I've already got that book. Having previously read the section on pulley injuries, I had a good idea of what happened as soon as it happened. I've also read Macleod's postings on the topic. At this point, I'm resting and moving forward with the idea that a pulley injury is the problem.

What I'm having some difficulty with is in determining the severity of the rupture. With your most recent pulley injury, you mentioned that bowstringing was visible. How obvious was it? Did you have to go into flexion against resistance to see it or could you see it simply by flexing your finger? I'd rather not put my finger into flexion against resistance at this point since the injury is only a few days old. However, aside from some minor swelling above the the PIP joint I don't see much difference from my other fingers when in the flexed position.

Thanks for the reply.

-Jon

After seeing a knowledgable doc today and armed with my own research it looks like it's my A4 (and not A3) on my left ring finger. He saw no bowstringing during resisted flexion. No suspected A2 and/or A3 involvement. It's either a full or partial tear. Imaging would be the only way to know for sure. However, imaging doesn't change the recovery protocol. Looks like it's time for some house projects.

Good luck. I know how it goes. You'll be back.

One other thing - since you mentioned house projects. I'd suggest using some kind of splint that supports/protects those pulleys whenever you're doing anything that could either stress or impact them, like swinging a hammer or picking up a heavy object. Lemme know if you want, and I can send you pics of what I fashioned. Although I'm sure you could buy a much fancier version.

Cheers,

GO

Out of curiosity, do you know what you did that caused the injury?

GO

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.