All I did was reach, as slowly as I could, to a not so great hold. As I grabbed it, I felt a crunch in my right middle finger. I moved my feet and then decided to let go. My finger felt OK but I knew something wasn’t right. I decided to try out a less steep climb and it seemed as though I had lost a little stability and strength in the finger.
I drove home going over what I did wrong in that moment. Did my foot slip? Did I pull too hard? When I arrived home, my partner, not hearing my excited report about my climbing, knew something was wrong. “What’s wrong?”
“I don’t want to tell you because I think you will blame me.”
“I’m not going to blame you.”
It really was my fault. It wasn’t a slip of the foot or a bad hold. I was exhausted and dehydrated. I had been training for 4 weeks prior and although my fingers were feeling a little tweeked, I did not take time off to rest.
Over the next few hours, my finger inflated. I did the flexor tendon and collateral ligament tests and was elated to find that neither were the issue. (I’ve had a pretty serious flexor strain in the past and it took 8 months to heal. It is a no joke injury and one that takes incredible patience to manage.)
This time, I believe that I had an A2/A3 pulley injury. There are so few finger injury types that afflict climbers so I used the process of elimination and settled on this diagnosis.
The Truth is Out There
From my experience, people are often hesitant to assess finger injuries. You’ll find that there is plenty of information about what could potentially be hurt but they fall short in giving you the tools to properly diagnose your injury. While the hand and fingers are very complicated that does not mean there are no tools that can help determine the underlying problem. There are in fact a number of physical assessments to diagnose or rule out what is wrong with your fingers. You just have to know what to look for when you are attempting a self diagnosis.
I have taken the best information I could find and compiled it here for your review. I hope that if you find this information useful, it is because you yourself are not injured.
Please note, that I am not a medical professional and have complied the best information I could find while working on this post. This information does not take the place of being assessed by a medical professional and is intended for educational purposes only.
Assessing Flexor Tendon Injuries
In the fingers, there are two major tendons that control hand movement and grip strength. The flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS). They are a common injury in climbers however, they maybe incorrectly assessed as pulley ruptures or strains.
From Tom’s Physiotherapy Blog I quote –
The finger flexor tendons are held in place by pulleys. These pulleys ensure the action of the flexor muscle contracting bends the finger all the way to the tip across each different joint. This means that a lot of force and friction can be exerted on these tendons when a large load is put through the finger tips.
One thing worth noting is that the A2 pulley contains the tendons of both the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS), whereas the A4 pulley only contains the tendon of the FDP as the FDS splits and inserts to the lateral sides of the A4 pulley.
Now, one thing to keep in mind is that you must test both hands to determine if you have flexor tendon injury. This will allow the person aiding you with the test to see how much weakness you have when you isolate each tendon. In this case, weakness and pain/discomfort during the test are necessary observations. Furthermore, you will typically not have the localized swelling at the base of the finger as you will see with an A2 pulley, for example.
If you are still unsure after performing the test, take a lacrosse ball and roll it (with medium to hard pressure) from the wrist and into the point of flexor tendon insertion in the forearm. If it causes discomfort, you likely have a flexor tendon issue.
Assessing Collateral Finger Ligament Injuries
The collateral ligaments are the glue that hold each joint together. They also help encapsulate the volar plates which are likely to be injured in younger climber children.
Thankfully, they are also the easiest injury to assess.
On the publication of this post, there is currently only one way to determine if you have a pulley injury. Get an ultrasound.
However, I would venture that if neither of the above tests caused you significant pain or discomfort, then you very likely have a pulley injury. Generally speaking, you may also have localized swelling where the pulley sits within the first 12 hours on onset. This swelling can settle into the base of the figure (where it meets the palm of your hand.)
It is an incredibly popular injury in the climbing world and often times it is only a matter of time before you get a personalized invitation to this party.
If I happen to find a good physical assessment for pulleys, I will edit this post to include this information.
Stay healthy y’all!