Fingers & Pulleys

  • Climbing too much or on particularly bad holds can cause an overstraining of the annular ligaments (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 treatments 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

Comments

  • Kris says:

    below treatment isn’t’t working
    Expected outcome Take advice from a practitioner
    After Warm up thoroughly and stretch

    These 3 sections are distracting, consider rewording/correcting

  • Paul says:

    Just ruptured the pulley of my left ring finger. The advice on this site (to not immobilise) is in DIRECT CONFLICT WITH THE ADVICE OF MY PLASTICS DOCTOR, which is a splint for 2 weeks so that the pulley hopefully knits back together, followed by review and physio. I suggest you consult your Dr after any injury of this sort.

  • kylerose says:

    A full rupture is a serious condition and something that is not discussed much on this site because it should be handled by a physician. Thanks for comment and I will make that more clear on this site.

  • Joshua says:

    @ Paul, the first 2 weeks are ideal for splinting and immobilizing as the tendon is actually in deconstruction stage. After two weeks it’s good to start moving the tendon with controlled movements slightly to help aligned the new cartilage that’s being created. If you immobilize after two weeks, statistics show that there are negative results including a weaker tendon.

  • gregory locker says:

    About 2.5 months ago I developed a likely Grade 1 strain in my middle A1 pulley. I decreased the intensity of my climbing, but probable not to a sufficient degree. The injury has only gotten marginally better and there are two rather unique things that I’ve noticed in addition to the usual diagnostic characteristics listed on this sight.

    1. When I wake up in the morning I can’t fully close the injured middle finger. Usually with in twenty minutes the finger seems to warm up and I can fully close the middle finger as well. Some days it seems to take several hours

    2. I believe that I actually feel the pulley (or some other hard piece of tissue a little thinner than your average earbud wire) at the site of the injury. Its quite painful to the touch.

    any thoughts about what’s going on?

    thanks for making all this information available!

    • Mike says:

      I currently have the exact same symptoms in my right middle finger. I also did not stop climbing immediately after the injury (although I have since). I have the same stiffness in the morning and the same painful pulley when I apply pressure.

      I ordered some putty (should be here tomorrow). I have noticed that when I massage the tendon as instructed here I have more stiffness the next day than if I don’t. Any additional information would be welcome.

  • tom says:

    hi my finger has been injured for about a month now, at first it was minor now it is significantly worse after stressing it at work, it has been swollen for a few days, how long does swelling last? is it normal to go on for days or weeks? My finger has been splinted now for a week does that conduce some swelling?

    thanks

  • Swiss says:

    thank you! supper helpful. A very minor pulley sprain, in my ring finger has been my first climbing injury ever. Im usually diligent about warming up, but that day i was lazy.

    Im excited to get back to climbing!

    would squeezing something like putty and promoting blood flow be something worth adding to warm up for an uninjured persons injury prevention tactics? I feel like squeezing something promotes blood flow better than the isometric action of climbing on holds, but i have no facts to back that theory up.

    • kylerose says:

      Yes, squeezing something is definitely better than static holds. Tendons insertion points get little to no passive blood flow. Moving the joints literally pumps blood in. So yes, keep squeezing.

  • Mark says:

    I felt a pop and pain when doing a hang on a board with index and middle fingers. Now I have pain in hand and wrist when moving ring finger and also, and mostly, pinky finger.

    After reading your post I’m guessing I’ve suffered the same but I was hoping it was just a sprain as the pain is there but minimal and I have not bruising or swelling.

    If we felt the pop does that always mean a Grade III?

  • Amund says:

    I´m having this injury (Grade I) for my second time now (different finger). The first time i had a period on about 10 months with highly decreased climbing. I think my mistake then (after the injury) was too much climbing in the beginning. I could´t wait with things such as climbing-trips to fontainebleau or competitions. It wasn’t until i stopped climbing completely that the injury got better. This time i will have an more realistic attitude rather than optimistic (which i had the first time), it will take the time it takes, if months so be it, the competitions or trips have to wait. This means no climbing while i´m having pain in the finger and no climbing in the first 10 days. I will also try icetherapy twice a day to increase the blood flow. In the future i will avoid dynos to small holds and climbing while being tired in my fingers ( These two things i believe is the cause of my present injury).

