well: rest for a month, then ease back in SLOWLY, taping over the pulley as tightly as possible without restricting ROM of the joint or causing numbness/tingling of the finger. That month of rest is REST- don't climb, don't carry bags with that hand, etc. Really and truly use it as little as possible.


procyonlotor


May 14, 2011, 9:38 AM
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Thanks for the thoughts! If it has the symptoms of a partial pulley tear, it seems like it would probably have to be the C2 pullley... that's where the pain is located. I've just never heard of anyone talking about c2 pulley injuries occurring, and now I would have gotten 2 different ones in the last year including this one. Could it actually be that?

I'm probably going to just face it and take a month or so off and then ease back in with taping.

Aside from warming up well (which can sometimes be hard in areas outside) and avoiding the crimp, is there anything else that can be done to help prevent this thing from happening again right away?


altelis


May 14, 2011, 9:49 AM
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Sorry, I just read "down" and was thinking proximal to the PIP, and just didn't register the fact that its the middle phalanx. Yea, then it would seem its an A4 (aka C2) pulley.

Certainly more rare than A2 pulley tears, but I have definitely had partners/friend's of partners who have torn the A4 pulley.

Coming from a friend who has torn multiple pulleys, and now has way too much experience with what works to treat them, totally not climbing for ~1 month is necessary. But that you shouldn't expect it to feel "healed" when you come back to climbing. You need another ~month of climbing to get back to feeling right. And the first 2 wks should be VERY light, tape well, warm up slowly, and pretty much only "warm up". If you were climbing V7 before, start out by warming up on V0-V1 for 30-40 minutes, then stay under V4 the rest of the session, avoiding very overhanging problems, no crimps. Avoid full body weight on that hand for a good week or two as well...

Aside from really not over crimping, warming up well, and really concentrating on form to reduce force on your hands, not much that I know of as far as prevention...


cacalderon


May 14, 2011, 11:40 AM
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Re: [procyonlotor] yet another finger problem I haven't seen described [In reply to]
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agree with above post, might be a tear of the pulley.

time off.. lots of time to heal. take care.


onceahardman


May 14, 2011, 4:24 PM
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Re: [altelis] yet another finger problem I haven't seen described [In reply to]
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altelis wrote:
Sorry, I just read "down" and was thinking proximal to the PIP, and just didn't register the fact that its the middle phalanx. Yea, then it would seem its an A4 (aka C2) pulley.

Certainly more rare than A2 pulley tears, but I have definitely had partners/friend's of partners who have torn the A4 pulley.

Coming from a friend who has torn multiple pulleys, and now has way too much experience with what works to treat them, totally not climbing for ~1 month is necessary. But that you shouldn't expect it to feel "healed" when you come back to climbing. You need another ~month of climbing to get back to feeling right. And the first 2 wks should be VERY light, tape well, warm up slowly, and pretty much only "warm up". If you were climbing V7 before, start out by warming up on V0-V1 for 30-40 minutes, then stay under V4 the rest of the session, avoiding very overhanging problems, no crimps. Avoid full body weight on that hand for a good week or two as well...

Aside from really not over crimping, warming up well, and really concentrating on form to reduce force on your hands, not much that I know of as far as prevention...

To be precise, an A4 pulley is not "aka" a C2 pulley. They do occupy a similar anatomic position, and perform similar functions, though. "A" pulleys are annular pulleys, and "C" pulleys are cruciate, or crossed pulleys. Here is a drawing to clarify:

http://www.wheelessonline.com/image2/phl3.jpg


altelis


May 14, 2011, 4:28 PM
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Re: [onceahardman] yet another finger problem I haven't seen described [In reply to]
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Cheers! I feel like I'm back in college learning about how all the stuff I learned in HS is actually way more nuanced than originally learned! Everyday is pretty much- "you learned x but in reality it's a, b, and c"


enigma


May 15, 2011, 12:35 AM
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Re: [altelis] yet another finger problem I haven't seen described [In reply to]
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altelis wrote:
Cheers! I feel like I'm back in college learning about how all the stuff I learned in HS is actually way more nuanced than originally learned! Everyday is pretty much- "you learned x but in reality it's a, b, and c"

Pure Genius !


onceahardman


May 15, 2011, 5:55 AM
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Re: [altelis] yet another finger problem I haven't seen described [In reply to]
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altelis wrote:
Cheers! I feel like I'm back in college learning about how all the stuff I learned in HS is actually way more nuanced than originally learned! Everyday is pretty much- "you learned x but in reality it's a, b, and c"

Yeah...anatomy is pretty logical. The presence of a longus implies the presence of a brevis, the presence of a profundus implies the presence of a superficialis, etc.

Back in school, when we took gross anatomy, some of the TAs were senior PT students, some OTs, some exercise science, and some med students. THe med students had actiually taken a different course from all the others, one specifically designed for med school. The med students seemed surprised that anatomy for PTs was actually more in-depth for musculoskeletal systems than anatomy for med students.

