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A2 Pulley Rupture
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Partner drrock


Oct 25, 2003, 11:54 AM
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A2 Pulley Rupture
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Anybody out there have a complete A2 pulley rupture? 3 weeks ago I did this on my left ring finger. Surgeons recommended surgery, but that is like asking a plumber if you need pulmbing. Anybody else out there do the same thing and NOT have surgery? How is the finger now? Can you still climb on it no problem? Any advice appreciated. :cry:


overlord


Oct 25, 2003, 11:58 AM
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man, thats BAD. condolescences. what did you do?

IMHO i would go for the surgery becasue if the tendon is really torn, not just pulled (liek you said) itll me kinda kard for it to heal otherwise. theyll probably cut open your finger and sew it together. it should heal perfectly (or almost), but the rehab will probably be long. i believe you stand better chance to be climbing again if you do get the surgery.


lazide


Oct 25, 2003, 3:35 PM
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from what I have heard, tendon pulleys (which are not like what you normally consider 'tendons' btw) don't necessarily benefit much from surgery. I would talk to a good sports doc in your area and get a couple of opinions.


dominicanclimber


Oct 25, 2003, 5:22 PM
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Well I cut the pulley tendon on my pinky finger about 4yrs ago, i had the surgery, it did not work for me due to some complications i wanted to keep climbing and i could not so i did pull ups instead and i messed up my hand more, to this day i cannot bend my pinky but you get used to it, i can bend it with the help of his neighbor finger, i climb pretty good i just dont use my pinky.
If you do decide to go with the surgery you get some kick ass pills.


jt512


Oct 26, 2003, 8:24 PM
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In reply to:
Anybody out there have a complete A2 pulley rupture? 3 weeks ago I did this on my left ring finger. Surgeons recommended surgery, but that is like asking a plumber if you need pulmbing. Anybody else out there do the same thing and NOT have surgery? How is the finger now? Can you still climb on it no problem? Any advice appreciated. :cry:

I thought that surgery wasn't ususally recommended for A2 pulley reptures. I thought I'd read once that if left to heal on their own that there is ususally no significant loss of functionality. Have you gotten a second opinion?

-Jay


afiveonbelay


Oct 26, 2003, 9:31 PM
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GET A SECOND OPINION!!!!

Popped mine two years ago in the gym in my right ring finger. Laid off the gym routes for FOUR months and climbed only outside (better feet) and avoided all right hand crimpers.

Taped extensively, first all three (middle, ring, pinkie) together. Gradually just taped midlle and ring, then taped fingers in an X pattern, then just in an annular support. This went on for over a year. I don't tape now unless inside on a hard route.

You will have a fairly long rest and recuperation period that will be frustrating and boring. There was an article in Rock & Ice (?) about 3 years ago covering this subject. Research it hard before the knife because I don't think you need it, but you DO have to lay off the hard climbing for a while.


Partner drrock


Oct 28, 2003, 2:59 PM
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Thanks everyone. I did speak with some sports medicine people and they all basically said to see what happens without surgery and if needed, can be done later on. Sounds like most people with similar injuries do pretty well with fairly conservative treatment and just laying off and taking it easy for a while.


doktor_g


Nov 4, 2003, 12:03 PM
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Good thread.

Hey amigo, I ruptured my A2 pulley of the middle finger of my right hand about a week ago. I'm totally depressed. There is an excellent discussion about the A2 rupture in a book by Eric Horst called Flash Training. It is written by a doctor/climber named Mark Robinson MD. In the article he said that up to 25% of competitors at some XYZ boulder comp had evidence of old rupture. Additionally he said that he'd opt for non op conservative treatment. Good consistent taping is the best I think. I'm not giving up on hard routes though like the other guy. Of course hard for me is an 11. Keep the faith and stay away from the knife. I'd very much like to hear from you personally about how it's going.

Contact me at the email address given in the signature.

Thanks,
Grover Shipman


doktor_g


Nov 4, 2003, 12:18 PM
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Just found this link on anouther forum search. It's a keeper.

http://www.physsportsmed.com/issues/1997/05may/jebson.htm

Grover


Partner drrock


Dec 14, 2003, 6:59 PM
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Update on progress:

I did not have the surgery like they recommended that I should. It has now been 2 1/2 months since the injury, and I think I am back where I started. Maybe a little weaker still, but getting there. Barely any pain in the finger when I climb, but it is still pretty sore after I climb, and can't climb two days in a row yet.

So anyone with this same injury, maybe this is what you could expect. I never actually stopped climbing, but climbed a lot lighter 1-2 days per week, only using big holds, and avoiding anything that hurt (which was most holds for a while). I now also always tape over the pulley very tight, about 5 turns around the finger.