  • Kat says:

    I injured my finger over two years ago and doctor could not diagnose what the problem was. I now know I had ruptured the tendon. I did have a splint for two weeks but never saw a physiotherapist and wasnt told what to do. I have stopped climbing completely now because when I climb the pain always comes back and I am unable to stretch my injured fingers out. I want to start climbing again, what should I do to avoid this? And if it happens should I see a physician?

    • kylerose says:

      Was there bruising?

    • kylerose says:

      That sounds bad. Very bad. (Assuming you were taking adequate time off during those 2 years). You need to see a hand specialist before climbing. You may have had a severe rupture that needed surgery.

  • David says:

    I injured my finger a couple of weeks ago, I did not feel any pain but noticed significant swelling in my hand just below my fingers. I went to the gym and did light bench works which pushed the blood into the top of my hand where is dissipated through the week. I went climbing again and re-injured the same area not nearly as much swelling but more localized pain. The area affected now seems to be just below the ring finger in the palm of my hand. Is this blood vessels or a tendon issue I am not sure?

  • Shaun says:

    I was climbing a couple of days ago and while pulling on a 2-finger pocket I felt something ‘go’ in my forearm. Immediately after i finished the climb i started feeling pain in my left ring finger. Two days on, i can still feel slight pain when i move the finger but i still have a full range of movement. Is this more than likely just a strain? Any suggestions on what i could have felt in my forearm?

    Thanks

  • sander says:

    about 10 days ago, i putted a lot of stress on my left ringfinger and i thought i heared a pop. after looking at some sites i think that i have a minor injury because my arm (profundus tendon) hasn’t swollen up and i can still move my ring finger. the point is that whenever i trie to gently put some stress on my ringfinger i get a sharp pain down my arm (t’ill 20cm under the wrist), does somebody have any good advice on what to do ?

    thanks
    Sander

    • Kevin says:

      I have this same issue, I was working on a gym problem and put a lot of weight into a two finger pocket. Long story short, there was no swelling or ROM loss (I can even crimp fine), but when I put a little stress just on my ring finger, I get that same sharp pain down my arm. I would love some thoughts about the seriousness and recovery time for the injury.

      Thanks

  • Lee says:

    If you can figure this out I will be very happy! About 2 months ago I was bouldering at the gym and while I was waiting for a route to open, I casually massaged my fingers and noticed that my left ring finger above the first joint was swollen. It didn’t hurt, and I didn’t hear a pop or anything, but it was bruised. I rested it a few days while the bruising subsided, but as soon as I climbed again the bruising came back. Pain was minimal, but noticeable. I took 3 weeks off from climbing and very gradually started climbing again, climbing 1-2 times/wk, doing only easy routes, and always taping my finger. But the bruising keeps coming back! It now bruises just from riding my bike. I haven’t seen a specialist yet because I didn’t think it was that serious, but now I am reconsidering. I have no loss of finger mobility and generally no pain, with only minor pain if I massage the joint. Thoughts?

  • Eileen says:

    I hurt my ring and middle finger on April 5th on the first hold (a large) pocket of my warm up climb.

    I heard a pop and felt as if my fingers had bent the wrong way (similar to knuckle cracking maybe).

    My ring finger seems normal but the section of my middle finger closest to the palm is swollen.

    I did not have bruising at any point during this. When it happened I stopped climbing and put my fingers in creek water and then wrapped them around a frozen gatorade bottle.

    Today I can close and extend my fingers but that one part of my finger is still swollen.

    I’m asking what someone else asked earlier, does a pop sound always mean grade III? Does lack of bruising mean it’s NOT grade III?

    PS Have gone climbing since the 5th but only did two routes with no crimping.

    Also…. I have strange fingers, sometimes they are called “double jointed” so the pop sound, it kinda felt like when I make my double fingers pop.

