All Climbing

94 Comments

1. Thanks for this post. I’ve been struggling with what sounds like the same injury. Mine is on my middle finger on my left hand. The tenderness is at the base also. Just like you described, I take 2-3 days off from the gym, then, when I return, it starts hurting again after about an hour. I’m going to try taping it today.

2. Will, yep I’m finding from personal experience that it takes longer than those couple days for it to heal. Now that I have a definitive diagnosis, I’m hoping it will keep me from repeating the pattern. It’s so easy to think that since the pain is gone everything is fine.

3. Will,

   I hate to break it to you, but if you pulley does have a partial tear, two days off isn’t really going to do anything. We’re talking weeks and months here. Based on your blog name (Gumby Diaries) I’m guessing you’re pretty new to the sport. Do yourself a favor and take it easy. “Climb through it” doesn’t really work.

4. I have a similar injury and have had a tough time diagnosing and treating it over the past two months. Do you know how the Dr. diagnosed it as a rupture as opposed to tenosynovitis?

   I thought it was an A2 rupture but began to question it due to the way it felt when and after light climbing and in part due to this thread. I am convinced when by the argument of one of the posters there that many rock climbers get tenosynovitis and think it is either tendonitis or a pulley injury.

   I also tried Dave Macleod’s cold water treatment. I think it may have helped a bit, but I think the light climbing he suggested and I tried with it made it worse.

   Eric Horst was very helpful over email as well, and suggested rest. I think he is right, and I’m taking another month off, praying it will work and I can climb injury free when the weather gets nice.

5. I had a torn finger pulley several years ago. My hand surgeon at the time gave me cortisone shots, twice, which seemed to help. Ken Duncan, in Fort Collins is an orthopedic surgeon specializing in hands AND a 5.12 climber – you might ask him for advice.

6. Hope you get better soon, dude! What computer habits did the doctor tell you to change? we all sit too much in front of the screen and might be harming ourselves more, than while climbing 🙂

7. I’ll probably say it can’t hurt, but that might not be the case, particularly if it evokes a false sense of safety. This article links to two credible studies that conclude differently.

   http://adventurehealthclinic.com/2008/12/19/rock-climbing-finger-taping-and-injury/

   “The British Journal of Hand Surgery also featured a nice study, by A. Schweizer, concluding that circular taping is minimally effective in relieving A2 pulley force and is probably ineffective in preventing pulley ruptures.”

   So, two decent studies have found that finger taping does not prevent injury.
   Please, consider all the data before you spray the magic of tape. Someone might not be as lucky.

8. Mike – he felt the finger then made me pull on it while he watched and felt it. He then did the same with the good finger on other hand and immediately came to his diagnosis. Hands / fingers are all he does so I guess it’s an experience factor. he told me he’s had at least 150 climbers come through his office with this exact issue. The sports medicine doctor made it sound like tenosynovitis could be the issue, but aside from injecting cortisone the treatment is about the same.

9. sibylle – Thanks , I’ll keep him in mind.

   climbbig – Proper posture mostly. I have a really bad habit of slouching while working at the computer all day. Basically he recommended the standard tweaks to your posture in front of the computer you see written up everywhere – feet on floor, arms at 90 degree angle while typing, not resting arms/wrists while typing and mousing, etc. While I’ve read these a million times, it’s taking the pain in my elbows and thumbs to finally make the change.

10. Rags – I’m not sure I’m convinced taping while recovering from an injuring gives a false sense of security. If that’s the case, and a climber thinks the tape will cause them to be healed and able climb anything, then that’s not an issue with the tape but the person.

    Nowhere in my post did I say taping was a magical cure. I simply stated that a) in my experience it has helped, b) practicing doctors have told me it is a good idea and c) if we think about what is happening inside the fingers it makes sense that it should help this issue. Not every issue, but the one I’m talking about in the post.

    In my opinion there is a big difference between studies done on cadavers and the experience of actual practitioners on healing athletes.

    Finally, you chastise me for not mentioning these two studies because “someone may not be as lucky.” The two studies you mention state there is no benefit to taping so that also means that taping is not hurting them either.

    So I’ll state it again, in my experience taping while injured (not to prevent an injury) has helped. I have also spoken to doctors who agree and have approved this treatment path.

    If it makes everyone feel better, here’s a disclaimer covering this entire post:

    I am not a doctor. This blog post and its comments are not intended to be medical advice.

11. Hey Tom,
    I’ve had that injury several times before, could be as little as one month, as long as nine. I had a good one last year that took 9 months to heal fully. Sounds like yours is minor, in which case I’d take a month off or just go climb hand cracks in the creek. massage and icing combo usually gets the blood going in the area.

12. In terms of ‘taping’ for pulley injuries… Yeh it works – but you have to tape your pulley SO TIGHT that you finger will go BLACK! 🙁 !

    Think again about the physics / mechanics of it. Try to hold your ‘crimping’ tendon right close to the bone… (at the A2 pully region) Notice how ‘little’ the tendon flexes out . Also notice the magnitude of force – given even a little light crimping…
    Now tell me that some taping is going to ‘hold the tendon in place’ when you crimp down… It won’t even offer any support unless it’s super tight – and if anyone has even tried climbing with super tight tape – you will realise that your finger is black within the half hour…

    Easiest way to ‘keep climbing’ so long as you’re not trying to ‘push grades’ is to keep your finger open hand – again look at the physics / mechanics – with open hand – your finger is straight across the A2 pulley – thus there is no force acting on the pulley and it can heal or at least you won’t make it any worse…

    If you tape over your whole finger – you can help force it to stay straight and this can also reduce further injury – but in essence – you will have to take at least 4 weeks to get a total recovery – even for a partial tear – since cartilage has no blood supply and can only repair from mineral / protein diffusion (slow!). For bad tears / complete ruptures – you are looking 2 months minimum up to 4 months – of keeping compression etc over the pulley to help it graft etc and make sure that the healing process is not disturbed…

13. Great article with a lot of good information.

    I have had such an injury and your finger can repair to be stronger than it was originally. I agree that using open-handed holds are a good way to minimize risk. I tend to get hurt on tight crimps, which is where the A2 is going to be at greatest stress.

    I have found taping to be helpful in the recovery process. Secession from climbing for a few weeks after such an injury along with isolation of the finger are also key. Rest, ice, NSAIDs, and isolation are the standard formula here. Return to climbing gradually and slow down or stop if it’s too soon. If you are disciplined you can put the injury behind you forever quickly. If you rush things you could have the problem dogging you for years.

    I have NOT found taping to be helpful in preventing injury (as opposed to recovery from an injury). The stress put on the A2 during a crimp is tremendous and the tendon/A2 combo is right against your finger bone. I suspect a little tape on the outside of your finger is of minimal help when faced with these sorts of localized and intense forces.

    The anticipation of pain is a major hurdle for some climbers that causes them to be hesitant to make dynamic moves, use tough holds or commit and follow-through. It’s a lot like the fear of falling on lead. These injuries can tap your performance in really subtle ways, so treat them seriously, professionally and objectively.

    So if you feel taping helps and makes you climb with more confidence… whether it really helps or not… tape up. Even a false sense of confidence is still confidence. I would wear rabbit ears and permanent clown makeup if I felt it would make me climb better.

    …but based on your post you know this! Thanks again for sharing your experience.

14. Thanks for the feedback Jim. I actually found a certified hand therapist who is also a climber and have been receiving treatment from her for the past month or so. I’ll be writing up a post soon that details the rehab program she has me on. A big issue we found is a large knot of scar tissue on the injured tendon sheath.

15. Great write up. I’m having the same problem with the A2 pulley on my left ring finger. Though I haven’t officially been diagnosed with it, I’m fairly confident that I’m suffering from it. Crimps are nigh impossible, and bearing weight in an open/closed crimp hurts too much. I took two days off, and it felt great — unfortunately, climbing on it for about half an hour just brought the pain back.

    I’m now currently on an indefinite hiatus in hopes of recovering fully. A friend of mine suggested I try taking glucosamine chondroitin with MSM and fish oil pills to help promote healing while resting. No active resting — just straight up staying off my finger. Unfortunate those, since I’m suffering from climbing withdrawal. 😛

    Best of luck to you in your healing process — I look forward to hearing more about your visit to your hand therapist.

