Finger makes cracking noise when bending?!

Hi all,

I have a weird issue with my right middle finger - was wondering if any of your experienced smth similar.

So it began a few weeks ago after a taxing boulder session. My right middle finger started cracking when bent from an extended position to about 90degrees. Its a distinct easy to hear crack every time I bend it. If I rly warm up well it disappears only to come back (this time with pain as well) after climbing. In the morning its really (!) loud the first time I bend it and then goes back to not so loud. As if its locked in neutral position during sleep and I have to to break it free... Super strange.

It hurts notably if I pinch my PIP joint with the other hand (more on the left side of the PIP). It also hurts quite a lot if I try to hyperextend.

Crimping (or any other type of holds) feels ok. I took 2 3 days off but it comes back after every session...

Experience tells me if smth like this doesnt go away within 2 3 weeks it probably more serious than I think.

Has anyone had this? What is it?

Do you have medical insurance that you could see a doctor? You'll get a better diagnosis than from climbers on the Internet.

Sounds like trigger finger.

FrankPS wrote:Do you have medical insurance that you could see a doctor? You'll get a better diagnosis than from climbers on the Internet.

I do! Just collecting as much extra info as I can :)

tlacny wrote:Sounds like trigger finger.

ill look it up - thanks!

Do you have any inflammation around the A2 pulley? And do you get the cracking noise when you are going from straight vertical finger to 90 degrees? If you go from straight vertical to 90 degrees quickly (e.g. doing it 4x in a row) does it do it everytime?

It'd be trigger finger it it's difficult for you to open up your finger when going from 90 degrees back to straight finger. I had an A2 pulley injury almost 1.5 years ago and I get a cracking noise when I go from straight to 90 degrees. It's not trigger finger - I saw a specialist and they said it's something along the lines of (it was awhile ago so I forget the specifics) the tendon sheath can't move easily in the finger. I do rehab with a hangboard and after a couple weeks it tends to goes away, as well as the inflammation.

definitely go to a doctor, maybe a PT or a chiro

however, if you want to read some research (not too heady) or just the condensed review on a2 and a4 flexor tendon injuries shoot me an e-mail (the articles are not accessible to the public so i can send you titles/abstracts and if your interested send full articles)

Luna wrote:definitely go to a doctor, maybe a PT or a chiro however, if you want to read some research (not too heady) or just the condensed review on a2 and a4 flexor tendon injuries shoot me an e-mail (the articles are not accessible to the public so i can send you titles/abstracts and if your interested send full articles)

Can you show me in private? ;)

oh tyler. OEC?

John Lombardi wrote:Do you have any inflammation around the A2 pulley? And do you get the cracking noise when you are going from straight vertical finger to 90 degrees? If you go from straight vertical to 90 degrees quickly (e.g. doing it 4x in a row) does it do it everytime?

Hi John, There is a bit of inflammation yes. I feel pain when i put my hand in the pocket to reach for the keys - any pressure towards hyperextension.

it cracks to the opposite movement of trigger funger yes - from straight to 90= degrees. The quicker i do it the more likely it will crack. Sometimes (in the morning or after long work with a PC mouse) it makes an uber loud crack and then its ok for 30 40 min. This scares the crap out of me...

thanks for the info. I have an appointment with my finger specialist but he is traveling for the next 20 days so I was wondering how to approach climbing. After 4 full days of rest nothing seems to have changed much so I think ill continue until my appointment avoiding thin crimps.