    Advice? Guesses?

    • Felix says:

      It’s not as black and white as pop ==> grade III, and no bruising ==> no grade III.
      A pop usually means grade 2 and up, and the severity can often be judged based on how loud/aggressive the pop was.
      Bruising can occur for different reasons, I once had bruising in combination with a pulley injury (non-acute), though it was not grade III. Bruising is a bad sign, but doesn’t always tell much about the severity of your pulley injury. You can have grade III with no bruising.

  • Alex says:

    Here’s some advice for anyone with a finger injury. See a doctor and preferably a sports specialist! Do not mess around like I did!

    I injured my middle finger with swelling at the proximal interphalangeal joint (the joint midway between the tip and the palm). I iced it and kept climbing over the next few weeks because I thought it wasn’t a big deal… Until I realized the swelling wasn’t going away. Now after seeing several doctors and specialists, it looks like I ruptured a tendon.

    Recovery is now lengthy and painful. It’s going to take a lot of work to get full flexibility and strength back in my finger.

    Don’t do what I did! Stop climbing and see a doctor that can refer you to a specialist!

    • kylerose says:

      Well said.

      I’m kind of in the same boat. I stopped climbing but I didn’t think it was a big deal. I’m 10 weeks in and I know I have a while to go.

      A really good hand specialist that deals with athletes is where I went. It helps.

  • Onita Mangini (@osjan201970) says:

    My pinkie finger on my right hand, middle knuckle has been sore and swollen since April 2013 that I have come to notice, with what appears to be purple or bruised as well on the knuckle. Some nights I am awaken by this pain on my knuckle on my pinkie. Sometimes I can bend it, and other times it hurts to bend. I am trying to figure out the pain pattern, only thing I seem to notice is when it rains or when it is cold that is when it seems to “flair” up. Now I do not know if this has anything to do with what I am going through, but I am 43 years old, from the time I was 19 all the way to age 36, I was a dancer, I did a lot of poll tricks which consisted of climbing up the poll, I also did poll tricks in what they called “The Cage”, when I was 28 I pulled my rotary cuff, I was told not to use that arm for 6 weeks, well after 4 weeks I used my arm again to do my poll tricks, I pulled my rotary cuff again and never went back to get it treated, I just let it heal how it was going to heal, I believe it is the same arm I am having the pain and swelling at in my pinkie. Now another thing, through all my years of dancing, I always got this pain in that exact same pinkie, but it was a different kinda pain, a pain like my finger had to crack BAD, I would always try and crack it, but it would never crack, the crack feeling would get so bad that I would start biting on my finger, sometimes really hard, because me biting it would feel better then the pain of it feeling like it needed to be cracked. When I stopped dancing that feeling went away, now here it is 7 years later, I am now experiencing this swelling and soreness to that exact same pinkie. Is there any possibility this could have anything to do with me not getting my pulled rotary cuff healed properly and it is just screwing up that side of my arm including the hand? OR could this maybe have something to do with me climbing the poll at work and doing all my poll tricks? OR could this just be coincidence?

  • jake says:

    I do not climb but yesterday I was trying to open the truck door with my left ring finger when suddenly I got a sharp pain quickly immobilizing me for a second. Its weird because its not swollen I think I heard a pop but can’t remember, could have even been a crack.. It hurts to separate my pinky and ring finger to far and as I just woke up it feels as if I hyperextended it although we know I didn’t. Plus its not swollen. Now its sore and tight especially when I try and close my hand…. Any ideas?

  • Kat says:

    I had a. Pulley injury years ago and never got it checked out fully. The doctor didn’t seem to understand what had happened, and I shrugged it off thinking it wasn’t a big deal. Now I’m back climbing and I’m finding that it’s very painful. After a problem or two, I can’t even move my finger because of the excruciating pain. It doesn’t bother me as fast when I climb routes, but bouldering is my forte and it gives me big problems! The finger I injured is my left index finger, and I believe I tore the A2 pulley. How can I help my finger get back to normal?

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