Ring finger Pulley injury?

I know there are a million posts about this stuff on mp, but I didn't find an answer in my brief search, so hopefully one of you wise folks will have an answer. A month ago I was crimping a terrible small hold when I heard the dreaded "POP", but it more sounded to me like a knuckle popping and bones scraping than a gunshot like I've heard others say. The most obvious deficiency is the tip won't curl in tight, so when I try to touch my fingertips to my palm or base of my fingers, it sticks out and I can't close that finger down. I've been resting it, doing cold water treatments, and limiting pull-ups and other exercises that require holding on to a bar.
I know that this is just the internet, but I'm looking for insight from anyone who's experienced a similar injury. Thanks!

this article helped me a lot, it comes from Dave Macleod's climbing coach website:

THURSDAY, 18 NOVEMBER 2010
AVOIDING PULLEY INJURIES - THE HARD AND EASY WAYS
In the comments of my last post, John asked about how to avoid crimping all the time and hence reduce the build up of stress and microscopic damage that leads to pulley tears.
Of course there is the short answer of ‘just openhand everything’ and you’ll get better at it. When it comes down to it, that’s what you have to do. It’s not easy to take the temporary drop in climbing grade while you gain openhanded strength. Most climbers who’ve not had pulley injuries yet are miserably weak at openhanding and really have to take a hit. But it’s your choice - it’s only your ego you have to beat.
I’ll make a very detailed case in Rock ‘til you drop not only for why you must do it, but all the ways you can make it easier on yourself. However, since you’ll have to wait a little longer for that, here are a few headlines for now:
- ‘It’s just training’. The biggest enemy of changing habits like crimping is that climbers are always trying to compete, even in training. When you go to the climbing wall, you cannot bear to do something differently to normal because you’ll have to take a grade hit for a while. And maybe your training isn’t going perfect anyway so you are trying extra hard to the standard you’ve become accustomed to. There is only one way around it; stand back and realise that you are just training. You are just pulling on plastic blobs. Who cares what the number is? If you think other people do, you’re kidding yourself. Sure it’s ok to compete once in a while. Climb openhanded most of the time, and allow yourself to crimp when it really matters. If you don’t, you’ll only have to later when your broken pulleys won’t let you do anything else.
- Get off the starting blocks. If your openhanded strength really is that spectacularly rubbish in comparison to your crimp strength, you could get yourself off the starting blocks by a little supplementary fingerboard work with a 4 finger and 3 finger openhanded grip. Use the protocol I described in 9 out of 10. After 10 or 20 sessions you shouldn’t have to take such an ego hammering blow when you climb for real with an openhanded grip. But don’t forget that the subtleties of the movement are realy quite different than when crimping; getting comfortable with openhanded needs both the strength part as well as actually learning how to climb with it on real moves.
- Know the score. A lot of people I’ve coached reckon they just aren’t cut out for climbing openhanded. They usually invent a reason like the shape of their hands or the length of their fingers. Rubbish. If it feels weak, it’s only because you’re weak. And the only reason you’re weak on this grip is because you don’t do it. I challenge anyone to climb solely openhanded for 20 sessions or more and still tell me it doesn’t work for them.
- Do it on easy routes first. Very experienced or expert climbers have a disadvantage in that their habits are very set and egos expect very consistent performance. But the advantage they have is that a lot of the movement decisions are quite automatic. Someone who climbs 8a+ can probably do a 7c while having conversation. So there is room on easier routes during warm-up or mileage climbs to concentrate on learning a new technique like openhanding.
Crimp everything and you will suffer for it down the line. Don’t worry about it too much - most people have to learn to openhand the hard way (post-injury). But injury is arguably the most wonderful motivator for changing the way you climb. That’s what happened to me. At 17 I scoffed at openhanded climbing. 5 years of constant pulley injuries later I couldn’t believe how much better it is than crimping on the vast majority of holds.
POSTED BY DAVE MACLEOD AT 11:20 PM 14 COMMENTS

CATEGORIES: FINGER PULLIES, INJURIES, ROCK 'TIL YOU DROP

Thanks, guys. I wish i could have open-handed that hold, but it was low and the width of a tortilla chip. A doctor friend told me 6 weeks, and I'm getting close to that but am still feeling uninspired by the progress. If it takes 3 months to be better than so be it. Any opinions of ice climbing to ease my mental pain, I realize it's the same clamp down hand position that is bothering me now.

That 6-week figure you were told sounds pretty bogus to me. In my (limited) experience with pully injuries it depends on the severity. For a serious strain then sure, 6-weeks is probably accurate for a full recovery. I recently tore a pully in my ring finger and I'm going on 5 months and it's still not 100%.

So your ring finger has three sections divided by two joints. The first joint is closest to your palm and the second joint is closest to your finger tip. Hold your injured hand up, palm facing you. Hold your ring finger with the other hand, hold it on the middle section. Don't let the first joint bend, but try to bend the finger tip toward you, try to bend the second joint.