16. first, thanks for the article. i appreciate that people are sharing their experiences in this arena. i’m in the same boat: RH ring finger, A2 partial, possibly partial on C3 as well but difficult to determine w/o ultrasound. i’ve been off of climbing now for about eight weeks and am really missing it. i have a prescription for a rigid plastic ring, which i’ll have filled this week, then i’ll hopefully be able to start reintroducing climbing into my life. a couple things to consider, regarding taping:

    1) depending on the study, 0.5 or 1mm of abnormal excursion is considered bowstringing (mine feels identical from affected to unaffected hand, yet crimping is impossible w/o a lot of pain)
    2) tear off some tape and wrap it tightly around something to simulate a finger. i’m thinking a pencil core with several layers of paper towels would be in the ballpark.
    3) squeeze your “finger” and if you can distend the thing 1mm, you haven’t achieved much protection. some, sure, no doubt. but as much as you need? i’m kinda doubting that. if it’s rock-hard, yep then i buy it.
    4) days after i first did this to myself, i found an article where army researchers took nine cadavers and rigged up matched right and left hands to a stress-test machine to simulate crimping, with one finger taped and the matched one on the other hand left untaped. the results (link below) are that the various pulleys ruptured at the same stress on each hand — meaning, the taping either wasn’t done how we do it, or it didn’t help, or perhaps cadaver ligaments don’t behave like ones in living climbers. there are lots of “what-ifs” but to me, this is about as thorough a study as i’ve ever read about this.
    5) i’m suspecting that your (and my) taping may well have a lot to do with thickness of tape on the finger pad, and how if we do it enough, it tends to become more and more rigid… something one could achieve with a ring, perhaps. i would think the best protection would be a very solid ring that wouldn’t deform, and is fit as close as possible to the ligament and which compresses the tissue enough to prevent (much) bowstringing.

    what’s my conclusion? i’m sure gonna wear the thermoplastic ring, if i can get it on over my fat finger. would i tape if i didn’t have a prescription ring? yep, sure would, even though it appears to be illogical given the study results. why would i? basically because i think that how i would do it would be more rigid than the researchers did.

    link: http://ajs.sagepub.com/content/28/5/674.abstract

17. Thanks for the feedback Leif. Let me know about your experiences with the thermoplastic ring. I’m not familiar with that at all.

18. this thermoplastic is ivory-colored and heated to about 110°F in warm water. once it attains that temp, it’s pliable yet isn’t painful to wrap around your finger and shape it a bit — you can also cut it if you have a heavy-duty shear (e.g. what one would use for hardware cloth). once it cools, it’s really pretty rigid. you can compress a finished ‘ring’ more than 1mm but that takes quite a bit of force — more than i think one who’s recovering from our injury would allow the tendon to exert on the A2 anyway. it can be resized by re-warming and re-shaping, as your swelling goes down. that’s where the good news comes to a bit of a jerky halt.

    in practice, a ‘ring’ done with this restricts the curling of the finger by blocking the natural compression of the fleshy part of the finger, to the point of discomfort — the more you curl, the more uncomfortable the mashing gets. in order to actually have one restrict bowstringing to the degree a ligament would (meaning, to protect the injured ligament), i think it’d have to be thinner than this plastic (this is about 1/8″ thick), and painfully tight, to the point of restricting blood flow. so… unfortunately i think that this isn’t the panacea i had hoped for. i’ve been doing some various exercises per the therapist, and during this week it has been getting better — hard to say, though, whether the therapy is the larger contributor, or if using it fairly strongly for a bathroom remake is the prime factor.

19. Hey folks,
    I injured a pulley on my right hand ring finger 3 years ago (A3). I took a month off from all climbing. When I returned, I taped my finger with a figure eight pattern. I taped a loop around the pad above my knuckle that then crossed to a loop around the pad below my knuckle. I then put another strip of tape crossing the opposite direction, forming a criss-cross with the first strip. The criss-cross was on the underside of my knuckle, where your finger creases. I taped it with my finger in a flexed position. The result was that it was taped into a position where I could not straiten my finger. (I hope that description makes sense) At first, I also then taped my ring finger to my middle finger. I later stopped taping them together, but kept the ring finger individually taped. For the next 4-6 weeks I only climbed on juggy routes, to avoid any crimpy finger tip strain. I was able to get my climbing fix in and keep my self in decent shape without pushing the envelope of difficulty. A buddy that worked at the local indoor gym put up a route where all the right hand holds were juggy and all the left hand holds were crimpy. I ran endless laps on that while I recovered.

    I have now injured a pulley on my right hand index finger (A1/A2). I have rested it for 3 weeks. My finger has remained swollen in the A1 area. I do not recall lingering swelling with my previous injury. I am now 2 days away from my first night of indoor lacrosse, where I am going to be swinging a stick and shoving/punching. I plan to tape it in the same fashion as before. Unfortunately, since I will be wearing lacrosse gloves I can’t effectively tape it to the adjacent finger. I am a righty, but I have a feeling I am going to be playing lefty alot. Who knows, maybe it will force me to work my off side more and make me a better player in the long run… hehe

    Good luck to all you fellow injured athletes who don’t have enough common sense to stay parked on the couch, living a “safe” life. I bet if my hobby was watching NASCAR, I’d be a lot less banged up… lol

20. It has been great to follow this thread.

    My right index finger A2 has healed slowly. It doesn’t have it’s full range of motion. I was shocked to find that fist jams (where your finger is totally bent) were some of the more difficult holds to get back into. I guess anything where the finger is not straight (like making a fist) is when you are going to stress the injury. So it sort of makes sense. I bought a giant wad of silly putty and knead it in my first during the day. It helps a lot with the flexibility and range of motion, but it’s still not back where it was several months ago.

    Still climbing, however, but it sure has been and remains a nagging injury.

21. i’m now 86 days into my recovery and doing most everything (except climbing, wringing washcloths and turning really tight jar lids) normally with little to no pain. well, military-style pushups still hurt, which is surprising, so i’ve kind of modified my style a bit for those.

    i haven’t resumed climbing because i’ve been stressing out the finger enough by a complete bathroom remodel including delivering and installing about 2500 lbs of tile. i went to one therapy session, paid my $$, but honestly don’t believe i learned much beyond what i already knew, and i got some toys and putty to mess with. to the previous poster who got the big wad of putty, be cautious of squeezing the stuff for any length of time, unless you’ve built up to it over a few weeks. heard about someone who got distracted, watching a movie, and re-ruptured his A2 from two hours of putty-exercise.

    i do a few juggy climbing moves just to test the waters, but i haven’t staged a full session at all yet, since gripping a texture gun for half an hour ends up making the finger sore for 36 hours. not a good ratio. crimping, oy, i just don’t wanna think about it. this darn injury is just plain slow, and very annoying at that. for those who think they can spring back in a hurry, either yours is a mild injury, your tissues are highly vascularized, or you’ve got a serious case of YMIS and may be heading for a worse mess soon.

    liquid mojo, good luck with your lacrosse. gripping the stick may well be really taxing. i’m curious to hear how it went.

22. First night of lax went well. The figure eight taping method that I had used before didn’t work though. My previous injury was to the A2/A3 area, with my knuckle being the main area that needed taping. Therefore the figure eight/criss-cross method worked because it restricted the range of motion of my knuckle, while re-enforcing the pulleys on either side. This time my injury is in the A1/A2 area, so it is more where the finger meets the hand. After taping and retaping a bunch of different ways, I finally settled on just wrapping the A2 pad of my finger (between my hand and knuckle). I wrapped it as tight as I could without making my finger turn purple. With the thickness of the stick’s shaft, I didnt have to close my hand too tight to have a good grip. I can’t close my index finger tight enough to hold anything skinnier than say a highlighter. Gripping something thicker like an axe handle is ok. Generally, when defending an offensive player, I would shove them away with both fists, with a punching motion. Instead of using my fists, I used my forarm and elbows. I had to over commit more than I would like, but I was still able to jack them up pretty good and save some stress on my hand… lol… My finger felt ok after Friday night’s lax game, but then on Sunday I replaced some light fixtures and my finger was killing me from twisting little screws and wire caps. I swear my wife thinks I was trying to get bonus sympathy points for replacing the fixtures, but she wasn’t buying it after I played lax and insisted my finger was good enough to play the season… lol

23. Have been told I have a ruptured finger pulley, right ring finger (no MRI yet but it’s worse at the base of the finger….A2??). 1st doctor recommended surgery though he acknowledged he’s only performed the surgery maybe 5 times. I’m in California – don’t mind traveling for a second opinion. Any suggestions on hand specialists who are more familiar with treating this injury? I saw the one name listed above, Ken Duncan in Fort Collins. Anyone else? Tom, you mentioned you found a certified certified hand specialist, where is she located? Thanks.

24. bonnie, sorry to hear it. definitely get an MRI (high-def if they offer that, because you’ll need to see tiny details). even the digital x-rays show some soft-tissue detail, often enough for diagnosis. how much bowstringing? persistent swelling, pain, all that good stuff? i went to dr. christopher brian, who works out of a couple clinics here in colorado. he’s a certified hand specialist. it’d be worth calling first as a referral -slash- pre-op consult. he was quite knowledgeable and cordial. i’d definitely have him examine my hands if i did this again.

25. Bonnie – I’d think it would be healthy to be skeptical about getting surgery for a torn pulley. From all the research I’ve done and doctors I’ve talked to, surgery for this injury is the very, very last option. I’d start with finding a certified hand therapist near you: http://www.htcc.org/

    I found a hand therapist who is also a climber which made a huge difference. Her name is Kim Raupp and you can find her contact info through that site. I’ve made great progress with her help. I had a partial tear of an A2 and it has taken many months of rehab (6+ months now), but I’m making great progress.

