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Finger Injury - Pain in palm and forearm
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By CollinT
Oct 5, 2011
I was bouldering last night and was pulling really hard on a very wide pinch (ie open hand)and heard a pop and had a sharp pain shoot through my palm and forearm. My ring finger became sore and I had some mild pain after. After doing some research it seems like it is definitely a flexor unit strain. I still have full range of motion, no swelling, and the pain is almost gone but their is a small hard "lump" at the end of my ring finger now. The lump is right where the finger connects to my palm and I think it is probably a ganglion cyst. Is this common with this type of injury? Should I be concerned? See a doctor? Any insight would be greatly appreciated

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By Morgan Patterson
Administrator
Oct 5, 2011
Stoked...
You should see a hand specialist ASAP... Rest, Ice, message, stretch, repeat. I have had to deal with years of finger pain and everytime I climb hard my middle knuckles swell and feel 'funny'. It's no fun and honestly it sounds as though you might have a pully tendon tear, or the cyst on the tendon. Were you having any trigger finger prior?

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By Aerili
From Salt Lake City, UT
Oct 6, 2011
The West Desert...it's not just for climbing, suckers! <br /> <br />Photo by Samantha
Well, a ganglion cyst is not the result of a tendon strain afaik. The cyst forms in the tendon sheath and can occur regardless of injury, whereas a strain occurs due to acute or chronic repetitive trauma and is in the tendon itself.

Your mechanism of injury and the associated sounds and symptoms are confusing. Open hand injuries do typically correlate with tendon strains. But popping noises correlate more often with pulley ruptures, as do lumps around pulley locations (in your case, A1 I think) since it can be indicative of bowstringing. Pain down into your palm and forearm seem more indicative of a tendon injury again, however.

I would agree a visit to a hand specialist could be highly prudent. The right treatment will depend on the correct diagnosis. Internet diagnosis via laypeople is pretty unreliable.

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By CollinT
Oct 6, 2011
Morgan and Aerili - thanks for the reply, I think you are both right that it is important I see a doctor. I have scheduled to see a specialist tomorrow and will update with what I find out.

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By Joseph Stover
From Batesville, AR
Oct 6, 2011
Good on ya for making an appt. It's probably better to spend a few bucks and get a diagnosis and treatment, than to wait months only to extend recovery time 10-fold+.

I've had luck with: cortisone patches, deep massage, ultrasound, heat, and following the PT's exercise recommendations.

I got the "pop" once... (bouldering, after a long gym TR session), it sounded like it came from my forearm and my forearm hurt really bad... but that healed quickly, and my pulley in the ring finger took a bit longer. I was climbing within 2-4 weeks and back full strength in 2-3 months. This was with religious physical therapy.

Another, less serious pulley injury, I ignored it and climbed on... after finally getting some PT (with a lower quality therapist), it took a year plus for the pain and bump to go away.

Best wishes to a speedy healing!

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By Will S
From Joshua Tree
Oct 6, 2011
I would just add that a wide pinch doesn't necessarily equate to what we commonly call an "open hand" grip when considering all fingers.

Relative finger length (i.e. if your middle finger is say substantially longer than the others), is a contributor. I can be on some fairly wide pinches and depending on angle and specific shape of the hold might have 3 fingers in classic "open hand" shape and one in a half-crimp.

As others said, see a specialist.

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By CollinT
Oct 6, 2011
All good thoughts guys, I think the bottom line is I have no idea what happened :(

I wasn't having trouble with trigger finger prior to this, I thought maybe ganglion cyst because a friend had a similar injury and found a bump that ended up being that. More I look into it the more I realize it could be a number of things.

Anyways, I appreciate the words of encouragement and I will update sometime tomorrow after I visit the hand specialist.

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By CollinT
Oct 7, 2011
Went and saw the specialist today, turns out it was a partial tear of the A2 pulley. The lump that I noticed is a ganglion cyst which I was told is pretty common with pulley tears, when it tears fluid "leaks" and the cyst forms. Doctor recommended 4-6 weeks and then a gradual return to climbing. Below is a more detailed explanation of the injury in hopes it may help someone learn from my situation.

Sunday night consisted of an intense hangboard workout with the thought that I would take the next three days off. On Tuesday a friend I hadn't seen in awhile happened to be in town and wanted to climb, I reluctantly agreed thinking I would just take it easy. She wanted to boulder and again I agreed thinking that I would make a point of not crimping anything (can't get hurt if your not crimping right...) Didn't stretch properly and about an hour in tried a problem with a large block that I could barely pinch, getting just my fingertips over the sides of the hold. And then came the pop and pain in my forearm/palm/finger. Pain quickly went away and no swelling or loss of motion but I noticed a lump at the base of my trigger finger. Went to the doctor on Friday and he poked and prodded and decided it was a partial tear of the A2 pulley.