Luna wrote:definitely go to a doctor, maybe a PT or a chiro however, if you want to read some research (not too heady) or just the condensed review on a2 and a4 flexor tendon injuries shoot me an e-mail (the articles are not accessible to the public so i can send you titles/abstracts and if your interested send full articles)

thanks a ton! :)

Petar Chalamov wrote: Hi John, There is a bit of inflammation yes. I feel pain when i put my hand in the pocket to reach for the keys - any pressure towards hyperextension. it cracks to the opposite movement of trigger funger yes - from straight to 90= degrees. The quicker i do it the more likely it will crack. Sometimes (in the morning or after long work with a PC mouse) it makes an uber loud crack and then its ok for 30 40 min. This scares the crap out of me... thanks for the info. I have an appointment with my finger specialist but he is traveling for the next 20 days so I was wondering how to approach climbing. After 4 full days of rest nothing seems to have changed much so I think ill continue until my appointment avoiding thin crimps. thanks a ton! :)

Hi Petar. Coincidentally enough, I have been experiencing symptoms similar to yours since last Wednesday: loud cracking sounds coming from the joint, pain and stiffness in the joint itself, and cracking and "getting stuck" a little bit when going from full extension to bent. I also have weakness, pain, and "getting stuck" when going from a half/full crimp and back to relaxed position. Open handed pulling doesn't seem to hurt or feel different at all. Also, if I really tightly curl my finger and then release it it also cracks. I have very minor swelling, but plenty of stiffness. It also looked like it was bruising slightly in the same spot.

I'm fairly certain it is not an A2 or A4 pulley injury. I have had various strains of those pullies and usually they are accompanied by pain on the underside of the finger (right where the pulley would be) when pressed hard with the other hand. I thought it might be an A3 pulley, since this is situated right underneath the joint, but that would be odd given where the symptoms are coming from (top left side of the knuckle, above the finger not below). I also do not get pain when I press the underside of the joint.

I am getting more and more confident that it's a joint injury. Mine has gotten a lot better every day, so I'm going to hold off going to the doctor and just take it easy. Maybe do some open handed, light hang boarding (since that doesn't seem to activate it) to try to aide in rehabilitation. If it stops getting better on its own I will see a doctor.

I have the same. Have had inflammation and some swelling for more than a year, After possibly some trauma from pulling hard when it was cold months ago (I didn't realize anything happened at the time) The next day it was swollen, tender, with restricted joint range of motion, and developed a sharp click inside the joint when flexing. I saw a hand specialist, got an xray, was told it's not osteo arthritis, it;s not rheumatoid, it's not any major cartilidge problem since joint space looks good. I was offered a cortisone injection or topical anti inflammatory (voltaren) and told i could get an MRI for more accurate diagnosis.

I took the Voltaren and when I read the label, turns out I have contraindications, can;t use the stuff.

It is problematic every day, and worse after climbing. Keeping it moving, gently flexing and extending when stiff, squeezing and releasing a handful of clothing etc helps loosen it and move out swelling. I am trying arnica, seems to help minimally, possibly just the massage of rubbing it in is helpful as well.

Essentially, it's chronic now but still mostly functional. Just another reminder I'm not 20 any more. I figure these days if I don't wake up with some kind of musculoskeletal pain It'll mean I'm dead.

Petar Chalamov wrote: Hi John, There is a bit of inflammation yes. I feel pain when i put my hand in the pocket to reach for the keys - any pressure towards hyperextension. it cracks to the opposite movement of trigger funger yes - from straight to 90= degrees. The quicker i do it the more likely it will crack. Sometimes (in the morning or after long work with a PC mouse) it makes an uber loud crack and then its ok for 30 40 min. This scares the crap out of me... thanks for the info. I have an appointment with my finger specialist but he is traveling for the next 20 days so I was wondering how to approach climbing. After 4 full days of rest nothing seems to have changed much so I think ill continue until my appointment avoiding thin crimps. thanks a ton! :)

Hi Petar,

Ok we have a similar finger injury. The reaching in pocket for keys I used to get some pain - nothing very painful but I could tell my finger didn't like it. I still recommend you go to a finger specialist but I have had a lot of success with doing finger rehab through the use of a hangboard. If you're interested I can type out my rehab plan with the hangboard. It has helped me remarkably in getting back to 100%.

Thanks for the replies people!

