I'm 30 and in good health and hoping I'll heal fast enough where I can climb at the level before I got injured. I don't want to be out a year because of a pulley strain.

If I go to a doctor and he recommends an MRI, will the MRI be able show the difference between a tear and a strain?

What were the treatments you ended up following?

Once you are pain free, and not inflamed, you can start very gentle resistive work. You can do this however you want, but if you were my patient, I'd have you proceed in a more controlled fashion than even easy climbing.

Out of curiosity, and in case I ever get another pulley tear...

2 questions:

1 - How do you define the point where you are pain free and the swelling has gone down? In my case, IIRC, I had very little swelling, and the pain was mostly present with climbing or direct pressure.

2 - Until that point, would you recommend trying to brace/immobilize that finger?

Thanks,

GO

Thanks for your reply.

No, not insulting at all. Like you said I simply do not know.

Now if light climbing is not the way to go, why do so many sources I've read say that taking long lay offs from climbing can actually do more harm than good. Reason being, the new tissue is not put under any stress and injuring the new tissue once healed will be even easier?

Thanks for your advice and look forward to your reply.

Good questions.

For really active, acute inflammation, pain at rest is a reliable indicator. Once you reach the subacute phase, pain which occurs at loads below the normal pain threshold would be a good, but less reliable, indicator. If you are generally healthy, and don't continue injuring yourself, this subacute phase should gradually decline over time.

Swelling can be measured with a tape measure, or more accurately, by measuring the volume of water displaced by (say) a finger. Again, this should improve over time.

Bracing or immobilizing can be good for certain injuries. Fractures, severe strains (ligament tears resulting in instability). I don't like immobilizing for pulley injuries UNLESS (a) you work a job where you need to use your hands a lot, and you would otherwise keep injuring it,, so you immoobilize only at work, or (b), you have tried relative rest with AROM, then PROM, and you still have pain at rest, indicating an injury so severe it shouldn't be moved for a while.

That answers question 2 - your answer would be a clear NO, if I understand you correctly (for a partial pulley tear).

For question 1 - Sorry if I wasn't clear with my question. I wasn't asking how you can tell what "phase" of pain\inflammation you're in, or how it is measured, but what exactly you mean when you say "pain free, and not inflamed". That sounds like neither acute nor sub-acute.

I mean, in an absolute sense, it took years before there was zero pain associated with the injury site, and there is still some "swelling" in the sense that the sheath/pulley is much thicker on that finger now (presumably due to scar tissue).

So you must have meant "when pain and swelling have dropped to ____________". I'm asking about how to fill in the blank. Is it when the pain and swelling is sub-acute? If so, then that means pretty much immediately, in my case.

Thanks again,

GO

I really can't speak as to why other sources say anything. I'd like to read one or two of these sources, so I can understand better.

In general though, yes, first scar tissue forms, and then this scar tissue needs to be remodeled into a strong, extensible scar that more closely resembles the original tissue. Otherwise it will be weak.

I am of the opinion that for severe injuries, this tissue remodeling needs to be done in a well-controlled fashion, or else you risk re-injury. Start with gentle manual resistance, progress to putty and resistance bands, and finally, begin some easy climbing on comfy holds.

And, learn to use the open grip. Pulley injuries are more frequent when crimping.

Thank you everyone for your replies and advice, really appreciate it.

The source that first gave me insight is here:
http://onlineclimbingcoach.blogspot.com/...njuries-article.html

This source and another source,
http://www.climbinginjuries.com/page/fingers

Share the same opinion. These links are given so you can read them since you mentioned you were interested in them.

I have adjusted my recovery regimen. It will consist of:

- Pulls ups w/ different grips and push ups
- General exercise
- Plenty of rest
- Sporadic climbing**

**Only climbing I will allow is climbing that allows virtually no stress on my right ringer finger's A4 pulley and will be once a week.

If my doctor thinks otherwise I will take his advice into consideration. It will be tough to not climb but a few months off will be good.

I think you are really looking for a black-and-white answer to kind of a "gray" question.

No, I really am not looking for a black and white answer.