I will update if I learn anything else. Thank you everyone that responded to my original post! Would hope that I would have eventually decided to see the doc but you guys definitely pushed me in the right direction.

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By CollinT
Oct 27, 2011
So it has been a little over three weeks since the date of the injury and I am beginning to suspect that the specialist I saw at least partially misdiagnosed me. I have noticed a few things since the time of injury that make me believe that I have a Lumbrical tear: klatring.no/LinkClick.aspx?fil.... I have tested the finger several times and the only thing that creates pain is when I apply pressure to the tip of my finger in the open hand position with my ring finger isolated (only extend my ring finger and apply resistance). When I apply resistance over several of the fingers no pain, even in the crimp position. Also, the nature of the injury made me slightly skeptical of it being a pulley injury; open hand with my pinkie finger curled and not in use, and pain was in my palm and forearm not in the finger. However, their isn't much about this type of injury and maybe the pop and ganglion cyst indicated that I did a combination of things (a2 pulley and lumbrical tear, sweet). Anyways I have found a physical therapist (I have had much better experiences with them than doctors) that has extensive rock climbing experience that I am meeting with in two weeks so I will update then. Any thoughts in the mean time are much appreciated.

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By CollinT
Oct 27, 2011
Great forum I found talking about Lumbrical tears, hard to find information on this so hopefully this will help queenslandclimbing.yuku.com/to...

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By wankel7
From Indiana
Oct 27, 2011
That is great you remained curious after your original diagnosis. Heal up and thanks for sticking with your thread!

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By Sam Lightner, Jr.
From Lander, WY
Oct 27, 2011
The Shield
Its not a cyst... OK, you might have one, but thats not the injury. That comes up over time. The "pop" would have nothing to do with the cyst (in the short term).
You might have blown the A2 pulley and strained the tendon in the process. Truth is that even a true hand specialist reading about your symptoms online is second rate to a good hand ortho taking a look at it.

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By Jonathan Williams
From Minneapolis
Oct 28, 2011
Me.
Lumbrical tears are very rare. Strains can happen.

You can still tear A1 or A2 with an open handed grip, especially if the tendon is exposed to regular stresses or has chronic injury. If I'm playing the odds, and it truly hurts in your palms, I'd wager on A1 pulley injury, knowing nothing else.

A good exam can easily tell the difference between these injuries. An MRI would not provide much use, unless you are seeing a very experience hand surgeon and are a high level climber who wants to try to repair a pulley surgically. The standard of care is rest, and data exists showing that this therapy (rigidly applied) leads to excellent strength recovery in the ligaments.

-A radiologist climber.

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By fat cow
From Salinas, CA
Oct 28, 2011
perfect seam
had a similar thing happen, exept on a hangboard, pulling on a two finger pocket on the smallest ledge. i heard no pop, but felt it all the way to my elbow immediately and it hurt like hell. drunken feats of strength after a climbing competition are stupid... have a bit of a lump right in the A1 region, even a year after it happened, does it mean anything in particular that i felt it all the way to my elbow?

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By CollinT
Oct 28, 2011
Sam Lightner - Thanks for the thoughts, just curious as why you don't think that it could be a cyst that came from the injury? Some google searching has yielded several forums of people saying they noticed the "bump" after a finger injury (a couple in this post). My understanding of a cyst is that it is caused by the "lubricating liquid" in your joints and tendons leaking out through a small hole, seems like an acute injury could provide this hole? Also, I have now seen two orthopedic hand specialists who both thought it was a cyst that was a result of the injury, one implied that it was pretty common.

Jonathan Williams - I agree that the odds would indicate it is a pulley injury and I suspect it may be a combination of things but the lingering symptoms are making me think lumbrical. The main reason I say that is when I apply resistance to my fingers, crimp or open hand position, I have no pain and can apply a fairly significant load (havn't pushed it to far). However, if I curl my pinkie and apply resistance to the other three fingers or just the ring finger I feel a sharp pain in my palm between the pinkie and ring ringer. I get the pain with only a fraction of the resistance that I applied with the pinkie extended. Also, I have chronically dislocated my pinkies to the point that they have very little strength so I tend not use them when climbing and as a result I have a bad habit of curling the pinkie with the other fingers extended when climbing.

The good exam you are referring to seems to be harder to get than you would expect. Doctor A saw me for all of five minutes, said partial tear of A2 pulley, tape it and you can climb, if the cyst doesn't go away come back in a month and I'll pop it. Didn't like his response and found out we have a hand specialist that comes to my campus every Wednesday night so I decided to see him as well. He was better but also said partial tear of A2 pulley, pain in forearm and palm came from muscle strains, and he actually tried to pop the cysts right then (didn't work but it hurt!). I gladly accepted the diagnosis but the symptoms I described above have made me think that their is more too it.

