Common climbing injuries - finger injuries

Overstraining the flexor pulleys of the fingers (notably ring and middle fingers) causing disruption of the pulley mechanism can result in finger pain ('climber's finger'). This can be anything from a grade 1 (strain) to a grade 3 (complete rupture).

The flexor pulley system of the finger consists of 5 pulleys, A1- A5, along the sheath of the flexor tendon. The most important, and also the most commonly injured, being A2 and A4. The pulleys attach to the bones of the finger (phalanges) and hold the flexor tendon close to the phalanges through the range of finger movement.

If the pulley system is not intact it can result in bowstringing of the tendon, which in turn will cause a poor transfer of the forces required for both pinch and grasp holds - putting greater loads through the flexor tendons and the end finger joint (distal interphalangeal joint). 

Symptoms

• Pain locally at the pulley (usually sharp)
• May feel a 'pop' or 'crack'
• Swelling and possible bruising
• Pain on resisting flexion
• Pain on extension stretch

Causes

Flexor pulley injuries usually result from sudden loading of the fingers forcing extension (straightening) from flexion, often associated with a period of repetitive loading or inadequate warming up.

Other than flexor pulley injuries finger pain can be caused by:

• Inflammation of the joint or capsule
• Sprain of the finger ligaments (collateral ligaments)
• Rupture or partial rupture of the flexor tendons (flexor digitorum superficialis - FDS, or flexor digitorum profundus - FDP)
• Tenosynovitis of the flexor tendon
• Nerve irritation
• Fracture of one of the bones of the finger (phalanx)

Injury management

Immediate
 

• Stop climbing
• Apply ice or cold immediately
• Keep the hand elevated
• Do not test it
• Start to mobilise in pain free range only
• Ask your doctor about the use of anti-inflammatory drugs
• If not showing significant improvement over 3 days, seek professional help

Other

• The injury management must involve a full assessment to determine that no other damage has occurred.
• Referral to a specialist if deemed appropriate
• Electrotherapy to modify the inflammatory process
• Manual therapy to improve the quality of the tissues
• Graded exercise to mobilise and strengthen the muscles and tissues.
• Gradual return to climbing. This will mean starting on large holds for short duration with lots of rest and recovery periods and a lower level of difficulty
• Addressing any underlying issues elsewhere that may be resulting in overloading of the flexor tendon and pulley system e.g. tight finger flexors.
• Taping may have a place, discuss this with your sports practitioner

Expected outcome

Take advice from a practitioner who specialises in climbing, but if treated early and effectively, with an appropriately graded return to activity, recovery will usually take 3-6 weeks. However, if the injury is pushed beyond its stage of recovery, re-injury will occur and may well result in a chronic injury that will require a much more protracted rehabilitation period.

Prevention

• Warm up thoroughly and stretch, paying particular attention to the elbow, wrist, and forearm.
• Climb easier routes with larger holds early in your climbing session.
• Avoid overtraining.
• Take adequate rest and recovery periods (particularly if feeling ' under the weather').
• Regularly massage through the forearm.