So don't despair if you just did this, it will heal. But be prepared for some frustrating days to come.

Peace.


thinksinpictures


Dec 15, 2003, 6:21 AM
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drrock (or anyone else who happens to know), how do they diagnose a pulley rupture v. a tendon injury v. a ligament injury or anything else that can happen to our prescious fingers? I had a bit of a strain in my right ring finger (pretty sure it's not severe since I have full range of motion and it only hurts when I pull off of the tip), and I'm trying to figure out if I ought to bother with seeing a doc or if I ought to just stick with good old RICE. The big thing I'm trying to figure out is how long I need to stay off the finger - I don't like going without climbing, but I'm only 22 so I'm not about to risk a chronic injury.

Any info is mucho appreciated.


Partner drrock


Dec 15, 2003, 1:13 PM
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Good question. Best diagnostic test is of course the MRI, which I shelled out $600 of my own money (insurance paid the rest of the $1800!). So that is not practical. That having been said, clinical exam is not perfect and if any doubt, MRI can be helpful.

Tendon rupture is bad. Usually this is a flexor tendon rupture, and you would know this with the following hand exam, which I will try to explain in words. There are 2 flexor tendons for each finger, the deep and the superficial. You need to make sure they are both still intact. Can you make a fist still? Do all the fingers flex the same amount against resistance? If yes, then stabilize the entire finger except the last joint, and see if that joint contracts against resistance. If any of these are suspect, get a hand exam, because I think tendon ruptures are usually surgically repaired.

Fortunately, a pulley problem is more common. Referred to as "climber's finger" for a reason, namely because it is common. The pulley system makes sure that the flexor tendons remain tethered to the bone while you are contracting your fingers, otherwise they would "bowstring" or move out away from the bone.

Below is a nice description of the injury:

http://www.timeoutdoors.com/climb/injuries/4CLMAMF01090404E.htm

There are varying degrees of this injury, from partial tear to complete rupture of a pulley or several pulleys. Most common pulley rupture is A2, then A4. A lot of people rupture several at once. I think most times a surgeon would recommend repair if more than one is ruptured. Incomplete rupture you will just have pain over the pulley site without tendon bowstringing against resistance. A complete rupture will be fairly obvious to a trained eye (or an untrained one, I noticed something bulging out from my finger against resistance by my self, with little prior knowledge of finger anatomy). Also a complete rupture will be unbelieveably painful with any use at all, and you will not be able to climb for a good number of weeks. With an isolated A2 pulley rupture (I had this 10 weeks ago, confirmed by MRI) you can expect about 2 months of painful healing, then slowly start climbing again with tight taping at the site and slowly gaining your strength back.

As far as ligament problems, I am not 100% sure, but think that the lateral ligaments that keep the finger straight are the more common ones to rupture or tear. You might know this because of pain on the sides of the joint and nowhere else, and if the finger is no longer straight. Maybe anybody else who knows about these can contribute. I think they are most commonly injured by sticking the finger in a small crack, and then falling on a twisted finger.

When you rupture something good, you might also hear a "pop". Curt from Scottsdale mentioned that this is not actually the tendon/pulley rupturing, but the joint after the rupture. If it is a chronic overuse thing and not an acute event, it is more likely a tendon problem.

So for now why don't you take a couple weeks off, RICE, and ibuprofen, and then see where you are at. If not better then, see someone. That having been said, most physicians don't know much about climbing injuries or specific hand problems and see someone who comes recommended or who is a climber.

Good luck! If there are any more specific questions, let me know and I will try to find the answer for you.


thinksinpictures


Dec 15, 2003, 2:22 PM
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Thanks for the advice. Most of that is what I was planning, since, as I said, I have full range of motion and it only hurts when I flex it against pressure on the first pad (imagine pulling a single pad crimp with just the one finger). My best guess is that it's a relatively minor A2 injury (the pain seems to be in about the right place for an A2). That being said, I'm gonna rest it for a couple weeks, then get back into climbing with gradual increase in difficulty (starting at something like 5.8 and moving up a grade per week or so until I'm back where I was). It seemed to me that upping the difficulty (and thus the strain on the finger) slowly would be best so I watch for any pain as I increase stress on the injury.

I don't wanna take time off! :x


gblauer
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Dec 17, 2003, 1:16 PM
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great thread thanks for all the info. I think I have an A4 injury. I am not climbing, icing, taking ibuprofin, glucosamine et al. and trying not to think about climbing. (Actually I am climbing one handed). I am scheduled to go to El Potrero Chico in mid January, worried that my right hand will not be healed enough to climb. Any ideas to speed healing? Does ultrasound work? Ice alternating with heat? range of motion exercises? Thanks.


