Climbers are always pushing their bodies to the limit. They also don’t always listen to their bodies telling them of potential injuries. Hand and finger injuries are the most common type of overuse injure know to climbers. There are many reasons injuries occur like: inexperienced or undertrained climbers pulling on small pockets, dynos, too much strain without enough rest, falls, etc. The list could go on. If you are reading this article because you sustained a injury. Read on to learn more about prevention and treatment, but remember sometimes it is best to seek professional medical attention. I make no attempt to treat your injuries, just give you a little more information.
First, injuries can usually be prevented. Just use your head. Climbing hard four days a week after a winter layoff is not the smart way to train. When your fingers start to ache, take a little rest or try to tape them to aid in support. Rest, ice, Vitamin I (ibuprofen), and good sense can be your best friend in preventing a hand injury. Take it gradually at the beginning of the season and know when to say when.
To avoid other overuse injuries avoid training on campus boards and limit your work on finger boards to short sets. An intense stretching program will help avoid injuries as well as allow for fluid movement and hopefully give you that extra critical reach to the next hold.
Explained below are most of the common injuries and treatments involving the fingers and hands.
Flexor tendinitis and tenosynovitis
In flexor tendinitis and tenosynovitis, an inflammatory response occurs because of repetitive stress. The patient has pain and swelling along the palmar surface of the digit, which may extend into the palm or forearm. While the patient’s passive flexion is normal, active flexion is usually limited(1).
A patient who has flexor tendinitis or tenosynovitis should rest, take anti-inflammatory medication, and do range-of-motion exercises. Corticosteroid injection is rarely used, but may be indicated in patients who have chronic tendinitis or tenosynovitis and for whom all other treatment modalities have failed. Injection should be performed carefully as intratendinous injections may result in tendon rupture.(1)
Flexor tendon strain
This injury is characterized by acute onset of pain at the FDS tendon insertion during a difficult cling grip. It is often referred to as “climber’s finger.”(1)
A patient who has flexor tendon strain should rest, take an anti-inflammatory medication for control of swelling, and do range-of-motion exercises. When pain has subsided and range of motion has been restored, a progressive strengthening program can be started, followed by a gradual return to climbing. Taping may be used as a preventive measure.
Tendon nodules
Stenosing tenosynovitis, commonly known as trigger finger or trigger thumb, involves the pulleys and tendons in the hand that bend the fingers. The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers and thumb. In the finger, the pulleys form a tunnel under which the tendons must glide. These pulleys hold the tendons close against the bone. The tendons and the tunnel have a slick lining that allows easy gliding inside the pulleys.
Trigger finger/thumb happens when the tendon develops a nodule (knot) or swelling of its lining. When the tendon swells, it must squeeze through the opening of the tunnel (flexor sheath) which causes pain, popping, or a catching feeling in the finger or thumb. When the tendon catches, it produces inflammation and more swelling. This causes a vicious cycle of triggering, inflammation, and swelling. Sometimes the finger becomes stuck (locked) and is hard to straighten or bend(2).
Triggering may be reproduced by applying pressure over the A1 pulley during flexion and extension of the involved digit. The goal of treatment in trigger finger/thumb is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort. Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon. The wearing of a splint or taking anti-inflammatory medication by mouth or an injection into the area around the tendon may be recommended to reduce swelling. Treatment may also include changing activities to reduce swelling. If non-surgical forms of treatment do not improve symptoms, surgery may be recommended. This surgery is performed as an outpatient. The goal of surgery is to open the first pulley so the tendon will glide more freely. Active motion of the finger generally begins immediately after sur-gery. Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tend-er-ness, discomfort, and swelling about the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use(2).
Flexor tendon avulsion and rupture
An FDS tendon rupture may occur with the cling grip, an FDP tendon rupture with the pocket grip. Patients who have these ruptures complain of the acute onset of pain during a grip. Findings include tenderness at the FDS or FDP tendon insertion, digital swelling, and an absence of active flexion of the PIP joint (with an FDS tendon rupture) or DIP joint (with an FDP tendon rupture). Frequently the end of the tendon retracts, and consequently tenderness and swelling may also be noted more proximally in the digit or even in the palm(1).
Flexor tendon rupture requires surgical reattachment or repair when recognized acutely. Patients who present more than 3 weeks after injury may be treated with a variety of surgical and nonsurgical methods. Referral to a surgeon familiar with contemporary methods of treatment for flexor tendon injuries is appropriate for these patients(1).
Second Annular Pulley Rupture
Rupture of the A2 pulley is a relatively common injury and in one study has been reported in up to 40% of professional climbers. Rupture occurs as a result of the excessive stress on the A2 pulley during a cling grip. The long and ring fingers are most commonly involved. Pulley rupture can occur acutely or develop insidiously(1).
