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Another play doctor and guess my injury thread
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FFSchooley


Mar 4, 2013, 8:28 PM
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Another play doctor and guess my injury thread
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I know many will say go to the doctor but I don't have any near by with climbing injury experience, so I am looking for some online diagnostic help Smile

Pain only when I press against the bone on the bottom of ring finger where it meets my hand (where my wedding ring sits, which i take off when climbing) No pain on the top or sides, and only some initial pain when grabbing a jug or other hold that presses that area, and only when warming up. Other than that, no pain any other time. Full range of movement and full strength. Any ideas what it could be? Plan on resting for a week and then re-evaluating...

Any ideas?


crackmeup


Mar 4, 2013, 9:18 PM
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Re: [FFSchooley] Another play doctor and guess my injury thread [In reply to]
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A1 pulley strain?

http://www.climbinginjuries.com/...-strain-the-classic/

Source: I have no idea what I'm talking about. My father was a psychiatrist, my mother is an endocrinologist. I am not a doctor, but this is the internet.

Treatment: chew off the affected finger. Shake hands with Tommy Caldwell and take a picture.


FFSchooley


Mar 4, 2013, 9:48 PM
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Re: [crackmeup] Another play doctor and guess my injury thread [In reply to]
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Thanks for the info. With that link I narrowed the pain down to the location of the A2 pulley. So the described pain is when pressing the a2 pulley against the bone with moderate pressure.


camhead


Mar 5, 2013, 5:36 AM
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Re: [FFSchooley] Another play doctor and guess my injury thread [In reply to]
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FFSchooley wrote:
Thanks for the info. With that link I narrowed the pain down to the location of the A2 pulley. So the described pain is when pressing the a2 pulley against the bone with moderate pressure.

More importantly, you probably do not need to see a doctor. Take two weeks off of climbing, ice it, and see how it improves. And don't injure it again, which is a whole 'nother complex topic.


Partner cracklover


Mar 5, 2013, 7:36 AM
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Re: [camhead] Another play doctor and guess my injury thread [In reply to]
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camhead wrote:
FFSchooley wrote:
Thanks for the info. With that link I narrowed the pain down to the location of the A2 pulley. So the described pain is when pressing the a2 pulley against the bone with moderate pressure.

More importantly, you probably do not need to see a doctor. Take two weeks off of climbing, ice it, and see how it improves. And don't injure it again, which is a whole 'nother complex topic.

A mild pulley injury is a good possibility, but from the way you describe it, a ganglion cyst in some ways fits better.

Feel around there with your other hand. Can you find a little bump, like a half a grain of rice? If so, it's a ganglion cyst. Far less serious than a pulley strain.

GO


lena_chita
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Mar 5, 2013, 8:01 AM
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Re: [cracklover] Another play doctor and guess my injury thread [In reply to]
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cracklover wrote:
camhead wrote:
FFSchooley wrote:
Thanks for the info. With that link I narrowed the pain down to the location of the A2 pulley. So the described pain is when pressing the a2 pulley against the bone with moderate pressure.

More importantly, you probably do not need to see a doctor. Take two weeks off of climbing, ice it, and see how it improves. And don't injure it again, which is a whole 'nother complex topic.

A mild pulley injury is a good possibility, but from the way you describe it, a ganglion cyst in some ways fits better.

Feel around there with your other hand. Can you find a little bump, like a half a grain of rice? If so, it's a ganglion cyst. Far less serious than a pulley strain.

GO

Cyst was my guess, too.

What makes me think of a cyst is the way you say that the pain actually lessens after you climb a bit. That's exactly how it felt. pain only when pressing on that spot, and gets better after climbing.

Mine was more like a little pea, felt like a bump on the bone, but if you tried, you could move it around a bit, and it got smaller after I climbed.


altelis


Mar 5, 2013, 12:29 PM
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Re: [cracklover] Another play doctor and guess my injury thread [In reply to]
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cracklover wrote:
camhead wrote:
FFSchooley wrote:
Thanks for the info. With that link I narrowed the pain down to the location of the A2 pulley. So the described pain is when pressing the a2 pulley against the bone with moderate pressure.

More importantly, you probably do not need to see a doctor. Take two weeks off of climbing, ice it, and see how it improves. And don't injure it again, which is a whole 'nother complex topic.

A mild pulley injury is a good possibility, but from the way you describe it, a ganglion cyst in some ways fits better.