26. Tom & Leif,

    Thanks for the input. I have fairly substantial bowstringing & some swelling at times. It’s not all that painful (maybe I have a high tolerance for pain??!!). It’s more achy/uncomfortable and annoying in that my grip strength is quite diminished but I definitely would not consider it really painful. I was originally told I have trigger finger a few years ago and I’ve had two cortisone shots during that time. I went back to the doctor a couple weeks ago figuring I’d need the trigger finger surgery since I don’t want to have anymore shots and that’s when I was told about the pulley rupture. I’m a very active person but not a climber… only tried it a few times. I’m on the computer all day for work (accounting) and we live in the mountains so all our recreational time is spent outdoors – riding (road bike mostly), hiking/backpacking, skiing…lots of gardening in the summer and shoveling snow in the winter. I don’t recall a specific incident that caused the problem, just noticed it happening over time. All my online research so far indicates it’s a common climbing injury and that’s how I ended up on this post. I definitely plan on seeing more than one doctor for additional opinions and I’ll check out the website to locate a certified hand specialist near me. I’ll post again soon with an update in case my research and input can help someone else. THX!

27. Thanks Bonnie. Please update us on your progress and good luck!

28. bonnie: i’m no doctor (and don’t even play one on tv) but i’d be skeptical (just as tom suggests) that you have more than a tear. hearing you say you had no definite incident (e.g. climbing-related or a fall off the bike and caught yourself somehow), i’m doubly skeptical about a rupture. bowstringing, swelling, loss of strength, limited ROM and some mild pain certainly are signs of ligament distress, but i get the impression that a complete rupture results in serious debilitation. this makes me think that surgery may not necessarily be in order. tom’s right too that this surgery is a last resort. it *does* seem to work per reports i’v’e read and when i consulted with dr. brian, but it’s quite invasive (there are pix online, fyi; just do some persistent googling), it borrows some tendon from elsewhere to make your new ligament (and thus you have a second incision), and takes its own sweet (sour) time to heal, just like a tear.

    if it’s totally torn, waiting a couple weeks now won’t result in any worse outcome. i’d say, do nothing with it, really nothing (though typing was fine for me even the same day it occurred). do this “nothing” for a couple weeks and see if you have any improvement in the pain and ROM area. do not expect (or demand) any strength from it at all for several weeks.

29. I’m going try and do “nothing” with that hand for a couple weeks (hard as that will be when it’s my dominant hand!). There isn’t enough snow yet to ski and no outdoor riding as it will be too hard to brake without using that hand….guess I’ll stick to hiking and indoor bike. By the time I see the next doctor for a second opinion I will be far better prepared with lots of questions about the surgery and especially re: alternatives to surgery…that thermoplastic ring you mentioned previously sounds interesting.

    More to follow on this post in the coming weeks – thx!

30. I tape my finger to a stick and its useless. I get this dyno jamming finger sticking straight out but I really can’t use it. Sig’ weakens the affected hand, such an efficient group, but I’m healing. Light climbing keeps my life going while I heal up for my future projects. D.

31. I tape my finger to a stick and its useless. I get this dyno jamming finger sticking straight out but I really can’t use it. weakens the affected hand. Light climbing keeps my life going while I heal up for my future projects. Works so far. Really is an isolate to rest option. Works. D.

32. today is day 101 for me. crazy to think it has been this long. i *just* now was able, finally, to touch my fingertip to the very top of the palm, in the fleshy part above the palmar creases near where the finger attaches (approximately at the A1). i don’t consider this full ROM because it felt kinda stiff and sore, but i *did* do it under the finger’s own power. yaay. now of course i’m taking down my climbing wall for a couple weeks to install tile. grr. but i’ll be back at it.

33. Hi there–

    I also have a diagnosed A2 pulley injury. I did not have the privilege of getting a hi-def MRI, but I can say that when I went to my first orthopedist, (supposedly a hand specialist) he said oh its tendonitis and gave me a cortizone injection in the hand. Upon going for a second opinion a few weeks later as I was unimpressed both with his bedside manor as well as course of treatment, as the injection only brought the swelling down…I was imediately diagnosed with an A2 pulley injury (unknown if its a tear, rupture or something else. I was sent to a CHT (Certified Hand Therapist) who made me a “pulley ring” out of thermoplastic material. This ring was cumbersome irritating and annoying. It was near impossible to do any normal daily activities. I went back and she was able to make me a new one, according to the protocols, the ring has to be at least 3/8 of an inch in thickness. I was able to go online to http://www.silversplints.com and find a metal pulley ring that may work better. As soon as hear back from them I will post the information.

    The problem I’m having currently is after 2 weeks of therapy its gotten almost impossible to move that finger (left hand ring finger) without excruciating pain. Any ideas…I’m up for anything at this point, I want and need my finger back.

    I should also mention that prior to the pulley ring my finger was approx. 3-4 cm from being able to touch my palm, now im more like 6-7.

    Mike

34. mike, wow. sorry to hear about your injury and how poorly the diag was conducted. to be honest, i never used my thermoplastic ring. i was smiling in agreement as i read your experience with yours; it’s just not worth it for most, i think. mine hurt my finger (skin and all) wearing it, and i really didn’t feel it conferred any benefits so long as i was very gentle with the finger.

    so…… that said, and keeping in mind i am not a doctor….

    1) un-wear the ring and cancel your order, too
    2) don’t use your finger for anything at all that involves force — no climbing, period, no biking, no wringing of a washcloth, shaking hands… zip! heck, add to that pulling up your socks. even now five months after my initial injury i’m careful about everyday things like squeezing out washcloths, opening bottle lids, etc.
    3) therapy should be administered in such a way that if it hurts a little while doing it, STOP before something really bad happens, wait 24 hrs, and if it still hurts, that line of therapy should be suspended indefinitely. if 24 hrs elapse and you have no pain when you’re not using the finger, then consider gentle therapy of that type acceptable, and continue on the careful path toward recovery.
    4) if you have persistent swelling, that indicates that stuff is fubar in there. yes, a moderate degree of swelling is natural… but a lot, the kind that restricts motion, is not healthy. stop using that finger.
    5) expect that recovering ROM will take a heck of a long time. if you need to speed it up, plan for a convenient time to visit the hospital for reconstructive surgery, and then start over at square one with obtw a big incision and some missing tendon tissue from somewhere else in your body.

    this is tough love… sorry to be blunt, but you don’t have and won’t have your finger at this rate. sounds like your initial injury might have been more severe than mine, and here i am, age 40, five fricking months out and still not climbing. it’s pissing me off but there’s nil i can do about it. be nice to it. the therapist i went to did NOT give me much confidence in her ability (despite being certified in something hand-related). she had never seen an A2 injury before, which blew my mind, and i haven’t been back. i can tell you that exercising a torn A2 simply stresses out the very little healthy tissue that’s left. just…don’t.

    (please all, pardon what probably seems preachy here. i just cringe at what i’m sure mike’s feeling, and i believe strongly that the therapy is too aggressive. i’m happy to discuss or retract, but it’s my take.)

    honestly, i think you’re too early for therapy. my hand surgeon said

35. [got cut off. sorry i went on and on.]

    my hand surgeon said that doing nothing — no exercise at all, no therapy, nothing — will be the best approach early on. i described the cool-water treatment i had been doing, and he said bravo, keep it up.

36. It’s been an interesting couple months since I last posted. I’ve now been to 3 orthopedic surgeons (all reputable, board certified hand specialists), two CHT and had an MRI. Last post, I had only been to one doctor who diagnosed a ruptured pulley and said I needed surgery. He didn’t instill much confidence when he said he’d done perhaps 5 of these surgeries with maybe 3 or 4 being successful.

    Second doctor had the same diagnosis and said he could do the surgery but warned about the potential for scar tissue forming that could leave me no better off than prior to the surgery considering the expense and rehab time (as in months) for extensive PT post surgery.

    The 3rd doctor suspected the same diagnosis (ruptured A2 pulley, right ring finger) but said he needed an MRI to confirm. He used the same fishing rod/bowstringing analogy as doctor #2 to explain what was going on, expressed the same concern for scar tissue forming and the potential for not much improvement post surgery. He then very firmly said if it were his hand, he WOULD NOT have the surgery and said if I still wanted the procedure done I’d have to work pretty hard (as in plead!) to convince him to do it. He also sent me to a CHT to have a plastic ring made.

    The ring has helped a lot – yes, it’s cumbersome but the support is great – with the ring I can make a complete fist, without it my ring finger only bends about 60% and then just flops around while the rest of my fingers continue bending into a complete fist. With the ring I can pick up a carton of milk, without it I wouldn’t dare try because I have such limited grip strength. My knuckle on that finger is about 1/2 a ring size bigger than the base of my finger so the plastic ring is overlapped (similar to those old spoon rings from the 60s or 70s – for those of you old enough to remember them!). The overlapping allows the ring to expand just enough to get over my knuckle and then it contracts back around the base of my finger. The CHT shaped the base of the ring that presses against the finger on the palm side of my hand as a straight line rather than curved like a normal ring – that straight surface (about 3/8 to 1/2 ” across) pressing against the finger keeps the tendon in place much closer to where it’s supposed to be – a normal curved ring wouldn’t give as much support. As I said in a previous post, this has never been what I’d consider a painful injury, it’s annoying, uncomfortable at times and achy but not painful (maybe I have a high tolerance for pain??!!). It’s been more of a functionality problem for me. My sports are skiing, hiking, riding (road bike) and I find I’m still OK holding a ski pole. Shifting and braking with my right hand on the bike is probably where I have more of a problem – we’ll see how the ring helps with that issue when I start riding outdoors again in the spring.