A patient who has acute pulley rupture complains of acute pain in the volar proximal phalanx region. The area is tender to palpation, and visible and palpable bowstringing of the flexor tendons is usually noted during active resisted finger flexion. The diagnosis may be difficult, and a limited magnetic resonance imaging scan or computed tomography scan may be necessary to help determine the integrity of the pulley and flexor tendons(1).
Minor A2 pulley injuries or partial tears with no evidence of bowstringing can be treated with either firm circumferential taping overlying the pulley or with a ring splint, worn full-time for 2 to 3 months to permit healing. Patients should also take time off from climbing(1).
The management of complete tears with tendon bowstringing is controversial. Surgical options include pulley repair or reconstruction. If there is any uncertainty regarding the diagnosis of A2 pulley rupture or the management of this type of injury, referral is recommended(1).
Joint Contracture
A fixed flexion deformity of the PIP joint is a common finding in rock climbers The deformity is frequently bilateral and most commonly involves the ring finger. The contracture is usually mild and is thought to be the result of recurrent joint effusions and synovitis(1).
Treatment includes rest, stretching exercises, anti-inflammatory medication, postexercise icing, and a dynamic PIP joint extension splint. Severe fixed contractures that compromise hand function may require surgical correction. Consultation with a hand therapist or surgeon is appropriate for such a patient(1).
Ligament Injuries
Sprain, acute rupture, and chronic attenuation of the collateral ligaments of the finger (PIP) joint and thumb metacarpophalangeal (MCP) joints have been reported in rock climbers. PIP joint collateral ligament injuries predominantly involve the long finger and occur during a maneuver known as “dynoing,” meaning rapid ascension of a rock face. As the climber ascends rapidly past a pocket in the rock in which his or her fingers are placed, a finger can become trapped and bent, stretching the ligament awkwardly. Sprains of the ulnar collateral ligament of the thumb MCP joint are associated with the pinch grip(1).
Examination of patients who have ligament injuries reveals mild to moderate PIP joint swelling, tenderness, and pain with motion. To assess the integrity of the collateral ligaments, palpate them gently and then stress the ligaments with the joint first flexed and then extended. The joint may need to be anaesthetized. Complete rupture is suggested when the joint can be widely deviated during stress testing(1).
Treatment of a patient who has a PIP joint sprain with intact collateral ligaments includes rest, icing, edema control, continued range-of-motion exercises, and “buddy taping” to the adjacent finger on the side of the injury. Persistent pain and swelling are common and may take months to resolve, but patients are still able to climb. Patients who have partial collateral ligament tears should be treated with the same protocol(1).
The management of complete tears of the PIP collateral ligament is controversial, and there are proponents for both surgical and nonsurgical treatment methods. Partial tears of the thumb MCP joint collateral ligaments are treated in a custom-fabricated, hand-based Orthoplast thumb spica splint (Johnson & Johnson Orthopaedics, Raynham, MA) for 4 to 6 weeks. Management of complete tears of the thumb MCP collateral ligaments is controversial and confusing, with many different recommendations. If such an injury is suspected or detected, the patient should be referred appropriately. Chronic injuries with joint instability that impairs hand function usually require either reconstruction or joint arthrodesis, depending on the duration of symptoms, patient demands, and the status of the articular surfaces of the joint (1).
Carpal Tunnel Syndrome
Compression of the median nerve within the carpal tunnel can be the result of a rock climber’s repetitive, sustained flexion of the wrist. Associated transient tenosynovitis of the digital flexor tendons is a common finding. The patient complains of volar wrist and forearm pain and paresthesias in the radial 3 1/2 digits. Night symptoms are common. Evaluation includes assessment of static two-point discrimination and motor strength and provocative measures such as Phalen’s maneuver and testing for Tinel’s sign. Swelling in the region of the distal forearm may also be noted. Unless the symptoms are longstanding, motor weakness and atrophy of the thenar musculature are not seen (1).
Treatment involves avoiding climbing, and splinting the patient’s wrist in a neutral position. Anti-inflammatory medication may be used in patients who have associated tenosynovitis. Injection of the carpal tunnel should be reserved for those patients who have complied with rest and splinting but continue to have symptoms for longer than 3 months. The majority of climbers respond to this conservative treatment approach, and surgery is rarely indicated (1).
References:
The Physician and Sports Medicine, Peter J. L. Jebson, MD; Curtis M. Steyers, MD, THE PHYSICIAN AND SPORTSMEDICINE – VOL 25 – NO. 5 – MAY 97
American Society for Surgery of the Hand
Camp4 Admin.
