A3 pulley fresh injury

Perica Levatić

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hello! I am a climber from Croatia and I would like to ask you to help me about my injury. Thank you in advance. I had a bad injury (yesterday) in the middle phalanx of the ring finger, just above the middle joint. When pulling from a small crimp, I heard a very loud and strong popping sound and felt something unpleasant in that finger, around the A3 pulley, and I believe that A3 is injured. There is a bit of swelling in the area, and I cant close a full fist with that finger (there is about 5mm gap between my finger and my hand), but I can extend it normally to full stretch without pain. Also, there is no pain in normal movement, and there is some preasure tenderness (but not too painful). There is more pain only when I try to put (any) load on it. I feel some pain even when holding a glass. There is no pain in A2 area. As I see (from the book one move too many) what happened is that my A3 pulley is either strained or partially ruptured or ruptured. Is anything else possible? Is it possible that the pulley isn't ruptured with a poping sound very loud, and only strained? Can you tell me how could I determine what exactly is wrong with my finger? Is the information above enough? The doctors here are not familiar with climbing at all. The book One move too many said that an ultrasound examination could determine whether there is a rupture - but with medicine system in this country it is possible that I wait for a specialist examination for weeks, and a MRI or private doctors would be to expensive. Is it necessary for rehabilitation to know exactly what is wrong or is rehab similar for the three injuries? If this is enough information to conclude that my pulley is ruptured (or only strained), what would the rehabilitation look like? Is there a difference in rehab between partial ruptures or strains in pulleys? I know I have to rest for a few weeks. If you can, tell me what rehab certainly is good for me, even if I cant find out exactly what the injury is. If you can't answer everything, please tell me what you can from this email. Should I apply ice to the area, and for how long and how often? Should I use anti-inflamatory gels and/or drugs, and for how long? When can I begin practicing the finger with somenthing like rubber band or qi-qong balls, and when can I begin climbing light? Perica Levatic, Croatia

4 replies

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Steve Amstutz

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Hi, First sorry for you. If you feel better, same thing happened to me last year. If you heard a pop (like when you break a piece of wood) in your finger, that's for sure your pulley. Bur it's pretty hard to know if it's partially or completely ruptured. If you understand French, here is a website done by professionals: http://www.kinescalade.com/ I'll translate to you what to do: Day 0 to day 30 Massage with ice 3 times a day. Put some gel, like Flector Tissu-Gel under the tape. Immobilize your finger with strapping (tape). From days 15, 2 to 3 times a week, physiotherapy (like ultrasonic 3MHZ pulse 0.5W/cm2, 5 min). Day 30 to day 60 Leave the tape on your finger 23 hours/24. If pain: Massage with ice 3 times a day. Put some gel, like Flector Tissu-Gel under the tape. Physiotherapy. You can start to climb again but under these conditions: 1. No pain 2. No crimps 3. You finger must be taped (tape two fingers together for example) 4. Don't try to climb hard If pain: stop immediately Day 60 to day 180 If the pain subsists or you cannot move your finger properly, well you should think of the surgery. If no pain, than you can climb with always your finger taped. But remember: 1. No pain 2. No crimps 3. You finger must be taped 4. Start slowly to climb hard To climb as hard as before the accident it will take 180 days, don't try hard routes, moves to fast. Physiotherapy. If you have any questions, here is my email and don't hesitate to contact me: [email protected] Be patient and everything will be OK. Steve

Christian Wied

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Hello Perica Sorry to hear about your finger. Did the same to mine last year. I had an ultrasound which concluded rupture of the A3 and partly of the A4 pulley. This diagnose got the doctors on my neck, everybody seemed to want to operate it, or as they said; at least have a look inside and see what they could do. Today I am glad I refused operation, I am a doctor myself and it was hard to say no thank you to operation, but I recovered much faster than I expected. I believe operation will be the solution if you have multiple ruptures especially if the A2 is involved, but in my case I doubt it could have been operated any stronger. I took two months completely off climbing, iceing my finger up to five times a day (ice in a bucket and a bit of water) lasting at least 20min every time. When not iceing I was playing around with a soft spunge to get the finger activated. After two months I started up on climbing plastic again away from crimps, but hard enough so that I after two months was crimping my way through harder routes outside and two months later back at my max performance. Hmm.. maybe I should try harder! My advice to you: If you are certain the A2 is not involved, then spare your money and let time and ice do the work. Hope you recover fast. Chr.Wied

Perica Levatić

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thank you all for help. also, I'd like to ask you about taking capsules for joints etc. as I see the most imortant is to take somenthing with glykosamin. does anyone have experience with which are the best for joint like Osteobiflex - http://www.osteobiflex.com , or Lakota - http://www.lakotaherbs.com/products/xsjc_directions.html and most importantly, do these capsules help rehabilitate and strengthen the fingers, or should I take them when I start climbing? (I wasnt using them so far, but I think i would start)

Bjoern Alber

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Hi Perica Sorry about your injury , without an inspection it is hard to be sure but I would agree with Steve and Christian above that you most likely have an A3 tendon rupture, The aproach taken by Cristian is a very sensible one and easy to follow, use twin taping of the finger as well as tendon einforcement taping ( see One move to many by Dr Volk) as you start up climbing again. Continue to use the foam ball regurlarly to enhance cirkulation. The effect of Glucosamine is mainly performed on the joint surfaces not the tendon structures - use it when taking up climbing again, now you would be better of with a good antiinflammatory drug ( Voltaren-T, 50 mg 2+1 tabl daily for 3 weeks) . Be patient and let it heal well - in the long run you will be doing more and harder climbing this way Good healing Björn