    I finally had the MRI earlier this week, went back to Dr. #3 and then the CHT. This was a miserable MRI – if you’ve ever had them before, just laying there on your back is totally manageable. For this MRI, I had to lay on my stomach, head turned to the left (no massage table opening so my head could face straight down!) and the worst part…my right arm was completely stretched out above my head with my hand propped on a platform, left arm was bent and tucked against my chest. I had to lay there in that awkward position, completely still for almost 40 minutes. I don’t normally sleep on my stomach so it was brutal. About halfway into the MRI, my hands started going numb, my lower back was aching and by the time it was over both arms were numb up to my shoulders. It felt like they had to slowly peel me off the table. The MRI was way more uncomfortable than the injury itself!

    Turns out A2, A3 and A4 pulleys are all ruptured…yeah, not good news. Dr. #3 reiterated he still would not recommend the surgery. He suggested the silversplint pulley ring Mike mentioned in his post. I discussed it with the CHT and the problem is those rings are round like a normal ring – similar to a wide wedding band and I want a ring that will be squared or straight across on the palm side edge of the ring that presses against my finger to give me maximum support. The CHT made two new plastic rings so we could play a little with the shape and width. Once I get a good template I plan on finding a jeweler who can custom make a ring with the straight part that seems to be working the best. I’ve also researched online and there are a few companies who make ring “hinges” so the ring can expand to get over an enlarged knuckle and still provide a snug fit where it’s suppose to. I’m determined to find a jeweler who can make exactly what I’m looking for with the straight section and hinge – I anticipate having to go through a couple prototypes before getting it right. If I have to wear this ring the rest of my life rather than having surgery, it will be worth the effort. I’ll post again with more info once I figure out about the ring.

    Happy Holidays to all!

    PS – I just saw Leif’s reply to Mike’s post. My injury is a complete rupture. When I asked the doctor (#3 – the one I liked the best) if I could injure it further by delaying or not having the surgery or by continuing to use it he said no, “it’s already done”. He also didn’t seem too surprised that it wasn’t painful. Maybe a partial tear is more painful than the complete rupture?? At any rate, for me, the ring has helped tremendously. Though it is a little bulky, I still gain more wearing it even with the awkwardness of it. That’s why I’m on a mission to get one custom made that provides the same support without the bulk.

37. Thanks everyone for this info-brimming thread. I’ve finally reached my 90th day of rest after severely rupturing my A2 pulley on my left ring finger. After the first month I consulted a doctor and a sports therapist. Both concluded that I had a partial rupture upon looking at my ultrasound results. I have full range of motion in my finger but it seems like I still have inflammation in my finger after three months of rest. I can’t crimp anything or really use my ring finger other than for typing. Also, there is palpable scar tissue around the A2 pulley. I’m wondering if the scar tissue is slowing my recovery or if it is preventing full recovery. Any thoughts on this would be greatly appreciated.

38. Hi all-

    (Disclaimer: I am neither a doctor nor therapist, and this will most likely be a long and jumbled post as I have a lot to say with no tactful way of saying it)

    Just wanted to post an update and let you know that Leif may have been right(and by may have been I mean DEFIANTLY). However Leif, you were only right about the fact that my injury was more severe than originally diagnosed. I had a follow-up appt today after speaking with my doctor last week about severe finger pain. He consulted one of the leading Musculoskeletal Radiologists (my doctor specializes in sports injuries…he works with a few NFL teams in the tri-state area) to look at my MRI. They concluded together that I have a complete rupture of not only the A2 pulley but also A3 and partial separation of A4. So with the MRI reading of a significantly more severe injury new options were discussed which I will get back to in a moment. In the mean time I was reformed a new ring also out of the thermoplastic material HOWEVER (major improvement) it is now held together with some cloth medical tape, rather than velcroâ??this combination is MUCH better. Between the 2nd and 3rd knuckle on my ring finger just a plain piece of tape to reinforce A4. This is to treat pain (place your hand flat on the table for this explanation) on the top of the finger distal (farthest) from the last joint but proximal (closer) from the nail bed. This may commonly be referred to as trigger finger, but my tendon does not snap.

    Collectively (it was like a parade in the exam room today, orthopedist, radiologist, hand therapist) we discussed options for rehab/attempting an increase of ROM (Range Of Motion). While I brought up the fact of the ring being non-conducive to my daily life, the answer to this was we can try the new reformed and refashioned ring with a new thinner material. Passive therapy and light stretching seems to be the course of treatment recommended. Surgery while a viable option is not my surgeonâ??s first choice. Get that, a surgeon who doesn’t want to cut! Anyway, he said if we operate there’s one of a few likely things that will happen,

    1-Status quo – things will stay the same — No pluses or minuses in ROM or pain
    2- Drastic Improvement
    3-Drastic Decrease of ROM and increase in pain

    For Leif:
    The exam concluded with my doctor assuring me (I brought a trusted friend who is in the medical field with me today to ask/remind me of questions that I was not/would not think of) that its important to remember that at this point in time, I have ruptured the pulleysâ?¦Thatâ??s it, they are gone, it’s not like a cut that will heal and reseal, the pulleys have torn, so the ring is to be a PERMANENT partner. He also encouraged getting a second, or in my case third, opinion (which I will forgo as I am very very comfortable with this doctor, and his skills).

    What I have decided: I think that I will attempt to keep seeing my therapist, and see if there is any increase in ROM and pain relief. I have set a goal of approx. 90 days. My birthday is in April, so I will (optimistically) wait until then to make any rash decisions. I will attempt to keep the ring and continue to search for other options (much like Bonnie said) from the thermoplastic ring solution as its acceptable but not by any means near where it needs to be if it will be a permanent â??appendageâ? to my finger.

    I welcome all responses as I have thick skin and can take the tough love. Thank you all for being as supportive and volunteering as much information as you have, Itâ??s nice to know that Iâ??m not the only one out there that struggles with these same issues.

39. Silversplints.com got back to me also– It is 110 euros for that pulley ring….I will post when if and when I get more information

    @Bonnie–If you find someone to make that ring, please let me know, I may want to have one made….Please PLEASE keep us updated on your progress. I can promise to try to do the same.

40. for anyone whose your ruptures are severe and/or complete, obviously take my ‘no ring’ thing with a big grain of salt in such cases. i hope you’re able to eventually manage w/o your pulleys by various means. i’d be curious to know ultimately how the silver rings do, for those who have them.

    mike, bonnie: i just cringe, hearing what is going on in your fingers and (eek) count myself fortunate that i’m not in the same boat (or so i think and so it feels, anyway, having had no MRI). question for you then: do you have essentially zero strength in the affected fingers? i did early-on, e.g. 2 lbs before it hurt enough that i didn’t dare squeeze harder.

41. Just read your A2 injury article. I feel your pain, I’ m just recovering from an A3 partial tear on my left ring finger. I climb about 150-200 days a year about half that is outdoor days and climb upto 5.13+. I’ve injured the same pulley several times to varying degrees. Looking back I have injured it once every 2-3 years or so for the past 15 years. I’ve never had a formal doctors appointment regarding the finger injury. My injuries are such that I always can climb, with only discomfort at the time, but the finger is sore and swollen for a day or two after climbing. This is the first time I’ve injured it on real rock. This time I took 2 weeks off after the initial injury, then climbed for 3 months pretty steady with the injury. It wasn’t getting any better so come fall I took 10 weeks off and I am now starting climbing again and I’m excited to say it is starting to feel much better. Here’s my take on recovery:
    1. time off, usually it takes at least 6 weeks, I try and take up a new sport in the mean time and take the opportunity to work on my muscle imbalances and flexibility. I think I can actually improve my overall climbing if I am focused in my cross training.
    2. Contrast bathing: seems to make a difference, especially lots of ice when ever the finger is sore.
    3. I compulsively massage the finger, I think this helps and it gives me a good indication of how sore it is: how much it is/is not healing
    4. after my rest period I have found that the finger is sore while climbing, but after several sessions (1-2 weeks) it begins to improve rapidly. This short period of discomfort has been consistent each time I am recovering. I think it has led to longer than necessary time off as it never feels good the first few days back when I am “testing it out”.
    5. Tape: for me the tape is 50% psychological, reminding me I’m injured and 50% reduced movement: I try and tape enough that is it physically difficult to move the finger to the injurious crimping position.
    6. Hydration & nutrition: I’ve tried a bunch of stuff, basically I think taking vitamins and eating right helps me heal faster. I’m sure dehydration has contributed to most of my injuries.
    Anyway, there is my two bits, good luck.
    Simon

42. First off, a huge thank you to both Tom for the post as well as all of the commenters – a lot of useful information all around, it really lifts the spirits.

    I’ve just had a similar injury (pulled tendon pulley, possibly small partial tear – any good way to tell the difference?) on my right ring finger. For now I’m resting (been only a week) and using a gel recommended to me by a friend to massage my hand. It’s for ‘connective tissue and joint car’ and if nothing else my finger feels better for it.

