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Lump on base of finger.
OffLine Michael Magenheimer
  2010-06-28 21:19:51    
So after training for a trip I had a bunch of finger pain, around the a2 pully on my right ring finger. Rested, then went on the trip. Climbed well, taped, not much pain. Came back, started bouldering harder and felt pain on my knuckle, but not horrible.  However, as I climb more, around the at pulley I feel a slight lump just below or on the bottom of my a2 pulley that runs horizontally along my finger. It gets noticeably larger and more tender as I climb more and is pretty painfull if it hits a jug. By the end of the session it is quite tender, but after resting for a day or so, 90%ish of the pain is gone. I've been climbing easy for 2 weeks, now no climbing for 2 more and it is much smaller and is just barely tender to the touch although I can still feel the lump there although much much smaller, the knuckle pain is totally gone as well. Spoke to another climber DPT who said she has had the same problem which could be "nodules of inflammation" or "synovial thickening along the tendon sheath," and told me its no big deal as long as I dont develop "trigger finger."
OffLine Ollie Duprey
  2010-06-29 11:09:35    
Hi, may be wrong, but, it could be a ganglion. That is a cyst of the joint capsule, where synovial fluid leaks out into the surrounding tissue. I have had one for about two and a half years now on my middle finger, just distal to the middle phalangeal joint. I originally had it operated on, but, it came back as apparently they do in 1/3 of cases. They do not cause any other problems though, and it is only if it is very painful or for aesthetic reasons that it is essential to have it operated on.

Mine goes up and down dependent on climbing and more specifically, indoor climbing where there is  alot of crimping hard, it usually gets bigger, but, as I say it is not a problem unless painful. You can massage it down, with a bit of moisturising cream, as you simply massage the fluid out and into the surrounding tissue. If in doubt go see a doctor and get it confirmed.

Hope this was a help.
OffLine Dr 8a
  2010-06-29 17:44:05    
HiAs speculated above it might be a ganglion of the joint capsule but it could also be a defect in the tendon sheath or tendon itself- see a doc - it is worth it to avoid long downtime (if a tendon ruptures- a ganglion is easily healed with a a precise scortison injection etc)
Björn
OffLine Michael Magenheimer
  2010-06-29 19:57:06    
Great. Thanks for the help. I am hesitant to get an injection if this can be treated by any other method or if it will not cause tendon damage.

Dr.8a can you please elaborate on "it
is worth it to avoid long downtime (if a tendon ruptures- a ganglion is
easily healed with a a precise scortison injection etc)" I feel I do not understand this.

If it is a ganglion, is discomfort the only result? if so I can deal with that.

Are the other options for more complete dissipation of the ganglion without an injection? or is it just symptom reduction? I have heard things that cortisone injections can damage joints or tendons and am hesitant to get one. I have great health insurance, but should I go directly to my GP or to a specialist for the injection. Should/could I keep climbing in the mean time? Thanks for the help.

 - Mike
OffLine Dr 8a
  2010-07-07 16:39:49    
Elaboration;if it is a tendon partial rupture - working it might result in a total rupture.If it a ganglion a steroid injektion will heal it - if the ganglion is permitted to grow it may cause more than just disscomfort. Cortisone administered by a specalist in the right amount, in the right place on the right indication will do good . only injection intoa tendon outright will hurt it.Good luck
Björn
OffLine Michael Magenheimer
  2010-07-13 14:30:34    
Ok so here is an update.

I went to the orthopedist who took x-rays and confirmed it was a ganglion cyst and recommended me to a hand specialist. The hand specialist said it was very small and just basically popped it with a small long needle. (this hurt like crazy)

Before this I had been climbing and the pain was much worse now, almost all the time when climbing, and it was radiating all down my finger and knuckle from the site of the cyst (around the location of my a2 pully). the cyst would become huge and painful to the touch, but about 2 days later it would reduce dramatically with some massage and reduce in tenderness to almost 0. I assumed this pain was because the cyst had grown so large when climbing it was placing massive pressure on my tendon and finger.

Now, the day after the hand specialist "popped" it, it is extremely tender and I can still feel the cyst, although it is somewhat squishy instead of hard. My gp, (a very very good gp in my opinion) said that its possible that I could have "bruised the bone or another part of my finger" by climbing on what he equated to a pebble along my tendon. I was under the understanding that popping the cyst would result in complete symptom reducion immmediately, even if it does come back eventually. Could my pain and tenderness coupled with the syptoms of pain I was feeling before the cyst popping be signs of an underlying tendon injury?

I would really like to do the right thing to perserve the longevity of my climbing career as I am only 23 and want to enjoy climbing into my 30's and 40's. Should I go back to climbing to see if the cyst has gone? or should I take alot of time off to ensure healing of a potental tendon injury? I am moving in about 2 months so this complicates things as I would need to find a new trusted doctor in my new home. Thanks so much for your help.

 - Michael
OffLine Dr 8a
  2010-07-14 23:03:48    
HiI would beleive from what you have written that this is now cured and a succesiv return to climbing is ok - try avoid "rubbing " that part of the finger for a while and use some antiinflammatory gel for 10-14 days
Best of luckbjörn
OffLine Michael Magenheimer
  2010-07-15 06:31:21    
Great. I figured it was just pain from the "popping" itself. Glad this doesnt indicate an injury. The pain has been subsiding slowly since I saw the surgeon.

Unfortunately NAISD cream is prescription only and the only other anti-inflammatory creme is hydrocortosone creme which is marketed as "anti-itch" creme. Would this work? I have just been taking pill form NAISD instead, is that cool? Thanks for all the help.

 - Mike
OffLine Dr 8a
  2010-07-15 08:34:17    
The pills will work even better -watch the stomach
;-)Björn
OffLine Michael Magenheimer
  2010-07-23 15:33:29    
Bjorn,

Thanks for all your help. Just a few questions for specificity of your guidance so far (and easing on my own anxieties about being away from climbing).

You said NASID for 10-14 days, should I expect to be pain free within this time period, because it is still quite tender to the touch. Tried hanging on relatively big edges and no pain while doing this (but pain when pressing on that spot, or just light crimping), but again, alot of tenderness and pain after and some pain around my middle knuckle, could the pain just be referred pain?

It has been feeling quite itchy on and off around the site of the cyst, I assume this is from it healing?

I can still feel the cyst pretty well on my hand, especially when I flex it, but again its still quite soft (compared to after I would climb and it would be inflamed).

Does the brusing theory of my GP make sense to you? and if so what time schedule should I be looking at for recovery. Can I climb with pain? no climbing if I am experiencing any tenderness at all?

A little more specificity in course and time of treatment would be very beneficial to me at this point. And again, thank you very much for all your help.
OffLine Dr 8a
  2010-08-11 16:00:20    
Sorru for late answer benn in thailand climbing :-)You should be able to start crnking by now, climbing witha little pain is ok but if it slowely increases- quit again for a while. I  think you had an a small tendon injury besides the cyst.
Best of luck
Björn
OffLine Kristopher Hall
  2012-12-31 11:18:56    

I think i have the same injury, i would be very greatful if you could shine some light on the situation. How did you get back to 100% and what have you learnt that could be useful to me.

thanks