Feel around there with your other hand. Can you find a little bump, like a half a grain of rice? If so, it's a ganglion cyst. Far less serious than a pulley strain.

GO

An injured pulley, esp A1 or A2, can feel like a half grain of rice upon palpation...

I agree that its most likely a ganglion cyst, esp given it hurts mainly with jugs and the pain gets better with climbing. I just wanted to point out that an injured pulley can feel like "a little bump" too...


onceahardman


Mar 5, 2013, 3:03 PM
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Re: [FFSchooley] Another play doctor and guess my injury thread [In reply to]
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Palpation is generally an unreliable method of achieving an accurate diagnosis. It has very poor inter-tester reliability. It can assist, however, when it is "clustered" with other tests.

A strained pulley would tend to be painful with crimping, especialy a really tight, end range crimp.

This is a type of "selective tissue tension testing", which is more reliable than palpation.

Visible bowstringing has mixed reviews.

Even better is MRI, or certain diagnostic ultrasounds.

Best diagnosis ultimately is, cut it open and look at it! (Not yourself, have a hand surgeon do it).

Treatment-wise, keep it moving, as long as movement does not worsen the symptoms. Understand what that means.


FFSchooley


Mar 5, 2013, 3:27 PM
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Re: [onceahardman] Another play doctor and guess my injury thread [In reply to]
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Well I can't feel any sort of bumps or grains. I can full crimp with no pain. I noticed the same pain in the same spot on my other finger after climbing yesterday, but it went away until i noticed it when using large pruning shears to cut big branches in my yard. The pressure on that spot on both hands hurt. Did a cold water bath and now can't feel any pain on my right hand with palpating, just left.


altelis


Mar 6, 2013, 6:31 AM
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Re: [onceahardman] Another play doctor and guess my injury thread [In reply to]
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onceahardman wrote:
Palpation is generally an unreliable method of achieving an accurate diagnosis. It has very poor inter-tester reliability. It can assist, however, when it is "clustered" with other tests.

A strained pulley would tend to be painful with crimping, especialy a really tight, end range crimp.

This is a type of "selective tissue tension testing", which is more reliable than palpation.

Visible bowstringing has mixed reviews.

Even better is MRI, or certain diagnostic ultrasounds.

Best diagnosis ultimately is, cut it open and look at it! (Not yourself, have a hand surgeon do it).

Treatment-wise, keep it moving, as long as movement does not worsen the symptoms. Understand what that means.

Couldn't help chiming in here as I'm finishing up a big review paper on pulley injuries (talking about it during ortho residency interviews made me a lot of friends!)-

generally agreed that a complete rupture of at least A2 & A4 needed to see visible bowstringing (obviously without US or MRI). Schoffl et al postulate (without data) that palpating for flexor tendon excursion while flexing the affected finger against the thumb is sensitive for A2 tears... but again, no data there


FFSchooley


Mar 6, 2013, 11:38 AM
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Re: [altelis] Another play doctor and guess my injury thread [In reply to]
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Well today they hurt a lot less and it takes squeezing pretty hard to get just a bit of mild pain. I did notice some mild pain (1 out of 10) when the spot wasimpacted by a tool handle though. Been doing arom pain free.


onceahardman


Mar 6, 2013, 1:58 PM
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Re: [altelis] Another play doctor and guess my injury thread [In reply to]
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Tendon excursion is defined as the distance a tendon travels while moving a joint.

If I palpate my flexor tendons while flexing my PIPs, I can feel excursion. I wonder how this is considered reliable as a test for A2 pulley tear.

But my real point is, palpation testing tends to have very poor inter-tester reliability. I might feel something, another, equally trained therapist or ortho might not, especially when properly blinded. That's really the problem with palpation, it seems to depend on WHO is doing the palpating.

If it's not reliable, it's not very useful.


altelis


Mar 6, 2013, 2:02 PM
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Re: [onceahardman] Another play doctor and guess my injury thread [In reply to]
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I think we agree, i just wasn't really all that clear as to my point...


onceahardman


Mar 6, 2013, 2:02 PM
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In reply to:
Well today they hurt a lot less and it takes squeezing pretty hard to get just a bit of mild pain. I did notice some mild pain (1 out of 10) when the spot wasimpacted by a tool handle though. Been doing arom pain free.