I just saw a good finger therapist (also climber) so wanted to share his tips as well to spread the knowledge a bit. Hopefully helpful for you too! He also has been having this for a long time so I i think i was somewhat lucky to consult him (if "luck" is the best word for two injured climbers getting together :) ).

We looked at the finger with an echo and compared it to the healthy one. The pain is apparently caused by joint inflammation just as Alexander suggested. Most likely the cause in my case was overuse. Good news is its not a deal breaker and I wont need to take serious time off the sport. Bad news is - its very hard to fully get rid of this (echoing mountainhick's comment that not all of us are 20 any more:( ). The therapist said the cracking sound shouldn't be a cause for concern so long as it doest hurt.

Things to avoid :
1. anything which fully flexes the joint - full crimps (duh), aggressive stretching, etc. Half crimps are also not very good at least at the start.
2. "Slapping" slopers. Dynamic moves which include slapping greatly aggravate this as I discovered a few days ago.
3. Getting tired. Sounds trivial but it makes sense. Two 1 h sessions are better than 1 3h session. Training limit bouldering was less bad for me compared to doing PE doubles on ropes. The second one tires you much more.

Things to do:
1. Rest (avoid 2 sessions in 2 days). Also allow complete rest for 5 6 days every 5 weeks.
2. Tape the joint in a specific way. Check out the Addidas Terrex video on YouTube for instructions - around minute 1.
3. Favor controlled and static open harded climbing to the reverse.
(EDIt) 4. Move the joint a lot in general. No need to load it, just flexing up and down

I rly hope this helps...

Hi Petar,

Thank you for the update. I did not end up seeing a doctor, as my symptoms gradually got better. I no longer have pain in the finger, although I still get the cracking and "getting stuck" symptoms after full extension and pulling it very tightly closed. How severe the symptoms are seems to depend on, just as you suggested, how tired or worked the joint is and how warmed up it is.

I have climbed on it a bit, and I do notice that while I am climbing it makes the popping sound but it does not hurt and is almost so small I hardly notice it. The climbing seems to help, but it does seem slightly worse immediately when I wake the morning after.

I suspect that I have a mild tear in one of the ligaments or cartilage in the joint. The popping/cracking sound, as well as the "getting stuck" feeling, maybe be coming from scar tissue build up interfering with the normal operation of the joint. I imagine it will get better with time as long as I am careful not to re-injure it and, as you suggest, keep moving it a lot so that scar tissue cannot build up too much in any area where it should not. This also explains why it is slightly worse in the morning when I wake, since during the night my hands remain in the same position, more or less.

I find that if I fully extend it and then get a good pop from it, then it tends to be better for a little while. I have been doing that sporadically throughout the day. I imagine it's somewhat therapeutic as long as I don't over do it.

Thanks for that follow up Peter.

The rest component is key for me for sure. A few other ideas there somewhat new to me. I'll keep them in mind.

John Lombardi wrote: Hi Petar, Ok we have a similar finger injury. The reaching in pocket for keys I used to get some pain - nothing very painful but I could tell my finger didn't like it. I still recommend you go to a finger specialist but I have had a lot of success with doing finger rehab through the use of a hangboard. If you're interested I can type out my rehab plan with the hangboard. It has helped me remarkably in getting back to 100%.

Hi John,

Could you write out your hangboard rehab plan, either in a PM or on this post?  I would much appreciate it! :)  

Also, I'd like to hear what you folks do to warm up before climbing, especially at the crag.  I've never really had a set warm up plan for before I start climbing in the gym and outside seems to be a totally different beast.  Direct me to a different post, or I'll create a new one if this question doesn't belong here.

-Josh

JR Cook wrote:

Hi John,

Could you write out your hangboard rehab plan, either in a PM or on this post?  I would much appreciate it! :)  

Also, I'd like to hear what you folks do to warm up before climbing, especially at the crag.  I've never really had a set warm up plan for before I start climbing in the gym and outside seems to be a totally different beast.  Direct me to a different post, or I'll create a new one if this question doesn't belong here.

