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Seeking a Hand Specialist for pulley injury

1:50:02 PM
So I suspect that I might have ruptured my A3 and possibly my A2 pulley on my left ring finger... There were two audible pops, a sharp pain and loss of strength when I was crimping hard in the gym. I iced it immediately, but there was still swelling and the following day the area in the vicinity of the A3 and A2 pulleys was bruised. The majority of the swelling subsided a day or two after, but the bruising took roughly two weeks to subside.

The issue is, I've had trouble getting a decent diagnosis from my GP. He sent me for x-rays initially, and confirmed that there was no break. He then advised me to stop climbing for two weeks - with no other recommendation to splint the finger etc.

I pushed the fact that it could be a rupture, so he hesitantly referred me for an ultrasound. I went in for the ultrasound yesterday, but the technician/radioloist advised that she isn't really an expert in U/S and would have difficulty picking up something as fine as a pulley. So she's suggested that I head back on Monday for an U/S with a better technician... but was still sceptical that he would be able to find anything.

The problem is, it's already been two weeks since I injured my finger, and it will be three by the time I have the U/S and then a few more days before I get the results. All of the literature I've read has said that splinting my finger for the first two weeks is the best initial therapy for a single rupture, but if I have multiple ruptures, or the finger isn't splinted properly at the initial stages then I will need surgery. So I'm worried that by the time I get the correct diagnosis I might have missed my chance to avoid surgery.

TLDR: I'm wondering if anyone can recommend a good hand specialist (in Melbourne) that has experience with these types of injuries in climbers and isn't just going to give me a funny look when I tell them that I think I've ruptured a pulley???
3:58:55 PM
The below paper is one of the best on pulley injuries, and has a good section on management. US is the gold standard for detecting pulley tears, but you probably just need an experienced sonographer.

Can't help with any specialist recommendations in Melb sorry, as I live in Sydney.
4:02:50 PM
When I injured my pulley I had a Skype appointment with Dr. Julian Saunders ( he was fantastic.

4:14:02 PM
Thanks dave, I have a copy of that paper and took it along to my GP appointment. He wasn't impressed. Didn't want to know about it, and didn't like that I was self diagnosing.

4:15:39 PM
Matthew, that's a interesting link. Maybe once I get my ultrasound results I'll give him/her a try. Looks promising.

I've sent an enquiry about an appointment and will post back once I have a diagnosis.
5:27:40 PM
I ruptured my a2 pulley and now have this weird finger thing called bow stringing. I heard a loud crack and could not even touch that finger for weeks and felt pain down into the palm of the hand.
The way it was diagnosed was measuring the ultrasound of the finger tendon against the same finger on the other hand...
X-rays are no good and if its a complete rupture pick another sport for six months but it will stop hurting

7:45:33 PM
You could try the Australian Hand Therapy Association. It has a hand specialists/Therapists listed in the "Find a Therapist link."
2:20:22 PM
Very good hand man at sports med centre next to rectangular stadium. All the rugby and football players go there. Does a lot of finger in jumper pull injuries. Sorry I don't have more info.

8:36:12 AM
I had a skype chat with Dr Julian Saunders last night. He confirmed that I've ruptured my A3, but that a conservative approach to recovery is the best way to go. He advised that an ultra-sound is likely to be a waste of time as the symptoms I've described (and sounds) are a better confirmation of the injury than I'm likely to get from an US anyway (which may not even pick up a pulley - ruptured or whole).

He's advised that I should continue to splint my finger for another two weeks in a slightly curved (relaxed) position. I can then remove the splint, and use that finger for everyday light tasks.

After a total of 8 weeks from when I first injured it I can start light open handed climbing, so long as I wrap the finger with tape, such that it can't bend at the middle joint.

I have to very slowly work back up the grades, but should be back to full strength in 12months (the only bad news)...

I was very happy with the consultation and highly recommend speaking with Julian if you've got any climbing related injury concerns.

Cheers for the input guys.


3:10:41 PM
Best of luck with the rehab. I hope your finger heals up quickly.
6:57:52 PM
Hey man, good luck with the finger, dynamic ultrasound will give you an answer if you need confirmation of a full rupture, it is very sensitive to bowstring detection, however it varies a lot on the person running the imaging. MRI will show 98% of full ruptures and can also be very useful. What Julian is getting at when he advices you not to get imaging is that it will tell it has ruptured, but then what? It does not really help to know and the symptoms and sound would indicate that it has a grade 3+ rupture, either way the treatment etc is similar for grade 3 and 4 injuries. So if you are taking a conservative path, which is recommended, then diagnoses at this stage does not help much. However if you find that after this period of time off followed by rehab you still have issues (multiple ruptures esp a2/a3 and a3/a4 can sometimes cause problems) don't climb through it! Seek further advice. Message me if you would like additional info. Good luck, oh yeah, if you did see a orthopaedic hand surgeon he would recommend a pulley ring (type of splint) full time for multiple months if there was a chance of full rupture to increase likelihood of reattachment in a serious full ruptures.

There are 11 messages in this topic.


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