• Climbing too much or on particularly bad holds can cause an overstraining of the annular (flexor) pulleys of the fingers (notably ring and middle fingers) This can be anything from a Grade I (strain) to a Grade III (complete rupture). Generally, if you have a Grade 3 injury you will have three phases of treatment. After graduating from Grade 3 treatment you will move to Grade II treatment, and finally Grade I treatment. The grade based treatment and are just guidelines. You be the judge. If it hurts to climb, then don’t climb. Avoiding pain is key to getting back to 100% (mild discomfort ok). Other finger injuries are possible with climbing (such as collateral ligament strains, flexor tendon strains, tendonitis and ruptures), so if your injury is not described below or the below treatment isn’t working, read these articles
• Orthopedic Problems in sport climbing
• Hand Injuries in Rock Climbing: Reaching the Right Treatment
• And/or consult with an orthopedic surgeon or physical therapist who is a certified hand therapist

Please Note:
“Any finger injury that is sustained by a young adolescent (12 – 16) should be seen by a physician and have x-rays performed. These skeletally immature athletes are very susceptible to developing debilitating joint arthritis later in adulthood.” Source

DIAGNOSIS:Pulleys

•  Grade III - Complete rupture of the pulley causing bowstringing of the tendon. Symptoms can include: Pain locally at the pulley (usually sharp), may feel/hear a ‘pop’ or ‘crack’, swelling and possible bruising, pain when squeezing or climbing, pain when extending your finger, pain with resisted flexion of the finger.
• Grade II – Partial rupture of the pulley tendon. Pain locally at the pulley, pain when squeezing or climbing, possible pain while extending your finger.
• Grade I - Sprain of the finger ligaments (collateral ligaments), pain locally at the pulley, pain when squeezing or climbing.

Knuckles

• Stress fractures- If your middle knuckle hurts and is swollen much of the time, you may have a stress fracture. This is especially common, and troublesome, in young climbers. I urge you to seek medical attention to confirm the diagnosis although it is often hard to see a stress fracture on x-ray. If you do have a stress fracture, you will need to take at least a month off (but as long as 3 months), especially from crimping. You can probably climb on jugs without irritating the finger, but if it hurts at all, you are just setting yourself back on the healing spectrum. You can assess your healing by noticing decreased tenderness, swelling and no pain when climbing. If it still hurts, don’t do it.

• Collateral ligament injury- This pain will be on one or both sides of the middle knuckle.

---

TREATMENT: General Notes on Treatment:

(1) Go buy some TheraPutty! All orthopedic doctors and physical therapists will recommend putty as a tool for successful recovery. (2) The fingers generally receive poor blood flow so getting blood to the injured area is important. Contrast baths have had mixed results in the literature, but it wouldn’t hurt to try. To do a contrast bath, get a bowl of warm water, and cold water. Put injured finger in cold water for a few minutes, then place it immediately in the warm water for a few minutes. Repeat 3-5 times. Finish with the cold water. This could be done after squeezing the putty ball to “flush out” the injured joint. Massaging the effected area can be effective as well. Start out lightly and gradually increase the pressure.

Pulleys

• Grade III: - Immediately stop climbing and apply ice or cold, no more than 15 minutes at a time (1-2 days) Take ibuprofen for 1-2 days, keep the hand elevated. (Week 1-2) Don’t climb! Don’t immobilize the finger. Unless there is a lot of pain, open and close your hand often, VERY light massage at the site of the injury. Concentrate on other aspects of your life. (Week 4-8) Warm the hands by use of a bath or an electric blanket, then squeeze the yellow (softest) putty. Don’t push it, if there’s pain…stop. Repeat a few times per day. Go to Grade II Treatment.

• Grade II: (Week 1-2) No climbing. Warm the hands by use of a bath or an electric blanket, then squeeze the red putty. Don’t push it, if there’s pain…stop. Repeat a few times per day. Lubricate and lightly massage at the site of the injury. (Week 3-6) Tape the injured finger, stretch your forearms (this relieves the stress on the finger tendons) and climb the biggest holds you can find. Start easy, this will be the quickest way to recovery. If you climb too hard, too fast, then return to the start of Grade 2 and do not collect $200. Always stretch your forearms after warming up and prior to climbing. Start squeezing the medium to firm putty. Lubricate and massage the finger at the site of the injury a couple of times/day. Start lightly and gradually increase the intensity using very short strokes on the injured site. Go to Grade I Treatment

• Grade I (Week 1) Tape the injured finger and continue to climb at a level well below your normal level. Gradually increase the stresses on the fingers. Stretch your forearms after warming up and prior to climbing. This relieves the stress on the finger tendons. Squeeze the medium to firm putty a few times per day. Lubricate and massage the finger at the site of the injury. Start light and gradually increase intensity. Very short strokes on the injured site. If treated early and effectively, with an appropriately graded return to activity, recovery will usually take 3-8 weeks. However, if the injury is pushed beyond its stage of recovery, re-injury will occur and may result in a chronic injury that will require a much more protracted rehabilitation period. If you have questions/concerns about your recovery, seek advice from a practitioner who specializes in climbing.

• Post Treatment Re-injury Prevention - Warm up thoroughly and stretch, paying particular attention to the elbow, wrist, and forearm. Do easier routes and use larger holds early in your climbing session. Avoid over training (depending on how hard you are climbing, you may only want to climb every other day). Take adequate rest and recovery periods (particularly if feeling ‘under the weather’). Regularly massage the forearms. Continue to tape the finger until there is no pain involved in climbing.

Collateral ligament injury

• Treatment involves rest (of course) and buddy taping the involved finger to the finger next to it (on the side of the injured ligament, if only on one side). Also icing (or contrast baths), and range-of-motion exercises are beneficial. Again, 4-6 weeks is the common time frame for healing. If the finger seems to have a lot of movement from side-to-side or is just not healing, you may have had a full ligament rupture and should seek medical attention.

---

SUMMARY:

Finger injuries are probably the most common of the upper limb injuries that are sustained in climbing. The large stresses transmitted through the pulleys make them vulnerable. Injuries can be traumatic or overuse in nature. Effective management is important for both climbing and everyday activities