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Complete rupture of A2 pulley


nmonteith

27-May-2011
3:02:48 PM

On 27/05/2011 Dave.k wrote:
>1) HOLD TYPE: crimp, open hand, cling, pinch, sloper, jug

Open hand small sloping hold with a bit of a pinch with the outer fingers - i was a bit bunched up - sort of half crimp half open hand.

>2) MOTION: pulling hard, unexpected foot slip, dyamic move to the hold,
>static

Dynamic move.

>3) MEDIUM: on rock, on plastic, on a hangboard, opening the fridge door
>/ carrying shopping bags

Rock - sandstone.

>4) CONSEQUENCES: popping sound, inflammation, nothing until the day after,
>didn't realise until the next time you went climbing, general tenderness

Loud popping noise - a bit like a rubber band snapping or popping bubble wrap. Didn't immediately hurt - in fact I didn't fall off and kept climbing to new high point on project - the last bolt on route (I did injury on first bolt). As soon as I lowered off it started swelling - and aching. 15 minutes later it was very sore and I couldn't climb anything.

>5) LOCATION: A2 Distal, A2 Proximal, A1, C1 (refer to diagram on P1)
>
>this might help us all understand the unique nature of each persons injury
>type, and thus the applicability of each persons experience.

A2


climbertron

27-May-2011
3:57:02 PM

1)Hold type
2 finger pocket

2)Motion
unexpected foot slip while pulling hard

3)Medium
Plastic in the gym

4)Consequences
popping feeling, no sound. Didn't hurt straight away but the day after I couldn't open the car power windows with my right ring finger. No climbing for a week and then easy stuff for months. It still plays up every now and then.

5)
No Idea, A1 or A2 some pain in palm so not sure.

climbingjac

27-May-2011
4:20:41 PM

1) HOLD TYPE: crimp

2) MOTION: pulling hard

3) MEDIUM: on plastic

4) CONSEQUENCES: popping sound, loud swear word, some swelling inflammation, some tenderness. Complete rupture.

5) LOCATION: A2 pulley


ChuckNorris

28-May-2011
8:17:00 PM

Flopping out war wounds - I'm all in.....the first time I f---ed my ring finga

1) Hold type: cutter edge on 30 degree hung wall

2) motion: trying to match and swap hands on said hold. wiggle wiggle wiggle pop f---.

3) Mediium: nothing medium about it. it f---ing hurt

4) consequenses: Well my finga was f---ed. Scott who was with me at the time heard it pop from about 10 m away. We went out that night and Scott pulled a bird that no shit you could see her brains through her nostrils. I stayed at Cathy's house in fitzroy. My girlfriend at the time didn't like that. Hung out there for a couple of weeks. Pretended to her that I was staying at Graeme's house in st kilda just off grey st. Classy joint that one - has a view over a carpark where you can watch the hookers blowing their trade.

5) Location: A2 ring finger

Every other time I've f---ed a finger it was a squelchy cracking noise on a crimp. The above was the only pop. Apart from a couple of weeks dossing at cathy's it never stopped me climbing - just taped the shit out of it and popped an inordinate amount of antiinflammatories.


ChuckNorris

28-May-2011
8:25:00 PM

Now that I'm backreading a whole bunch of posts - I can thoroughly recommend using putty as suggested by Eduardo. Only thing that ever worked (apart from the drugs)

Dave.k

28-May-2011
8:51:33 PM

Thanks for all the responses folks. Seems clear that pulling hard on a crimp or pocket is the most common cause and that it's A2's for everyone, usually with an audible pop!!

I've done milder A2s on both the index and ring, but never to the point of a popping sound or swelling. The index finger was diagnosed by the radiologist as tenosynovitis and took well over 6 months to get back to 80%. The mild tweak on the ring finger took about 4 months.

I think that it's good to keep climbing after the finger feels capable, but by "keep climbing" I mean it in the therapeutic sense (as it promotes increased blood flow). I was doing 1's (of boulder problems rated from 1 to 6) at the gym for 1 month, then 2's for 2 months, then slowly worked up to 3's. You have to be super conservative and realise that even the most moderate of tweaks takes 3-6 months. Plan a rehab process around that time period - not 10 days or 6 weeks.

paulmilliken

29-May-2011
8:04:27 AM

Hi climbingjac,

I injured my A2 pulley in the left ring finger last August after cooling down and then trying a hard bolder problem without warming up again. It took 6 months until I dared to crimp carefully on it. I followed the advice of Dave MacLeod in http://onlineclimbingcoach.blogspot.com/2010/05/pulley-injuries-article.html , especially the ice-therapy to provoke the "Lewis Reaction".