-Josh

Sure. My hangboard rehab wasn't really much different from a regular repeaters hangboard workout. To warmup for a hangboard workout I do ~16-24 minutes of climbing. I have a 35 degree wall in my living room so I use that to warm up on. It's just steep enough where it is not super ideal for warming up but it gets the job done. I can usually do 4-5 minutes of consistent climbing before I get pretty pumped and then do a 4-5 minute rest. 

For the hangboard workout I just experimented with how much weight I should take off with a pulley system. I weigh 135-140 lbs and I started off with -30 lbs. I would do the normal repeater hangboard protocol. My workouts were something like:

Jugs (7s on 3s off), -30 lbs, 8 reps. 3-4 minute rest. 2-3 sets.

Large edge (~20mm), 7s/3s, -30 lbs, 8 reps, 3-4 minute rest between sets. 2-3 sets.

Then 1 other grip. I also experimented with doing 2 finger hangs on the non-injured fingers. My ring finger was the one injured so I would do a 2 finger pocket with my index and middle finger. This didn't seem to irritate my injured finger at all and I thought it was a good way to strengthen the other two fingers.

I would usually total no more than 8 sets. I would do this 1x or 2x a week usually 2 resting days in between. I open-handed everything. I also kept the workouts the exact same and either decreased weight (-30 lb to -25 lb) or I kept the same weight and increase the number of sets. This seemed to help a lot with getting my finger back to where it should be. And allowing me to feel more comfortable cranking on it. I still can't do one finger ring finger monos or anything, but I feel comfortable using it in finger pockets. Climbing at wild iris once this past summer I definitely tweaked it a bit on a couple fingery routes, but just resting and then restarting the hangboard rehab got me back to 100%. 

Hey Petar- Any update on your injury now that a good chunk of time has past??

I've had a collateral ligament injury in the PIP of middle finger for about a year and half (pain w sideways pressure towards the thumb).  After an overuse session (44yrs old- foolishly climbed three days in a row on boulders and steep 12c crimps) felt BIG pops/clicks and something shifting around on the back of the pip joint (opposite of palm side).  Then injury has continued much as you describe.  In the morning the first pop almost feels like the scar tissue that has formed over night is breaking apart - and I can definitely feel some ligament moving/raking  sideways across the back of the joint when bending from a straight position.

Quite oddly- sideways pressure on the PIP joint no longer creates any pain. Instantly- from the moment of this new injury if feels as stable as my other fingers and I haven't felt that in over a year!

I've dealt with other injuries before- and have a ortho doc appointment already set for this one - But just wanted to hear your outcome. 

Hey everyone, I think I've finally found a diagnosis for my finger injury (described above).

I'm fairly certain I have a central slip injury of my middle finger PIP joint. I have a slight Boutonniere deformity as a result, and I can see it when I do the Modified Elson's Test as described here: https://www.aliem.com/2016/07/diagnosing-the-central-slip-injury/. If I had known then what it was, I would have splinted it straight, as described in the article.

As for an update on the progress, it's been about a year, the injury is much improved although still present. I mostly just climbed through it with some light hang boarding at times, but it seemed to slowly get better on its own. It no longer "gets stuck" or clicks, but it does hurt from time to time and still swells occasionally when I use it a lot. Mostly I have to take care to warm it up properly. I've found taping it a certain way helps while climbing: I pull enough tape in about a cm of width to wrap my finger 2-3 times. Go once around the finger on the proximal side of the PIP joint, then cross the joint and go once around the distal side of the PIP while holding my finger in a slightly flexed (open crimp) position, and then finish over the top of the joint. Mostly I think it just keeps me from loading it straight or fully crimped, which seems to help. 

Thought I'd jump back on and give an update as well- after a visit to Ortho, Chiro, and PT.