If you can't you've torn the Tendons connected to the Flexor digitorum profundus. Hopefully someone with more experience will give a Better explanation and correct anything that I've said that is wrong.

Oh yea, if you really tore something you're in for much longer than 6 months. I strained mine and it took months of light to no climbing and it's still tender.

Is diet related to pully/tendon injuries in any way? Are their foods that are good for increasing finger strength and decreasing pully/tendon injuries?

I would also question whether this is a classic pulley strain/tear. I'll qualify this by saying that I have no formal medical training, but in my 20 years of climbing have had many injuries and done pretty extensive research on climbing related injuries.

The symptom of not being able to fully flex the finger is, as best I know, not one associated with pulley strains. Pulley strains usually present with tenderness in the area and pain on resistance. Extreme strains show bowstringing when the finger in flexed. Any limited range of motion is usually associated with swelling, which should have gone down a few days post injury. The inability to fully flex the finger suggests the possibility that the injury might be to the tendon itself. The worse case scenario would be that the tendon has torn at the insertion in the tip of the finger. This would mean surgical treatment.

The pulley strains I've had have involved something like 2-4 weeks of no climbing/gripping at all (use wrist straps for pull ups) and then another 3-4 weeks of slowly progressing back to climbing at my limit. If you're still suffering from basic range of motion problems at 6 weeks, I'd encourage seeing an orthopedic and/or an occupational therapist.

If it is only a strain that doesn't need a more involved treatment, I'd first recommend avoiding any kind of real gripping until it is nearly pain free and full range of motion. I've heard that any load over 15 lbs. can tear tissue, especially tissue that's already injured. A treatment I've used with good success recently has two parts. The first part is immersing your hand for 15 seconds in ice water then 45 seconds in hot-as-you-can-stand-it water for 5-10 sets (1 set = ice + heat). This gets great blood flow. I do it twice a day. The second part is eccentric finger extensions. Basically, hold your finger straight and use your other hand to force it to curl into the palm of the hand. Do 3 sets of 10 reps daily. Make sure to isolate the injured finger and to put force on the length of the finger. I also do a lot of self massage on the muscles on the outside of the forearm (finger extensors). Best of luck.

I had a similar injury on my right hand. I used hydrotherapy like you already are, and bought a set of ring splints. They are little plastic splints that hold your finger straight. Wearing one of those and not climbing, it took about 8 weeks before I felt comfortable using my hand again, but everything healed just fine.

scriphessco.com/products/ov…

I've heard the dreaded pop too. It's hard to do, but the best thing to do is stay away from climbing and pull-ups for a few months. I had my initial injury and stayed off it for approx three weeks. Figured maybe I could follow a pitch on ascenders and severely worsened the injury. I now have an irreparable bend in my finger due to a volar plate avulsion. I was out for four and a half months which could have probably been two or three had I listened to the advise and let the tendon heal.

Best,
Nathan

In regard to diet, I've heard nothing about diet and its relationship to tendon strength and/or tendonopathy. Rock and Ice published an article a while back about the anti-inflammatory diet, but that's only tangentially related. Not to be smug, but I think the diet that most influences tendon health is the diet that makes you weigh less. Less force on tendons makes them less likely to break.

In reference to Ryan, Christopher and Evan's thoughts I'd say it would be worth talking to an occupational therapist, specifically a hand therapist.
Being in the medical field, it definitely sounds like it's more tendon related than a simple pulley injury and certainly worth getting it looked at. You don't want to deal w/ a chronic profundus tear or avulsion, get it looked at sooner than later and it will save you a lot of time and trouble down the road.
Good luck healing up,
BA

Andy you didn't say exactly where it hurts on your finger. Is there still pain?

I had a complete A2 pulley rupture on my ring finger of left hand in August 2005 from crimping. It took about 3-4 months of light climbing before I could really crimp again, and the pulley area hurt while climbing for probably close to a year. I never stopped climbing, I just readjusted my goals. Six years later my fingertip still doesn't go all the way down to my palm when I make a fist (just like you describe). I also had to have my wedding ring resized because my finger swelled and never went back to it's original size. I think A2 rupture is the most common pulley to rupture. I did a lot of research on this when it happened, but probably have forgotten more than I remember. A thread on another forum.

It hurts just above the first joint. It is basically pain free until I use it the wrong way and apply pressure on the tip. Ryan - if I hold the first joint I can wiggle the tip back and forth fine.

There is a lot of stuff going on in our fingers, and it's impossible to get any more specific than people already have. It is good that you can wiggle the tip normally. That means the tendon that connects to the tip of your finger is intact. And it sounds like you can also bend the first (largest) knuckle normally as well which means that the other tendons and muscles responsible for bending your finger are working properly.