Now I almost never crimp and if I do it is with my middle finger, index finger and thumb only. I recommend learning to climb with an open-handed grip. You can train this by hanging from a couple of 2 or 3-finger pockets and eventually it will become stronger than your crimp grip. You'll know you've got the grip right if you try it gently with your injured finger and feel no pain at all. If you feel any pain then stop.

I always tape my finger with the H-taping method as shown here: http://www.youtube.com/watch?v=0ThzPFaxgEE . This taping method will stop you from accidentally crimping as you will feel the tape working against the flexing of your finger provided you apply the tape with your finger straight.

On the bright side, I didn't stop climbing. However, I only climbed easy routes using only 2 fingers on my left hand for a couple of months. Then I started using my injured finger exclusively in the open-handed position. I was careful to avoid even the slightest amount of pain. Hand-jamming is also finger-friendly. Now I'm climbing stronger than I ever have *without* crimping with my ring fingers.

A couple of other things I tried were massaging the injury with castor oil and drinking warm water with half a teaspoon of gelatine dissolved in it. I'm not sure how effective these treatments were but they certainly didn't do any harm.

Good luck with the rehabilitation.

Paul


ChuckNorris

29-May-2011
12:42:25 PM

As a reformed crimper - I can thoroughly recommend practising open handing as much as possible. Once you get the hang of it what was previously a crimp becomes a rest.


BoulderBaby

29-May-2011
6:27:59 PM

I think for best possible chance of healing, surgery is the option to go with.

spicelab

29-May-2011
7:03:54 PM

On 29/05/2011 useful wrote:
>As a reformed crimper - I can thoroughly recommend practising open handing
>as much as possible. Once you get the hang of it what was previously a
>crimp becomes a rest.

Just checked your profile and no surprises that you're a Victorian.

The limitations to open-handed purity quickly become apparent if you're a Bluies climber!

davepalethorpe

29-May-2011
7:06:06 PM

On 29/05/2011 BoulderBaby wrote:
>I think for best possible chance of healing, surgery is the option to go
>with.

????? This is based on what evidence?

kieranl

29-May-2011
9:58:21 PM

On 29/05/2011 davepalethorpe wrote:
>On 29/05/2011 BoulderBaby wrote:
>>I think for best possible chance of healing, surgery is the option to
>go
>>with.
>
>????? This is based on what evidence?
Why is it that no-one has asked for evidence for the proposed treatments people have been offering until surgery is mentioned?

mikllaw

29-May-2011
11:09:08 PM

On 29/05/2011 kieranl wrote:
>Why is it that no-one has asked for evidence for the proposed treatments
>people have been offering until surgery is mentioned?
>

Good question
surgery is generally a bad option
1) ask vanessa
2) Wilderness and Environmental Medicine, 14, 94 100 (2003)
"Pulley Injuries in Rock Climbers"
Volker Scho¨ffl, MD; Thomas Hochholzer, MD; Hans Peter Winkelmann, MD; Wolf Strecker, PD, MD


BoulderBaby

29-May-2011
11:51:31 PM

I've been debating wether or not to reply to this page or not, as I'm currently studying musculosketal structures, and from my currently basic understanding, and few discussions with lectures, tendons, ruptured tendons need emergency surgery to correctly replace/reattach them, allowing them to heal correctly and as strong as possible. . Now, I personally haven't experienced this myself, nor have I come across this yet, but to me, When something is completely ruptured, it does need that bit of help- If it was me I'd be getting a professionals opinion from physios/myos and an orthopeadic surgeon.

http://www.ncbi.nlm.nih.gov/pubmed/18776779

davepalethorpe

30-May-2011
9:09:19 AM

Tendon ruptures do require quick surgical re-attachment, as they retract and will not reattach themselves to the bone. A pulley is not a vital attachment point for a tendon, it just assists in keeping the tendon close to the bone, preventing it from bowstringing. There are multiple pulley structures in a finger, so rupturing only one is not a major problem. In fact there are studies proving that climbers return to full function, AND STRENGTH, within one year of single pulley rupture.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term=Sch%C3%B6ffl%20VR%5Bau%5D&dispmax=50

VR Schoffl is a german orthopaedic surgeon, who has done extensive research into finger injuries in climbers. I have another journal article on finger injuries in rock climbers, but cannot find the pdf link on google. If anyone is interested, please pm me your email address and I will forward it on. It includes a nice table on managing differing grades of pulley injuries.