What I'm looking to do is to reconcile this:

"Once you are pain free, and not inflamed.... when the pain and swelling have dropped to the point that you can no longer tell an injury occurred.... you can start very gentle resistive work. "

with this:

"I don't think it's inconsistent with anything I said above. 1-3 weeks of total rest from climbing (or until the acute inflammatory phase is over), Then start rehabbing, including easier climbs with open grip. "

Unless I'm missing something, the first would lead to no resistive training for six months or longer, while the second would wait only a couple of weeks for the same injury. That's a factor of 12 difference.

You yourself seem to recognize the issue, when you say: "When I said they can be 1-6 month injuries, that does not mean no climbing for 6 months. That means you may well have pain for 6 months, or even longer. They can be very stubborn. "

So if it can take 6 months or longer to be pain free from an injury, and you can be climbing long before the end of that time, but you don't recommend even light resistive training until you are fully pain free...

Um... what?

GO

For really active, acute inflammation, pain at rest is a reliable indicator. Once you reach the subacute phase, pain which occurs at loads below the normal pain threshold would be a good, but less reliable, indicator.

When you jump around and ask a different question using quotes further downthread, it's kind of like "moving the goalposts" a bit...but I think I understand what you mean. I also answered it:


Pain at rest is a reliable indicator of acute inflammation. Pain which comes on with very minor forces can still be an indicator of acute inflammation, but is less reliable,

Let's say you sprained your ankle. A bad sprain will be red, puffy, hot, and painful, even at rest, when not bearing any weight at all through it. It might be excruciating to bear weight.

A minor sprain might well be pain free at rest, but still quite painful when bearing weight, and very painful if you loaded the sprained ligament(s).

A sprained pulley would be similar. A complete tear can be quite painful, even at rest, for several days. As it begins to heal, macrophages clean up cellular debris, and lymph carries away inflammatory chemicals, and the pain at rest goes away, but you still have pain with minor loading (either compressive or tensile). And you could be in considerable pain if you specifically load the pulley by crimping.

So, in general, when you have no pain at rest, you can start ROM. Try AROM. If AROM is painful, back off. Try PROM. If that is still painful, Continue resting.

When you have full, pain free AROM, start gentle tensile loading. Be careful you do not do this too aggressively. You do not want to make it worse, and return to an earlier inflammatory stage, characterized by pain at rest, or pain with AROM. It's OK if it hurts a bit with the loading, as long as the pain does not remain worse as a result of that loading.

Continue to prgress the intensity of the loading exercises, as long as you can do so without making it worse. remembering you need rest between sessions.

I hope that's better.

Better? Hell, it's superb! Clarifies the situation, more than I thought possible. Thanks very much, I appreciate it.

Couple of random thoughts, seeing a lot's gone on since I last checked in...

1) Diagnosis. Current literature shows that ultrasound is equally sensitive as MRI for diagnosis of A4 pulley tears. HOWEVER, the caveat here is that if there isn't a pulley tear on ultrasound, the specificity is too low to be able to rule a pulley injury out. And usually the ultrasound won't be able to give any more information.

MRI is better able to rule out a tear as well as rule in or out other possible concomitant injuries as well. There are, of course, some caveats.

It needs to be a 3 tesla MRI. A "normal" MRI doesn't give enough detail for a proper diagnosis. Also, the radiologist really needs to be an orthopedic specialist. This is borne out in the literature, and my own injury is a good example. MRI initially came back clean, but my orthopedist (a hand specialist) had enough suspicion that he had a second read of the films done by a radiologist who specializes in orthopedic imaging. Sure enough, found the tear as well as a strain in the extensor tendon, both missed originally.

There's the "short" answer about imaging.

2) Something to think about with pull-ups: light climbing as a recovery method involves putting as little weight on your finger as possible. Especially in the beginning- slabby climbs, climbs with very positive feet, etc. While you don't think about pull-ups as climbing, they are, in essence, full on climbing. They are fully weight-bearing. They don't have to be full weight on the injured finger, but you'll need to be deliberate on how you hold the bar/hang-board. Don't forget that part...