Brent Apgar wrote:In reference to Ryan, Christopher and Evan's thoughts I'd say it would be worth talking to an occupational therapist, specifically a hand therapist. BA

I did that, went to a hand specialist in Boulder who was supposedly a climber. She just told me I might benefit from surgery, or not, or maybe, then gave me literally worthless splints and charged me a bunch of money. I had to go find the ring splints (which a hand specialist had somehow never heard of) myself and just keep it from moving while it healed. The pain your describing Andy is exactly what happened to me, NOT bending you finger for a while will let the connective tissue heal, then you have to rehabilitate it, but better than your finger never working right again.

Hey Rich wrote:A pulley rupture is very specific (and obvious) and can only be repaired with surgery.

True, but not all pulley ruptures NEED to be repaired. I had an MRI which showed complete A2 rupture. The ortho I saw said he could fix it, but after reading more about it, I decided it wasn't really necessary.

Andy, sounds like the pain you are having is exactly what I had. Only way to know for sure is get evaluated, MRI or ultrasound, or possibly a competent hand surgeon can diagnose it on clinical exam alone. I got a ring splint too, but really didn't use it.

Christopher Barlow wrote:In regard to diet, I've heard nothing about diet and its relationship to tendon strength and/or tendonopathy. Rock and Ice published an article a while back about the anti-inflammatory diet, but that's only tangentially related. Not to be smug, but I think the diet that most influences tendon health is the diet that makes you weigh less. Less force on tendons makes them less likely to break.

Damn, and I always wanted to think that the grease and fat in donuts and bacon helped to lubricate the tendons...

LeeAB wrote: Damn, and I always wanted to think that the grease and fat in donuts and bacon helped to lubricate the tendons...

Only if the donuts are frozen and you stick your finger in the hole to ice it, then immerse it in hot bacon grease as you're eating the donut. The combined benefits of reduction of swelling, increased blood flow, and lubricated tendons will instantly heal any tendon injury. That's science.

Evan S wrote: I did that, went to a hand specialist in Boulder who was supposedly a climber. She just told me I might benefit from surgery, or not, or maybe, then gave me literally worthless splints and charged me a bunch of money. I had to go find the ring splints (which a hand specialist had somehow never heard of) myself and just keep it from moving while it healed. The pain your describing Andy is exactly what happened to me, NOT bending you finger for a while will let the connective tissue heal, then you have to rehabilitate it, but better than your finger never working right again.

My experience with medical folks and climbing injuries has also been fraught with frustration. That said, one ineffective specialist doesn't make them all worthless. Many of these injuries seem to heal well with rest, inflammation and scar tissue management, and increased blood flow. Severe tears in tendons and ligaments often do require surgical intervention, but most surgeons are hesitant - as they should be - to go down the road of major procedures like MRIs and cutting you open.

The kinds of PT I've had that have actually gotten better results than what I can do for myself have involved ultrasound (for locating damage/inflammation), laser therapy, ASTYM, and deep tissue massage. I've had this stuff for shoulder problems, elbow tendonitis, and tendon problems in the fingers.

Thanks everyone for the help and input. This is my first time with a finger injury and felt this was a great place to ask people who have been there. I've had a lot of experiences with doctors who do very little if anything for injuries I've been concerned about and then I still have to pay their lofty prices. I'll have to check out the ring splint and keep taking my time. Thanks again, climb hard for me!

Christopher Barlow wrote: My experience with medical folks and climbing injuries has also been fraught with frustration. That said, one ineffective specialist doesn't make them all worthless. Many of these injuries seem to heal well with rest, inflammation and scar tissue management, and increase blood flow. Severe tears in tendons and ligaments often do require surgical intervention, but most surgeons are hesitant - as they should be - to go down the road of major procedures like MRIs and cutting you open. The kinds of PT I've had that have actually gotten better results than what I can do for myself have involved ultrasound (for locating damage/inflammation), laser therapy, ASTYM, and deep tissue massage. I've had this stuff for shoulder problems, elbow tendonitis, and tendon problems in the fingers.

Evan and Chris I completely understand the frustration w/ the medical community. By in large if you can walk around, feed yourself and do some kind of work most medical professionals say that you're fine and don't need any treatment. So when you start talking human performance and then god forbid detour down the road of climbing specifically you're going to find very few folks that are all that helpful when it comes to injury management and sound training advice.

A lot of times I'm at a loss when I get asked about what to do for climbing related hand injuries. That's because there really isn't too much you can do for them other than take it easy on the injury, let it heal and then slowly start putting stress on it so that it becomes stronger.
In general, dealing w/ hand injuries is a nightmare. Hand surgery doesn't have the greatest outcomes because the hand is just so damned complicated. Self massage, drugs, supplements and home therapy can all be helpful but the real key to healing an injured hand as quickly as possible is to not keep re-injuring it.
I think a lot of people are coming around to the belief that it's best to climb through mild to moderate hand injuries, provided the climber can practice enough self control to only stimulate the soft tissue to heal and not go overboard.
Anyhow, that's my two cents. Sorry for the longer post, the topic of health care (the whole thing, patients, providers and the standard of care) can just frustrate the shit out of me... guess that's true of any job.
Hope everyone's hands survive the winter plastic pulling and come out stronger in the spring,
BA