Stop squeezing your finger. You can only slow your healing. Keep it moving, start axial loading, loading it gently, gradually in the direction you will be using it. Stop the compressive forces.


mr.tastycakes


Mar 6, 2013, 4:01 PM
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onceahardman wrote:
In reply to:
Well today they hurt a lot less and it takes squeezing pretty hard to get just a bit of mild pain. I did notice some mild pain (1 out of 10) when the spot wasimpacted by a tool handle though. Been doing arom pain free.

Stop squeezing your finger. You can only slow your healing. Keep it moving, start axial loading, loading it gently, gradually in the direction you will be using it. Stop the compressive forces.

I was under the impression that massaging the healing tissue (which necessarily involves some squeezing/pressure) was good for healing. Is this incorrect?

OP - if you can crimp hard without pain, I think you can rule out a pulley injury.


FFSchooley


Mar 6, 2013, 4:13 PM
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Re: [mr.tastycakes] Another play doctor and guess my injury thread [In reply to]
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Well that would be good news if the fact that i can crimp hard and climb without pain means its most likely not a pulley injury and Maybe is just soreness from over use? Either way it will probably be good to take 2 weeks off and let things heal. After that I can probably climb without worry as long as I am pain free, right RC forum docs?


onceahardman


Mar 6, 2013, 4:20 PM
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Re: [mr.tastycakes] Another play doctor and guess my injury thread [In reply to]
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mr.tastycakes wrote:
onceahardman wrote:
In reply to:
Well today they hurt a lot less and it takes squeezing pretty hard to get just a bit of mild pain. I did notice some mild pain (1 out of 10) when the spot wasimpacted by a tool handle though. Been doing arom pain free.

Stop squeezing your finger. You can only slow your healing. Keep it moving, start axial loading, loading it gently, gradually in the direction you will be using it. Stop the compressive forces.

I was under the impression that massaging the healing tissue (which necessarily involves some squeezing/pressure) was good for healing. Is this incorrect?

OP - if you can crimp hard without pain, I think you can rule out a pulley injury.

My impression, mr.tastycakes, is that the OP is squeezing his finger daily, maybe sevral times daily, in order to assess whether or not it is healing, or if it is getting better. I think he is squeezing as a diagnostic technique. I could be wrong.

Deep friction massage is targeted toward a specific tissue, and when applied to tissue that is no longer in the acute (or probably even subacute) phase of healing can help with scar tissue remodeling. My reading of the OPs complaint does not sound like massage is yet indicated.


mr.tastycakes


Mar 6, 2013, 4:35 PM
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Re: [onceahardman] Another play doctor and guess my injury thread [In reply to]
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onceahardman wrote:
mr.tastycakes wrote:
onceahardman wrote:
In reply to:
Well today they hurt a lot less and it takes squeezing pretty hard to get just a bit of mild pain. I did notice some mild pain (1 out of 10) when the spot wasimpacted by a tool handle though. Been doing arom pain free.

Stop squeezing your finger. You can only slow your healing. Keep it moving, start axial loading, loading it gently, gradually in the direction you will be using it. Stop the compressive forces.

I was under the impression that massaging the healing tissue (which necessarily involves some squeezing/pressure) was good for healing. Is this incorrect?

OP - if you can crimp hard without pain, I think you can rule out a pulley injury.

My impression, mr.tastycakes, is that the OP is squeezing his finger daily, maybe sevral times daily, in order to assess whether or not it is healing, or if it is getting better. I think he is squeezing as a diagnostic technique. I could be wrong.

Deep friction massage is targeted toward a specific tissue, and when applied to tissue that is no longer in the acute (or probably even subacute) phase of healing can help with scar tissue remodeling. My reading of the OPs complaint does not sound like massage is yet indicated.

Gotcha. Thanks.


FFSchooley


Mar 6, 2013, 8:02 PM
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Re: [mr.tastycakes] Another play doctor and guess my injury thread [In reply to]
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To clarify, I am using palpation to assess my injury since that is the only way to induce any sort of pain other than grabbing something that puts pressure on the spot, which has happened several times today. I am only palpating it a few times a day. I have not began massage as I have no idea what this injury is or how to treat other than taking a break from climbing.


onceahardman


Mar 7, 2013, 3:39 AM
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Re: [FFSchooley] Another play doctor and guess my injury thread [In reply to]
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I understand. I recommend you stop inducing pain daily.


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