    A question for Simon – what sports or other activities do you do for cross training? I need something to keep me occupied if I can’t climb 🙂

    Also, to everyone in general, how do you (or did you) get back into climbing? Taking it slow, obviously, but how long did it take before you felt confident putting any serious weight on the injured finger? Is it better to do small excercises (by small, I mean something as strenious as typing) or just rest as much as possible to let the pulley heal?

    Once more, thank you for all of your inputs, and I hope for the best for all of you!

43. another victim… sorry to hear about your finger, @jure. be super-gentle with it. depending on which ligament (or ligaments), typing may feel just fine and pose little to no risk. it offers only low resistance and the angle shouldn’t be such that you’re really engaging the ligament much if at all. i found myself able to type without pain immediately following my injury. just about anything else, from carrying groceries to picking up cats to even dreaming of climbing… everything hurt or at least scared me in its own devious way. i’m now 7 months out, plus a few days, from my injury, and am happy to say i’ve reintroduced, finally, some pull-ups on the hang-board (using the jugs only), and so far have no pain. i’ll keep it low-key and hopefully with some caution i’ll be able to get back on the wall and start bouldering again. i’ll be taking it really, really slowly.

    as for gentle exercises, anything that involves curling your fingers into a fist, whether open or closed, is important both as an indicator of the damage, and of your degree of recovery. do you feel confident that you’ve isolated which ligament(s) are damaged? try very gently, slowly, tightening your fingers into a fist. stop immediately if it hurts. remember where that point is, and if it’s nowhere near your palm, as mine was, count yourself fortunate that there’s something still attached *to* make you feel pain. but don’t count yourself so fortunate that you go climbing tomorrow 😉

    as for recovery, you’ve probably seen from medical papers or this post, that the tissue is not vascularized to any appreciable degree… your healing is approximately by osmosis. get ready for it to take a while if you beat it up. do whatever you can to noninvasively encourage bloodflow. your kneading may be a good approach, but remember that tissue is super-delicate.

44. Thanks for the reply – it really is great to get feedback and info from fellow climbers.

    It seems that in my case it’s not that bad – I can do all of the above, that is, carry groceries and other heavy stuff, drive (manual shift), etc. I’m not sure what you mean by tightening my fingers into a fist – I feel pain when I have my hand streached out and tighten from there – I haven’t tried, but I feel as if I could easily hang from a jug, but not put any sort of pressure on slopers (and forget about crimpers – it’s what started this for me in the first place). Even with day-to-day things I only feel pain when I have my fingers streached a bit and then apply pressure – not if I have them currled up in a fist. Since it’s been less than a week, I don’t want to experiment just yet and stay on the safe side.

    I’ll stick with the kneading and also try the contrast bathing, sounds like it should help. Since I’m pretty new to climbing (only about a year and a half), I really don’t want to take chances.

45. @jure, yeah slopers would hurt me still. i can feel it a bit if i just palm my opposite fist a bit in the way i would, if it were a sloper. for me, with a confirmed A2 tear and possibly lesser degrees of damage to the C2 and A3 adding to the fun, drawing the fingertip of the injured finger down and inward to touch the first fleshy “pad” directly below where the finger attaches to the palm… that hurt more than the original injury. i can do it now w/o pain, and have for a month or so, but have been very conservative in reintroducing anything strenuous.

    hanging from a jug is a lot of palm and thumb, and not all that much A2, which makes it a good way to slowly get back into it. and yeah, crimpers… scariest if the knuckle is hyperextended.

46. I have full range of motion – that is, I can move the finger in the way you describe with no pain or trouble. I’ll see how it goes – and I’ll post the progress back here for any future climbers.

47. I’ve decided to check in again with an update regarding the injury which I’ve already mentioned above – I hope it helps anyone looking for information in the future.

    Anyhow, I spent a good month with no climbing at all. None. I did some hiking, and a bit of mountain biking, and I think the mountain biking helped, since it put a different sort of pressure on the hand/wrist area – if nothing else, activity helps the blood flow, which helps with the healing.

    Speaking of healing, I tried the cold water – hot water treatment once, but I don’t think it did much. I did massage the hand with some lotion, which felt quite good (the stuff is called Pernaton, should anyone look for it on-line).

    After that month, I tried climbing on rock with some very easy grades (5.6). It felt OK, so I tried some easy dry tooling – holding an ice axe also felt alright, though my hand felt tired quite quickly. I’ve started climbing more and more, but only rock (no plastic) and easy grades – up to 5.10a. I tried climbing on plastic today and sticking to jugs (it’s been a month and a half), but it doesn’t feel good. My hand feels like I’m going to damage something if I pull to hard, so I’ve decided to stay away from plastic for at least another month or so.

    This will probably be my last post on the subject, so good luck to everyone! Stay safe!

48. Hi Everyone,

    I think I am having the same sort of symptoms as I’m reading here but not quite as severe. I can crimp at what feels like maximum strength with little pain (as long as I warm up very well) but when i get off the wall and i squeeze the base finger pad I can pain. 48 hour after a hard day of climbing I don’t feel any pain anymore what so ever. Even if i squeeze the area or crimp things around the house. But then as soon as I begin climbing again I can feel the pain if i squeeze the area. I am really not sure what to do because I have competitions coming up soon and it doesn’t really feel as if I am making the injury any worse because after 48 hours the finger is back to normal until I climb again. I am planning to compete and then rest it for a couple weeks because I don’t think it will take that long to heal as the injury doesn’t seem nearly as severe as others on this page. I haven’t yet seen any doctors about it. I think it happened when I was warming up and I grabbed a hard crimp too early in the warm-up and I felt a large pop in left middle finger. There seems to be some bowstringing in the bad finger compared to the normal one. Not a huge amount.

    I have never been injured before from climbing even though I have been climbing for 9 years so this a new experience for me…

49. Eric – sorry but it sounds like you absolutely have a pulley injury, at least grade 2. You are absolutely making it worse by climbing on it that soon. I had the same issues for several years. It’s easy to think it’s minor since the pain goes away so quick, but it’s not healing properly. Those symptoms are similar to as mine (except I never heard a pop nor bowstringing) and it took over 9 months of rehab to heal. My recommendation – stop climbing asap and go to a hand therapist to put you on a proper course of rehab.

50. Hi again,

    Thanks for the input Tom. So yesterday was my first day climbing since I posted last (about 17 days) and it seems like the injury is much much better but not fully healed. Here’s whats happened. Previously I was feeling pain when I pressed or massaged the base pad of my middle finger. I went to a physiotherapist specializing in the hand and she didn’t give me a definitive answer as to what was wrong with me. All she said was that I should stop climbing for a week and a half. So I added a week to her estimated rest time and climbed for the first time yesterday. I buddy tapped my middle finger to my ring finger with the criss-cross pattern on the underside of my joints. After a day of long endurance climbs on vertical to roof climbing here’s the verdict. The pain where I used to feel it is basically all gone which made me very happy, however; I started to feel some pain when I pressed THE TOP of my 2nd/middle knuckle (first one after the palm) on the side of the hand. So since the original pain is basically gone so I am lead to believe that my A2 injury is basically healed. I am hoping that this pain I am feeling is just a shock from my fingers after getting back into climbing. Has anyone experienced this pain in the healing process for an A2 injury? I’m going to climb again on on Monday and see how it feels after 2 days rest.

    Thanks in advance,
    Eric

51. WOW!!
    What a resource this thread has been; one of those “read the whole effing thing” threads. I’m on DAY 3!!! UGH, and screams, of a suspected A2 rupture. Here’s my question.

    Is the *POP* that some people have reported hearing/feeling (which by the way, made me throw up at the crag it was so sickening) indicative of the severity of the injury? I have never heard a finger pop in any way remotely similar to this. My injury was left ring finger 2nd “pad” from the palm. It popped while in a large two-finger pocket at Rumney, NH.

    Again, thanks to all the climbers who have contributed here, I shudder at the though t of taking off as much time as you’ve all indicated/recommended, but I’m coming to terms with it; I guess I’ll go the beach and swim all summer.

    -nick

52. @nick, some people have a pop, which my dr. said is usually attributable to the tendon flopping forcefully from one point to another, and when it’s accompanied by the kind of force we exert on our fingers, it is more likely to be a sprain or rupture. mine just made this awful crackling sound with no pain.

    what’s vexing about this injury is its actual severity is difficult to non-surgically determine. a high-res digital x-ray can reveal a tear, but unless it’s perfectly focused, the extent can’t be really diagnosed. my hand specialist dr. said he can palpate the thing to get a feel of how bad the bowstringing is, to have a reasonable guess at the extent of the tear. you could probably google and find pix of really bad bowstringing, where the victim has a complete rupture and no protection whatsoever by the ligament tissue. so long as yours isn’t doing that, you probably still have some connected tissue left, but don’t risk a real blowout by trying to go climb on it again.

    if you suspect it’s pretty bad, and if you have lots of swelling that you can’t get under control, significant pain, all that… go see a specialist. don’t wait. i’m at about 9 months out, and feeling like i could probably go climb gently with it now. slow slow healing for mine.

    get used to babying it. do not pull up socks or shake your hands dry. don’t catch a football. don’t use a hammer. tried those, had a freakfest.

