Pop sound while crimping and pain in the palm of the hand

Hey,

A friend had a bit of a weird injury while climbing outdoors the other day.... Seems somewhat similar to a pulley injury, except it doesn't hurt at the pulley.

His foot slipped on a warmup climb, which prompted a reflex to crimp. The hold was described as something of a 2-ish pad edge, half-crimp sort of position. A pop (not crazy loud, but definitely a sound) was heard. He came down soon after.

The pain is not located on any of the finger, but rather closer to the center of the palm of the hand. Hurts more when closing/trying to form a first. Range of motion seems OK, but applying strength is painful. I didn't notice any bowstring. There was swelling initially (few days ago). Now swelling is less, but the pain remains similar when trying apply strength.

Has anyone heard of a pulley-like injury in the hand? Are there tissues there that can be injured in a way comparable to pulleys? Or are we somewhat off in thinking along the lines of a puelly-like injury? Right now guessing the best course of action is to treat it as a pulley injury and follow a similar protocol... there was a good MacLeod article on that.

Obviously he may get it checked out once inflamation is down etc. etc.... but mostly trying to see if we're looking at a full summer of not much climbing or if there is reason to be more hopeful....

This exact same thing happened to me about two months ago- a large pop during a hard crimp followed by swelling and pain around my right ring finger. Initially I thought it was an A2 pulley injury but the pain was closer to the center of my palm, about 2cm below where my ring finger starts. Looking at the image below, it makes me think is was an A1 pulley injury. I've continued climbing since the injury- it gets a little inflamed and sore for the 1-2 days after, but overall it's continuing to improve. Crimp strength is really reduced and I've avoided doing any 3 finger drags with the injured hand. I've just stuck to easier, non-crimpy routes while I let it recover. My range of motion is coming back and soreness continues to improve, but I still have a little pain if I try to make a tight fist or fully open my hand.

My advice would be to stick to non-crimpy routes if you want to continue to climb. Don't push it or you may end up injuring it worse to the point that climbing is not a possibility. If you must crimp, just use your index and middle finger- time to get strong at the 2-finger crimp!

This is my first injury and it's a major bummer to be limited by a finger when the rest of my body is feeling strong. Hope you heal up soon.

If you want/need some professional guidance on finger rehab, there's a climber specific physical therapy practice called Onsight Movement in Vegas. Dr. Jennifer is really knowledgeable about pulley injuries and can make custom thermo-plasic splints if you need one.

Check it out. onsightmovement.com

Here's a detailed pulley recovery program with videos and guidance through the whole rehab process

https://wavetoolstherapy.com/pulley-rehab/

After physio diagnostic: turns out it was (mostly) a lombrical issue. Might have slight A1 pulley damage but mostly lombrical. It really looked like a pulley issue (except perhaps for the location, which what more middle of the hand). The main difference was that strength returns much faster. So in case of doubts, I guess wait a week or two, monitor strength along the way. A quick increase would seem to indicate muscle-related damage, while slower... well might be the dreaded pulely.