(Alexander- did you get a professional diagnosis for that central-slip injury? I only ask because I had come across that webpage in my own research as well-  I misdiagnosed this thing several times over and considered that one too...)

So-  the visit to the ORTHO was pretty uneventful- and surprisingly to me,  the least helpful (in resolving the issue).  It did have the benefit of an X-ray to let me know that it was not osteo-arthritis and also did not look like any fractures were present.  They said probably a strained collateral ligament- to avoid movements and positions that irritate it and with time it would go away.  (did not)

By the time I visited with the CHIRO - it had gotten to the point that I was convinced there must be floating debris in the joint that was making it hurt- along with a seriously damaged collateral ligament.  Of course- pain does not manifest in such a way as to make correct assessments I've come to learn...  (if you've had an A2 pulley strain/tear you can probably relate that the pain often comes from the A2 area- but sometimes from your palm, wrist, etc even).  Chiro seemed VERY quickly to gravitate towards something I didn't expect - - - that it was strain on the ligaments and extensor tendons due to tight extensor muscles as well as weakness in the lumbrical muscles.  Rather quite like the causes for tennis/golfers elbow if you've gone through that.  And that the clicking was an overly tight tendon clicking across the joint as I bent it. Her recommendations were:
--Arm-Aid (or other tool) roll out knot in the extensor muscles on the back of the forearm (and flexors while at it)
--with fingers or small tool (like a sharpie) work out knots in lumbrical muscles (spaces between fingers in the palm/back of hand where tender)
--strengthen lumbrical muscles with rubber-band exercises
--Ice cube massaging the area if inflamed

Went to the PHYSICAL THERAPIST very soon there after to just get another opinion. He landed on basically the exact same diagnosis almost immediately (without me mentioning what she had decided). He leaned a bit more heavily on my noticeably weak lumbrical muscles on that hand. His advice was:
--strengthen lumbrical muscles.  He gave exercises different from the ones she gave.
--Similar instructions to "roll out" the lumbrical muscles to break up tissue adhesions that lead to stiffness in the joint (and exacerbated the stressed tendons because of it)
--Stretches to stretch out the extensor muscles.

I followed both of their advice and honestly the issue resolved itself more than it had in a year and a half in just a few days (though not totally gone - but I had gone a long time with no improvement).

A couple days later I was on a tough training day (for me) on really pumpy overhangs - and came down after getting super pumped out- and my finger went right back to the severe locking up and the tendon snapping across the joint when I bent it from a straight position.  I immediately went and sat down and rolled it out (not super aggressive, but just to roll the pump out) and it went right back away. I was amazed frankly,  The previous time it had gotten that bad - it lasted for days.  So now I've been on a regimen of their combined assignments and I do not think all too often about an injury that I had assumed I would have to deal with for the long haul.  For me- it turned out that just like the tendon connection at the elbow end of the forearm muscles can get stressed by imbalance, tightness, and knots - so can the tendon connections and joints involved at the finger end of the chain.

Sorry if its TLDR - just thought someone may find some use in it. (and go to a PT/Chiro that works with climbers -its worth it!)

Went to the PHYSICAL THERAPIST very soon there after to just get another opinion. He landed on basically the exact same diagnosis almost immediately (without me mentioning what she had decided). He leaned a bit more heavily on my noticeably weak lumbrical muscles on that hand. His advice was:
--strengthen lumbrical muscles.  He gave exercises different from the ones she gave.
--Similar instructions to "roll out" the lumbrical muscles to break up tissue adhesions that lead to stiffness in the joint (and exacerbated the stressed tendons because of it)
--Stretches to stretch out the extensor muscles.

No, I never received an official diagnosis, but the pain and symptoms seem consistent with what I read. I'll try this out for sure though. Can you link to videos or articles describing more accurately the stretches and exercises that were given to you?

Is anything here relevant: http://handtoelbow.com/physio-tendon-gliding/ ?