53. I too, felt something snap inside the finger when it occured in mid-July. Like a small rubber band letting go. I was diagnosed with an A-2 pulley rupture to the left middle finger a day or 2 later. The diagnosis was provided by a hand specialist within a local orthapedic group with an excellent reputation. His diagnosis was based on my symptoms and visual observations. Xray and ultrasound were inconclusive and MRI was not recommended. He did not recommend surgery even though I was more than willing, hoping it would speed up the healing process and provide an equal or better result.

    His opinion was that, if partially torn it would heal itself with rest and proper imobilization and… if fully torn, it could be repaired later using a ligament from the wrist and looping it to fashion a new pulley for the tendon(s). He also indicated it was considered a last resort since there would be a lot of trauma to the area, presumably leading to somewhat less than a perfect result. (my presumption)

    I spent 2 weeks with a pulley ring that their hand therapist fashioned out of a similar thermoplastic material some of you have described. It had a velcro attachment and it was flat on the bottom (palm side) of the finger. I had problems getting it tight enough so they came up with a similar ring with a slightly upward concave in the bottom that would apply a light pressure to the pulley/tendon area without restricting the blood flow around it. It seems like a more comfortable design, not having to be worn as tightly. Due to its width (5/8″) however, it is still restrictive enough to prevent me from making a fist.

    At this point, it has been about 4 weeks since the injury and I am due to see the hand specialist again in 2 weeks. I can’t really tell how or if it’s healing since I’ve been very reluctant to test it lately. I do plan to post an update after he sees it again.

    In the meantime I will continue to read what I can about pulley rings, silversplints and surgeries in the event this doesn’t work. It seems that, after reviewing the material posted here, it can take more than a few months to heal. I wasn’t quite prepared for that but I can see that patience seems to be key to recovery here and every patient is different.

    If there’s anyone out there who has had any experience with any of the long term fixes… surgery, silversplints, etc. I’d like to hear how you did.

    Thank you all for posting your experiences.

54. Bill – how has the pulley ring been working for you? That was never even a suggestion from my hand therapist. Essentially her plan (which appears to have worked) was putty, stretching, deep tissue massage (esp. to break up the scar tissue in my case) and getting back to easy climbing. The key for me was a very slow and deliberate increasing of my climbing, not jumping back to where I was. Warming up extensively has also helped a lot.

55. Bill,
    I’ve been to 3 hand specialists (in ’09…see previous posts) and was told I have a ruptured A2 pulley, right ring finger. Dr #3 (who was the best of them) ordered an MRI which revealed A2, A3 and A4 were all ruptured, not just A2. He was pretty surprised himself and called in his assistant and a couple of therapists from the PT department to show them the MRI and my hand – none of them had ever seen such a bad rupture (I know, not very comforting!). If yours is a complete rupture then the tendon is no longer attached at that spot. PT, therapy, massage, rest, stretching etc isn’t going to fix that – as my doctor said “the damage is already done”. He also was not very positive about the same surgery your doctor discussed with you. It’s a complicated procedure and a very long, slow recovery period (ie months of PT). He did not feel the odds of a successful procedure without scar tissue forming warranted the surgery and recommended against it. His exact words “if it were my hand with this injury, I would not have the surgery”. He said if any scar tissue forms my range of motion could be limited and I could end up not much better off (or even worse) months after the surgery than I was before. I wasn’t willing to take that risk on my dominant hand and have decided, for now, to learn to live with the injury. For the most part, I’m not in pain though I have limited grip strength and it gets a little swollen and stiff if I’ve used it too much. I’ve had good success with the thermoplastic rings made by the hand therapists…with it on I have much improved grip strength and I can almost make a complete, closed fist, without the ring, not even close. Hard to do pull ups, braking on my bike is more difficult but with the ring on, it helps (not 100% by any means, but definitely better than without). I’ve just had to make a lot of adjustments in how I do things. The problem is I’ve gone through 3+ plastic rings in only several months. If you’re active, they don’t last. I’m in the process of talking to several jewelers about custom making a ring that mimics the shape of the plastic ones I have..mine are not perfectly round, flat on the palm side as you described and they need to expand slightly to fit over my knuckle and then contract again around the base of my finger which is considerably narrower now since I ruptured the pulley. I’m sure it will be a period of trial and error with the rings a jeweler makes but I’m hopeful I’ll eventually come up with a good shape.

    I hope some of this info is helpful to you. Good luck with your injury.

    -b-

56. Bonnie,

    Thank you for your comments. It seems that my doctor may be taking a similar â??the damage is already doneâ? approach. As far as I can tell he’ll assess any progress at my next visit Sept 1st. If it’s a partial rupture, it’ll slowly begin to heal itself and show some sign of progress. If there’s no sign of progress, then an MRI before surgery might be warranted. Either way, the damage is already done and, if fully torn, the surgery can apparently be done any time.

    Many of the drawbacks and complications you mentioned, when your doctor described the odds of a successful procedure, are strikingly similar to what I was told.

    Like you, I find it amazing how many adjustments I’ve had to make to the way I do things. The thermoplastic ring allows me more use of the hand than without it but anything other than light gripping is out of the question and I’m not able to fully close to a fist. I’ve only been using my rear brake while cycling, avoiding the front brake if I can. The swelling and stiffness also sound all too familiar. The stiffness is mainly at the middle knuckle. I’ve also found out our refrigerator door is mounted on the wrong side (at least for me). I haven’t quite learned to live with it yet.

    I completely ruptured a distal biceps tendon about 10 years ago on my dominant side and had it repaired by the same orthapedic group. I remember the surgeon looking at my arm and saying with confidence, “I can fix that”. I remember the recovery and rehab to be long but the repair went perfectly. It took time but it really is “good as new”.

    Compared with the biceps tendon, this tendon pulley should be any easy repair but I’m finding out that’s just not the case. It’s not my dominant hand so, if surgery becomes a final option, I might be a little more willing to take a chance. The months of recovery and rehab are not something I’d look forward to though if the results are too uncertain.

    It’s good to hear from someone that thinks a more permanent ring has some potential and I’m sure I could get a local jeweler to make one.

    Hoping to know more Sept 1st.

57. Tom M,

    The thermoplastic ring they made up has at least given me the ability to lightly grip things i.e. to curl my fingers around a steering wheel without pain. It does limit my range of motion and I’m unable to close to a fist. I guess you could say that it allows me to move the finger over a limited range with little or no pain. It does swell, as Bonnie mentioned, and it does get stiff mainly at the middle joint.

    As far as how the ring is holding up, they made this one up over a month ago and it seems to be holding up pretty well. The velcro is getting a little shabby but it should last til my next appointment. It’s good that it is adjustable with velcro since I can compensate for the swelling during the day.

    Not sure where the doctor’s heading from here but putty, stretching and deep tissue massage haven’t been part of his plan. At least not yet. It doesn’t sound like he’s trying to rehab it. At this point it sounds like he’s trying to have me rest it, limiting what I’m able to do with it while still providing some freedom of movement and then re-evaluate when I return.

58. Bill – what about physical activity? Do you think you’ll able to bike, climb, etc. with the ring at some point?

59. Bill,

    Good luck with your Sept 1st appointment. Please send an update! Just curious…what state do you live in? I live in California and the 3 orthopedic clinics I went to were in southern CA.

    If you end up having an MRI see my 12/17/09 post. I’ve had several MRIs in the past for other parts of my body (knee, etc) that were fine so I was quite surprised at how uncomfortable the one for my hand was because of the position they had me in.

    If you have the surgery as a last resort, I would be very interested in following how the procedure and your recovery go.

    Best,

    Bonnie

60. Well, I had my Sept 1st follow up and promised some comments on how it went so here they are…

    The doctor recommended continuing use of the pulley ring for another 3 weeks for most everyday activities but he’d also like me to work on getting back some of the range I’ve lost over the past 5 or 6 weeks. Warming it up with moist heat and then simply flexing it in and out slowly and gently. He said to repeat this frequently. If it hurts at any point, STOP. His exact words were “let pain be your guide”. He also advised me not to do anything that involves putting any stress on it but he did recommend removing the ring for driving. He did not recommend anything to build strength in the form of any putty exercise just yet.

    He did say that at this point it is healing, but if it tears again…it is back to square one. Not very comforting although it was good to hear that, after all this time, he thinks there’s progress. He seems to be very sure that it’s not a complete tear and that was also promising. Surgical options were not discussed at all this visit.

    After only a few days of warm moist warm-ups and finger flexing, the middle knuckle is showing less stiffness. Still unable to flex the finger inward toward the palm enough to make a closed fist but he says that will improve with time. It’s much more comfortable driving without the ring. Next follow-up is in 3 weeks.

    Keeping my fingers crossed and hoping my patience does not run out in the meantime…

61. Bill,

    Glad to hear your injury was not a complete tear. I hope your recovery continues to go well even if it feels like it’s moving at a turtle’s pace! Hang in there and be patient!

    Best,

    Bonnie

62. Thanks for the post. I have a partial tear right now on my A2 pulley. After about 8 weeks off of any climbing, I started to get back on the beginner problems at the gym. Hardly any pain, but there’s still a small amount of swelling (after about ten weeks now), so I’m still staying on the easy stuff. I do tape, and am a supporter of taping. I have friends who said for them it has taken 4, 5, or even 6 months for this injury to heal.