The problem with pulley injuries is that they very rarely happen outside rock climbing, and therefore even specialist hand surgeons may not have much experience in treating them.

Re: Kieranl "Why is it that no-one has asked for evidence for the proposed treatments people have been offering until surgery is mentioned?"

It is because surgical intervention is quite radical, and inappropriate. There is plenty of evidence for conservative treatment (both research based, and anecdotal...ask just about any professional level climber!). If you like, PM me your email address, and I will forward you a few papers on conservative management!

kieranl

30-May-2011
10:29:53 AM

On 30/05/2011 davepalethorpe wrote:
>Re: Kieranl "Why is it that no-one has asked for evidence for the proposed
>treatments people have been offering until surgery is mentioned?"
>
>It is because surgical intervention is quite radical, and inappropriate.
> There is plenty of evidence for conservative treatment (both research
>based, and anecdotal...ask just about any professional level climber!).
> If you like, PM me your email address, and I will forward you a few papers
>on conservative management!
You miss my point. I am not arguing for surgical intervention, in fact my personal experience has been with conservative treatment. The point is that noone raised the question of evidence over many posts of people advising conservative treatment but as soon as surgery is mentioned, the issue comes up.
It is one thing to say "this has been my personal experience", it is another thing to suggest a course a treatment. If a treatment is going to be suggested, especially over the internet, then I would suggest that some clinical references for that treatment are required. Evidence is required whether the treatment is surgical or not as the consequences of inappropriate treatment can be severe.
I think people let things through that reinforce their own prejudices and question ideas that aren't.

davepalethorpe

30-May-2011
11:17:44 AM

On 30/05/2011 kieranl wrote:

>You miss my point. I am not arguing for surgical intervention, in fact
>my personal experience has been with conservative treatment. The point
>is that noone raised the question of evidence over many posts of people
>advising conservative treatment but as soon as surgery is mentioned, the
>issue comes up.
>It is one thing to say "this has been my personal experience", it is another
>thing to suggest a course a treatment. If a treatment is going to be suggested,
>especially over the internet, then I would suggest that some clinical references
>for that treatment are required. Evidence is required whether the treatment
>is surgical or not as the consequences of inappropriate treatment can be
>severe.
>I think people let things through that reinforce their own prejudices
>and question ideas that aren't.

Nope, I didn't really miss your point. Conservative treatment is appropriate for this type of injury, so all the posts above saying don't crimp, take a few weeks off then start climbing gently, tape it etc. etc. are roughly on the right track, and its helpful to hear peoples own (anecdotal) experiences. In reality, with most conservative treatments a week or twos rest, followed by gradual re-introduction to sport will do the trick, and depending on the severity of the injury you will be back to normal in 6 weeks to 6 months (of course there are exceptions, and if you are not sure, you should consult an expert!). I agree that evidence is required for all treatment rationale, but someone saying "you need surgery" is not on the right track, which is why I questioned their post asking for evidence on their point-of-view. If someone wants medical evidence on my point-of-view I can happily provide it :)

climbingjac

30-May-2011
12:17:58 PM

Right well here is the update. Specialist has now seen the finalised ultrasound report which says complete rupture of A2 pulley, so no surprises there. Surgeons in a recent conference on this very topic have formally announced they no longer think it appropriate to operate on a ruptured A2 (unless other pulleys are also ruptured) since the outcome would be no different. The concern is by initiating surgery at this stage (when the area is already traumatized) would introuce more scar tissue which may not form in a desirable manner. The approach being taken in my case is splint for a week to help swelling etc settle down and then commence therapy. Reconstructive surgery of the pulley can be done later on if necessary (ie if the finger doesn't heal well enough by itself). Will add a pic of the said splint in a sec.

climbingjac

30-May-2011
12:33:54 PM

Alrightey here is the pic of the splint... it is made from a plastic that they heat up and form onto your hand. The shape of this particular splint is, I am told, to assist with reduction of swelling, and to keep the injured finger gently stretched to minimize bowstringing of the tendon.


Eduardo Slabofvic

30-May-2011
12:45:32 PM

It looks more like a sock puppet. "Hello boys and girls, my names Mr Splinty. Lets play a game"

There are 74 messages in this topic.