Fat Cow - Interesting that you had something similar, check out the two links I posted above and maybe they can provide some insight. Not sure what having the pain travel all the way the elbow would indicate but I will keep my eye open as I research more. Also, I am seeing a physical therapist in a couple weeks that has extensive climbing experience and has worked with a lot of the local climbers so I could run it by him, more details on the injury would help though.

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By CollinT
Nov 17, 2011
Final Update:
I have now seen a great physical therapist in Fort Collins (PM me if you want his info) and have confirmed that it wasn't a A2 pulley injury. He also thinks it's a strain of my lumbrical muscle and suspects that I also strained my tendon. The biggest thing I learned from this is to trust what your body is telling you, nothing about the injury or pain I was feeling suggested A2 pulley to me but I readily accepted it when a specialist said that is what it was. This prolonged my rehabilitation and made for a frustrating month. I found a great paper titled "Finger pain in rock climbers: reaching the right differential diagnosis and therapy" that is worth checking out. It isn't free but you may be able to get it through your library or I can send a copy if interested. It breaks down the different types of injuries common to climbers, typical symptoms, how to check for them and suggestions for therapy. Thanks for all the responses and I hope this helps someone down the line.

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By T.Chin18
Nov 20, 2011
@CollinT - I just came across this thread and am suffering from what seems to be the same type of injury. I've been delaying in seeing a specialist, hoping that the bump at the base of my ring finger and pain would go away, but every time I try to grip anything the pain returns. I would very much appreciate the article you previously mentioned, and any advice on the type of specialist you believe best helped you. I'm stuck between scheduling an appointment with a hang ortho or a Physical therapist with a certified hand therapy specialty. So far I've been buddy taping (taping my ring and middle finger together) and taking a break from climbing. Any suggestions from anyone would be of great help!

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By CollinT
Nov 20, 2011
T.Chin18 - Sorry to hear that man, if you shoot me your email I can send you the article, also check out the post and article I linked above because they are both helpful. I ended up seeing a physical therapist that has been climbing for a long time so he new climbing injuries well. I have always had more luck with physical therapists but I am sure it just depends, I think finding a doctor that is familiar with climbing is most important. For me taping the fingers together helped (didn't at first and kept aggravating it) but I would suggest seeing a doctor of some sort that can assess where you are at with the injury. I took ~5 weeks off climbing and have just recently started gradually returning and it has been pain free and the bump disappeared about a week ago. If you give me some more info about the injury (where was the pain, swelling, range of motion etc.) and what is hurting now (where is the pain, open hand vs crimp, does it hurt if fingers are together etc.) I can tell you how it sounds compared to mine/give you my very unqualified opinion, but I think the biggest thing is find a doctor that knows climbing.

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By Ben Rakozy
From Phoenix, AZ
Oct 4, 2012
@CollinT Thanks a ton for your postings regarding your injury! I've got the same problem and was wondering what therapy techniques helped in recovering. Also, do you do anything special for taping and do you do anything now to prevent the injury from recurring? Thanks again!

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By CollinT
Oct 15, 2012
@rakozy1 My physical therapist did two session of trigger point therapy as well as some form of electrotherapy and ASTYM. I am unsure how big of a difference these made but if nothing else they made it feel temporarily better. The biggest thing for me was just starting to buddy tape the two fingers together which allowed the injury to heal. Once I started buddy taping every day it completely went away, I did this for a month or so and then gradually stopped taping. I stretch my lumbrical muscles now and am more conscience of how I am pulling on holds and make sure I don't curl my unused fingers. So far this has prevented any reoccurring injuries. Good luck and hope you heal fast.

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By Dgillis
Oct 19, 2012
Just incurred this exact injury this week. Minus the cyst. Good info.

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By Tony B
From Around Boulder, CO
Oct 19, 2012
Got Milk? How about forearm pump? Tony leads "Alan Nelson's Bulging Belly" (5.10, X) on the Lost and Found Flatiron. Belayer is Mark Ruocco. Photo by Bill Wright, 10/06.
Make sure you go back to the original physician and let him know what the end provided for you. You owe it to him and to his future patients to help improve the care people get. I have done this and have been thanked by doctors. They actually WANT that kind of feedback. Of course I have never been charged for that kind of follow up. Their offices have scheduled me for free when I said I wanted to visit to follow up on a doctor's misdiagnosis or incorrect treatment...

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By Charles Kinbote
From Brooklyn, NY
Oct 20, 2012
On Waimea, 5.10d
Sounds exactly like a flexor tendon injury to me.

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