63. Sara – not to discourage you, but my partial tear of the A2 pulley took at least 9 months of active recovery to heal fully (and I’m still taking care not to re-injure).

64. I am adding my name to the list of left-hand, ring finger, A2 partial tear victims. Thanks for all of the info, everyone. I am going to get an MRI this week to confirm, but based on all of this info I think that is what I have. I was doing pull-ups on a finger board and heard the sickening A2 tendon pop. All of your symptoms match mine.

    For those that have not found a permanent “pulley ring”, please send me pictures of it. I am the manager of a high-tech tooling company that has very sophisticated machining equipment that could make one out of metal. If I can get one made for myself using your info, I will make one for you for free as well. Send it to mtndude3737@yahoo.com. It would be adjustable and made of stainless or something similar. Of course, you would get no warranty, but I would love to test these out and get something to work that is durable.

    Also, check out this link for a more detailed medical look into the finger: http://books.google.com/books?id=fkBSxDyH_O4C&lpg=PA1839&ots=lKXw1se4Ma&dq=%22finger%20bowstringing%20photo%22&pg=PA1840#v=onepage&q&f=false

65. So, I was climbing over 1 month ago. Had my right hand middle & ring fingers crimped on a hold, weighted them as I was lifting up, then heard a loud “popping” sound as my fingers went slack and the hand flooded with pain.

    My right hand ringer finger was in acute pain for a few days, then seemed to get relatively better. Lately, it’s become worse. It hurts most badly when I wake up in the morning, but the pain fades as the day goes on. For a couple weeks, when I’d wake up and flex my hand, the pointer finger would “catch” and then jerk out as I slowly uncurled the fingers (“trigger finger”). I can’t touch the base of the finger — probably a 1″ gap or so.

    So, my self-diagnosis is this is an A2 Pulley Injury (judging by the similarities to all of the posts above). Here’s my question: is there a way to tell if it’s a complete or partial rupture by the range of motion? Could anyone here with a full confirmed rupture comment on this? Is that fact that I can touch the center of my palm with only mild pain a “good sign”? Or inconclusive?

66. Stephen, you have my sympathies… and you should see a specialist about this. When I talked with a hand specialist about mine, he indicated that the only way to truly know whether it’s a complete rupture is surgery — go in and look… which is idiotic of course. Just his analytical example. He was able to evaluate my degree of visible bowstringing, palpate the affected region of my finger, and look at a low-power digital x-ray and determine that I still had some attachment. Aside from that, there’s really not a lot that can be done in terms of noninvasive evaluation. I’ve seen that some success can be had with a CT scan, so you may look into that.

    Good luck. Hope you’ve got a partial.

67. I was lucky and a good friend of mine is a Radiologist. He gave me an MRI (for free, whoo hoo!) and we both sat down and examined every minute detail of my finger. We determined that I have a partial rupture. It has been 2 months now and it is still quite inflamed. I can touch the base of my palm with minor pain, but can’t touch the pad under my knuckle. This is largely due to the inflammation around the A2. I also ache when I wake up, but then it feels somewhat better as the day goes on. This is common with any inflamed joint or tendon. When I ice it and take ibuprofen (800 mg) it feels much better. I also tape it whenever I have to do anything strenuous at all. I have modified my weightlifting to not grasp the bar, and I don’t climb at all. I work out a soft squeeze ball for 15 minutes a day, ice it, then tape it with athletic tape on the top side of the finger. All of this seems to slowly be improving it. I think the only way you can know 100% that it is fully ruptured is: 1) it is obvious – you would notice “bowstringing” of the flexor tendon (an abnormal sagging look to the palm side of your finger), or 2) have an MRI done. Either way, I have heard nothing said by anyone on here or my doctor that surgery is really an option. If it is a partial rupture, you have to stay off it, slowly strengthen it, and over time it will heal. If it is a full rupture, you will be taping it or using a ring like Bonnie describes above. Good luck.

68. Stephen,

    From what I’ve learned over the past year and a half and multiple doctor visits, the only way to really tell if it’s a partial or complete rupture (short of having a doctor cut open your hand to look at the damage) is with a MRI. In my case, the doctor suspected an A2 rupture when he examined me (right ring finger) but wasn’t willing to make a conclusive diagnosis without the MRI. Much to everyone’s surprise, the MRI revealed it was actually a complete A2, A3 and A4 rupture so PT, rest, ice, heat or any other alternative treatment is not going to “fix” my finger. He was surprised at the extent of the damage he saw with the MRI vs his initial diagnosis from just the physical examination.

    As far as touching the palm of your hand with your finger being an indicator of partial vs complete rupture, I doubt it. If I reach hard I can still just barely touch the palm of my hand with the tip of that finger (without the plastic ring on…it’s no problem with the ring on) but it’s not pretty and it doesn’t feel great. For the most part, while doing day to day activities (without the ring) that finger just flops around once I try to close my hand past a certain range – the rest of my fingers curl up into a fist no problem but the ring finger sticks out and is limp. I’ve learned to live with it (don’t have much choice!) and have adapted in so many ways for various activities.

    I still haven’t found a jeweler to make a ring in the shape I want. I did find a company back east that sells sheets of the heat moldable plastic and I’ve been experimenting with making my own plastic rings. I haven’t come close to mastering it yet – I’m right handed so trying to mold the plastic around the injured finger with my left hand has been a challenge. Each attempt gets a little better. I can tell having different width rings for various activities would help. For instance, the rings the hand therapist made for me are too wide and thick to use while weightlifting, to wear under gloves with a ski pole or for braking confidently on my road bike but they feel great for everyday use. I’m hoping I can make a narrower ring that will work better for sports. Speaking of skiing and winter sports, I do notice my right hand and that finger in particular seem to get cold and go numb much sooner than my left hand. I plan on experimenting with hand warmers and possibly some heated gloves this winter.

    In general, I notice my finger hurts more than it used to several months ago though I still wouldn’t consider it serious pain. It aches most of the time and I suppose I’ve just gotten used to it. I use my left hand a lot more now and fortunately that doesn’t feel quite as clumsy as it used to.

    And to Rick who first posted on 11/8th – I would be interested in talking to you about making a ring. Once I master making my plastic rings, I can send you a picture of the shape – it’s a custom mold of the circumference of my finger which is now a really odd shape, far from round like a normal ring, with weird angles due to the bowstringing.

    Good luck to all – I hope some of what I’ve shared about my experience with this injury is helpful to others.

    Happy Thanksgiving!

69. Bonnie,

    Feel free to send me a plastic ring that fits your finger. I will do my best to duplicate it in metal (more than likely stainless steel). That way I can copy the basic design for myself. Taping works but I would rather have something solid. Feel free to email me directly at mtndude3737@yahoo.com for my address. A warn-out one would be ok although ya might wanna wash it first 🙂

    Happy Thanksgiving to you too! Let’s be thankful for the good fingers we do have!

70. Leif, Rick, Bonnie — thanks for the quick responses! It’s disappointing that severity can’t be more easily detected.

    I had a Doctor appt today, and without me mentioning anything about my suspicions, they correctly diagnosed it as an A2 pulley injury. The MD said they only see them in climbers and seemed to be relatively familiar with them (Beth Israel in Boston). I have an MRI scheduled for Wednesday and a follow-up next week.

    Although, it’s sounding like there’s really not much you can do…! I guess it’ll be good to know if it’s full or partial for my own enrichment, but it sounds like surgery really isn’t the optimal solution either way? I had assumed that the next step would be: partial = rest & rehabilitation, full = surgery.

    Again, appreciate all the comments on this thread — it’s an enlightening (and a bit disheartening) read.

71. Stephen,

    I was diagnosed with a partial tear to the A2 on my left middle finger 4 months ago without the benefit of an MRI. It was his opinion that MRI’s are often inconclusive. The doctor, a hand surgery specialist, discouraged surgery even if it was a complete rupture and said that complications from the scar tissue could cause chronic pain and permanent loss of range of motion. I wore a thermoplastic pulley ring with a velcro closure, fashioned by their hand therapist, for several weeks and it seemed to keep me from injuring it further.
    Four months after the injury and I can touch my palm with the fingertip of that finger only after a 5-10 minute soak in warm water. I do that twice daily. Several hours later, it is right back where I started with little noticibale improvement. If I try to close it fully, without the warm water soak, the pain is mostly in the palm. It is comfortable to grasp a thick object like a steering wheel but impossible to grasp something thin like a rope. It slips right thru my fingers. Similar to Bonnie, I have noticed that the finger gets cold faster than the others. The doctor did say that it will take a long time to heal and if it tears againâ?¦back to square one if it’s re-injured. I made the mistake a few weeks back of (instinctively) trying to catch a fly with that hand. I tried it without thinking. OUCH! that hurt. I’ve seen comments from others here that they’ve gone nine months before a partial tear completely healed. I am hopeful that it will heal fully and I’ve adjusted to it as well as I can in the meantime.

    I’m also thankful for the nine good ones I do have. Best of luck with it and have a Happy Thanksgiving.