Of course, the meds got more visceral, and somewhat more vascular than the PTs. Similar amounts of neuro, though.


PS...back to the OP, sounds like a pulley injury, AROM, and time.


(This post was edited by onceahardman on May 15, 2011, 6:07 AM)


altelis


May 15, 2011, 5:57 AM
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onceahardman wrote:
altelis wrote:
Cheers! I feel like I'm back in college learning about how all the stuff I learned in HS is actually way more nuanced than originally learned! Everyday is pretty much- "you learned x but in reality it's a, b, and c"

Yeah...anatomy is pretty logical. The presence of a longus implies the presence of a brevis, the presence of a profundus implies the presence of a superficialis, etc.

Back in school, when we took gross anatomy, some of the TAs were senior PT students, some OTs, some exercise science, and some med students. THe med students had actiually taken a different course from all the others, one specifically designed for med school. The med students seemed surprised that anatomy for PTs was actually more in-depth for musculoskeletal systems than anatomy for med students.

Of course, the meds got more visceral, and somewhat more vascular than the PTs. Similar amounts of neuro, though.

I'm worried that that was surprising!


onceahardman


May 15, 2011, 5:49 PM
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Re: [enigma] yet another finger problem I haven't seen described [In reply to]
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So, you get banned from the injury forum for 2 weeks, and your first post upon returning is an insult.

Are you capable of being constructive?

If you can't play nicely, then go to campground.


enigma


May 15, 2011, 9:40 PM
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enigma wrote:
altelis wrote:
Cheers! I feel like I'm back in college learning about how all the stuff I learned in HS is actually way more nuanced than originally learned! Everyday is pretty much- "you learned x but in reality it's a, b, and c"

Pure Genius !

(compliment) doctor onceahardman.


onceahardman


May 16, 2011, 4:09 AM
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I'm not sure why you think that is a compliment. I have always been clear and open that I have chosen a career as an orthopedic physical therapist.

Yet in our last exchange, you kept carrying on about how you think I'm not really a doctor, or that I shouldn't be practicing. Like I said, this forum is for inquiring about, and helping injuries. If you want to argue, there are plenty of threads in campground for that.


enigma


May 16, 2011, 5:01 AM
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onceahardman wrote:
I'm not sure why you think that is a compliment. I have always been clear and open that I have chosen a career as an orthopedic physical therapist.

Yet in our last exchange, you kept carrying on about how you think I'm not really a doctor, or that I shouldn't be practicing. Like I said, this forum is for inquiring about, and helping injuries. If you want to argue, there are plenty of threads in campground for that.


------------------------------------------------------------

1.Oh. I, along with some others on the forum had thought you were a doctor, not a physical therapist.


2.Some of your advice is incorrect, for instance someone who has surgery for a collarbone,
(according to medical research as well as friends it generally takes alot longer than 4 weeks to recover and climb again.)- Obviously dependent upon the severity of their injury.
3. ( friends of mine who have sustained that particular injury it is more like 6-9 months.)
4. I'm sure that you don't want anyone to start
climbing too soon and become re-injured. Do you?
5. Its prudent to suggest they check with their own doctor!

''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Obviously the topic is now on a finger injury.

I'm sure the OP wants to get as much feedback that will be helpful for their particular injury.
You may be correct.( I am not a doctor either.)


onceahardman


May 16, 2011, 2:08 PM
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enigma wrote:
onceahardman wrote:
I'm not sure why you think that is a compliment. I have always been clear and open that I have chosen a career as an orthopedic physical therapist.

Yet in our last exchange, you kept carrying on about how you think I'm not really a doctor, or that I shouldn't be practicing. Like I said, this forum is for inquiring about, and helping injuries. If you want to argue, there are plenty of threads in campground for that.


------------------------------------------------------------

1.Oh. I, along with some others on the forum had thought you were a doctor, not a physical therapist.


2.Some of your advice is incorrect, for instance someone who has surgery for a collarbone,
(according to medical research as well as friends it generally takes alot longer than 4 weeks to recover and climb again.)- Obviously dependent upon the severity of their injury.
3. ( friends of mine who have sustained that particular injury it is more like 6-9 months.)
4. I'm sure that you don't want anyone to start
climbing too soon and become re-injured. Do you?
5. Its prudent to suggest they check with their own doctor!

''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Obviously the topic is now on a finger injury.

I'm sure the OP wants to get as much feedback that will be helpful for their particular injury.
You may be correct.( I am not a doctor either.)

As far as I know, you are the only one who thought I'm a doctor, and I have never made such a claim. In fact, you insisted (more than once) that I called myself a doctor, despite the lack of evidence for such a claim.

I will address the clavicular ORIF issues you have raised in the appropriate thread, because they are off-topic here.


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