Partner drrock


Dec 17, 2003, 2:56 PM
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That is too bad. I think you are doing everything I would be doing. I would stretch the finger to keep it from contracting while you are avoiding useing it. Icing it a couple times a day with Ibuprofen in reasonable doses seem like okay things to do.

Ultrasound may help in your case. It is primarily used for tendon pain and has been shown to promote healing. I don't know specifically about pulleys, but I guess I don't see why it wouldn't help... Physical therapists typically do this treatment. Could help, won't hurt (except the wallet).

But time is the best healer. And avoiding things that cause it pain. I hope you are better by your trip!

Anybody else have experience or thoughts on speeding up the healing process?


jenfu


Dec 17, 2003, 4:13 PM
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This is a great thread, very complete, but I thought I would chime in too. A study from a few years ago in Britain found that something like 60% of international world cup climbers had a A2 rupture and none reported declined climbing performance from the injury. Surgery is a big step with a possible complication being scarring in the area of the pulley causing problems with the tendon passing through it. So, chances are, you will be ok without the surgey. Just a thought. Good luck and I hope you heal soon!
JenFu


papounet


Dec 23, 2003, 12:57 AM
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you may want to view the schematic and the video at
http://perso.club-internet.fr/jocelyn.loubriat/poulie1.html

the explanations are in french.

Beware: many climber mistake a tenosynovitis (tendon inflammation) for a pulley

http://perso.club-internet.fr/jocelyn.loubriat/tenosyn.html


leec


Dec 23, 2003, 11:38 AM
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Quit climbing altogether for as loing as you can survive!
I did my A1 and A2 pretty badly in March and it's only been the last couple of months that I've got back. Though a 13b last Sunday shows you can get back pretty quick once you allow proper recovery.

Tendons take for ever - I had over six weeks of three times a week ultra sound from my Chiropractor climbing buddy. Big help as was continual massage.

I spent a lot of the summer canyoneering to at least keep active, just don't expect anything quick. In fact, early stresses will only extend recovery. Lots of warm up when you start climbing again and tight taping. There's a bunch of stuff out there on 'how to tape'. Basically, you're trying to reinforce the finger. Most tape loosens badly, do do plenty tight - if it's too tight you'll soon see the blue finger tips and be able to undo it! Don't panic, you'll not cause any lasting damage.

Next time - heed the early warning signs of aching joints/tendons/fingers after a cragging and rest between. Stretch and warmup and protect.

Oh - alternatiing ice and warm hand baths will also help increase circulation in the early days. Use Ibuprofen immediately for the first few days only - then avoid as it will slow the healing process, you're only trying to reduce inflamation with it.


Partner drrock


Mar 24, 2004, 1:34 PM
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Bump due to increasing number of finger injury threads being started.

BTW: after about 5-6 months, my finger and strength are good as new without surgery or any specific therapy. I climbed very light for about 3 months, then slowly started increasing and now am completely back to where I was if not better. I do tape pretty tight around that area every time I climb. If I don't, it is sore for a while. But if I tape tight, then no problems.

So this could be an example of the natural history of a complete A2 pulley rupture.

Peace.


usmc_2tothetop


Oct 7, 2004, 2:06 PM
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I'm bringing this thread back up. It's very helpful and I found a great diagram for the finger. http://www.uoregon.edu/~opp/climbing/injuries.htm


Partner drrock


Oct 7, 2004, 2:19 PM
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Its too bad that that original article I linked to is no longer free. This one is pretty good too, but not as nice of diagrams.

http://www.physsportsmed.com/issues/1997/05may/jebson.htm

Plus the one USMC linked to is excellent also, many of the same original diagrams actually.


nickstach


Aug 28, 2005, 7:41 PM
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Certainly a great thread. I had an A2 pulley injury six months ago, and had to stop climbing at all for about three months. Then I started progressively to climb again. Mostly trad, ranging from 5.7 to 5.10. The recovery was going OK, but right now I am a little worried since the pain started again (though not as intense as before), probably due to the silly idea of starting some campus board training. Not very wise. I guess the best thing to do is to stop for a few weeks, icing, antiinflamatories and to stay well off the campus board and the fingerboard.


majid_sabet


Aug 28, 2005, 8:17 PM
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Today's doctors are nothing but midnight plumbers with different set of tools, do a lot of research before you let them work on you.That is all I have to say and good luck.


maxiter


Sep 24, 2005, 1:15 PM
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Bumped cuz I popped an A4 ring finger today.

Found this to be an informative read:

Pulley Injuries in Rock Climbers


Partner drrock


Sep 24, 2005, 8:43 PM
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sorry to hear it mate. could be worse. pulleys heal relatively quick with no ill effects on climbing ability. don't worry about it. just takes time.

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