72. The sun also rises. I’m pleased to report that after 16 months (?!) of recovery I have started to slowly reintroduce gentle bouldering into my regimen. I tightly taped my A2 area and buddy-taped that finger with my middle finger, set a few really easy routes with big jugs, took down crimps to avoid the temptation, and am starting out slowly, just a few minutes a day. So far, no pain while climbing and no pain later or the next day. As well, I’m adding more warm-up time and gentle stretching beforehand. Anyone have a link to, or a summary of, your stretching and warm-up approach?

    @Bill: fly-catching… yeah, been there. That really smarts. I’m sure you already discovered that pulling up socks and wringing washcloths are also giant no-nos.

    @Stephen: did your MRI tell you anything new?

73. Hey gang. Great post. Unfortunately I think I may have the same injury in my left middle finger A2 pulley. In comparison to some of the entries I’ve read here, however, it sounds like I may be catching it pretty early as I can definitely touch my palm and even the base of my finger with little to no pain depending on the time of day…waking up it hurts and limits me much more.

    Anyway, I was curious to hear if anyone ever tried taping the affected finger in a straightened position to do some lighter climbing. The tape would be more just a way of keeping me from bending it and therefore remind me to not use it on holds while climbing. My main concern with this is that the added stress on my other fingers on that hand may invite injury to a new finger.

    Also, many of you have mentioned massaging the affected finger. What do you do for this massage? How forceful do you get? Is this really beneficial? It seems like it would just irritate this area when it needs to be left alone to heal.

    Thanks for any info and best of luck/quick recoveries to you all!

74. @Mike G, unfortunately you’re part of this sorry clan now. If you can keep from using it while climbing, well, you have better motor control than I do. I would recommend against it because further injury will severely prolong your recovery. Give it a couple weeks of doing nothing at all, then see how it feels. It’s my understanding from reading a lot about this, that massage is detrimental. You’re not needing to smash a muscle knot smooth: you’ve got what sounds like a partial tear. If you had a sprained ankle, would you think to massage it? Probably not, and not run on it either.

    I think your concern is well-placed, that climbing with your healthy fingers could injure them, too. Just consider yourself fortunate that it’s not worse than it is, and be heartened that you can control that it isn’t going to get worse.

75. followup…

    Yeah, I know that after some healing, one could massage a sprained ankle, etc. In this case, it sounds fairly fresh, so to speak, and so my note above was meant in that context: a fresh injury of this sort would just be aggravated by massage. It never felt good at any time, to massage my finger. I also laid off climbing for months and months. Hopefully if you give it a couple weeks to rest, you can be back at it sooner than if you tried to avoid using it, and kept climbing.

76. Mike,

    I second Leif’s opinion – don’t get back on it until it is 100%! It will prolong the pain and suffering. I tape my finger so that I can do my basic weightlifting, but I avoid exercises where I have to grip the bar hard to hold it. I use standard athletic tape and tape parallel to my finger with it bent back, and then 3 wraps around the injured area.

    Light massage is OK for a few minutes every day to bring some blood to the area. I am talking VERY light. The idea is that it speeds recovery by drawing attention to the area. I also GENTLY pull and GENTLY stretch it, never passing the point of pain. I also have a soft squeeze ball at my desk, and I do multiple and single finger exercises on that finger for 10-15 minutes per day. If it gets pretty sore I will ice it for 15-30 minutes. Over the last few months it really feels like it is getting better. I have not climbed on it for almost 3 months now, and I plan on using the winter to do other activities.

    Good luck man!

77. Thanks for the words of wisdom, guys. I think you’re right about just keeping off it at the gym. Like Rick, I do plan to do some weight training during my time off, but only the exercises that wouldn’t require a pull from my fingers. I figure these to be: bench, dips, curls (keeping the bar toward or in the palm), maybe some forearm stuff if I can find a good way to do it without recruiting that finger.

    The timing of the injury would normally be ideal given it’s winter. Unfortunately I JUST joined the gym a couple weeks ago to get in some work during the off-season. I guess it’s better to to take some gym-time off than lose time on the rock this spring/summer. I just hope I don’t lose these callouses that took many a skin-ripping hanger to finally build up!

78. Hey gang,
    I curious if anyone has ever tried TENS (transcutaneous electrical nerve stimulation)? I hear its good to block pain and with the minor electrical stimulation, it will bring blood to the area to help the healing process. Physical Therapy clinics use it for back pain and other injuries. I have also come across a couple climbers of the years that swear by it and say that it got them back to climbing much sooner, but I wonder if it really works or is it just a placebo effect.

    I know that icing and IBU is the best thing at the on-sight of injury to help reduce swelling and inflammation before trying to rehab it. I hope someone hear has some experience with this and come shed some light for me as I do some more research.

79. can’t say in terms of personal experience, but i can say the PT i went to for a bit, did not endorse it. however take that with a grain of salt since that’s just one PT. the preferred approach (at least at that stage of recovery) was putty, a rubber band, etc.

80. Like most climbers, I too have sufferd from many climbing injuries. I have done a lot of reading on the subject and spoken to medical experts on the matter. Here are my views.

    Climbing is bad for your fingers, arms and shoulders. We are not meant to climb rocks.

    Taping can work, but only if you are recovering from a injury. It should be avioided once your fingers are better as this allows to tendons to grow stronger.

    Cold water therpy is OK but conbine it with ice treament (for the first week after injury), alternate hot and cold treament. Cross fiber massage (not after ice or cold water), Distilled Witch Hazel on a bandage and leave on finger over night (this can be done as much as you want, it will bring any swelling down). Non-steriod anti-inflammatory drugs (only use for one week).

    As far as climbing goes, dont do anything that hurts. Climb on easy routes or holds that dont hurt. Try some endurance climbing for a while. Lots of endurance climbing games on my climbing courses and tips website.

81. Hi

    I agree with all you have said. I have a page on my website all about this, but I have forgotten to add the taping information. I agree with you, taping helps when recovering from an injury.

    I hope the stuff at My rock climbing site will help.

82. hi guys, I read everyone’s comments and learned quite a bit. I was curious to hear if anyone has recommendations on my current condition. I stopped climbing in November due to moderate carpal tunnel syndrome. So that has improved, and I decided to return to the indoor gym last Sunday. I warmed up on some 0s and 1s and felt pretty good. Then halfway up a relatively simple 2 I felt a pop in the base of my middle finger in my dominant hand, followed by some mild pain. I hopped off the wall and called it a day. I have been taking advil and applying ice, and it’s now been about 48 hours. I can’t quite close my finger to my hand, but i can flex the finger and touch the base of my palm. It is swollen a bit as well.

    I am wondering if anyone can tell me what to expect. When do you think the swelling will go down? How can you tell between a strain or a rupture or a tear? Any new light will be much appreciated. Thank you

83. I had a partial middle finger A2 tear (undiagnosed) from 45 years of bowling. I felt it when the partial tear happened. Bowling a week later, I still felt a little pain, but continued bowling a I had no reason to suspect what was causing the pain. Then I threw a shot and immediately felt – and heard – the pulley completely tear. I had never had a problem with this, so the entire happening was a shock. I guess what I’m trying to say is if your pulley is partially torn, it is my opinion that if you keep doing what caused it to partially tear in the first place, it will eventually rupture completely. I can’t see how a partial tear can fix itself with rest. It is still going to be partially torn no matter how long you rest it. Then, when you go back to your activity, it is going to immediately start hurting and tearing some more. Anyway, I had the reconstruction and was back bowling in 3 1/2 months.

84. Hi Neal,
    You’re the first person on this post that’s actually had the surgery and I’m thrilled to hear it was a success for you. I’d be really interested to hear more detail about it (and I’m sure a lot of other people would, too)…the procedure itself, your PT/rehab, how long ago was the surgery, how does it feel now. If you’ve read this entire post then you’ve read my entries – I have a right ring finger complete rupture of A2, A3 and A4 so I hope you can understand why I’m especially interested in learning more details about your experience with the surgery.

    Thanks!

    Bonnie

85. I heard and felt the “POP” in my middle finger of my right hand two weeks ago crimping on a hold….I just started reading all these posts and now will do the right things to get back climbing soon!! Great tread and excellent topic.

86. @keith, sorry that’s happened. damn crimps… ha. that’s what mine happened on, too. a little advice not about recovery per se, is to avoid losing your muscle tone while recovery via some resistance training like bungees, to at least keep your other hand and the arm whose finger is affected, strong. i didn’t do this and wished i had.

87. Whats up dude? I cant stand hearing all the crap I just read. It is looser talk! Are you a fighter or what? Just because you have one painful spot in your body does not mean you stop climbing. Climb one armed if you have to. I am climbing v10’s with a swollen ring finger A2 full blown pulley injury. Its a matter of pain tolerance not some scientific fear based intelegence. Raise your pain tolerance a bit, get back on the rock and quite complaining. What are you going to do when you are 80 with every pulley blown, lung cancer, a brain tumor, and you can barely see? Are you going to quite then to? Man up!

88. Neal Vital
    Would love to know about the surgery. My 19 yr old
    Ruptured A2 and we are considering surgery.

89. Has anyone ever had their ring finger injured from climbing and it be permanently bent from the injury? Any help for straightening this finger?

90. Regarding taping: Personally, I climb differently when a joint is taped. It is one of the easiest ways to distinguish me from a cadaver rigged to a machine 🙂

    Nursing a torn A2 at the moment; we’ll see how it goes.

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