Climbing finger injuries are a frequent occurrence. Of these injuries the finger pulley is known to be commonly affected.
Each finger has two tendons that make it bend/ flex. Both tendons arise from the inside of the elbow, pass down the forearm as muscles, change to tendon and go under a tunnel at the wrist, then split to go to each finger. One tendon, known as the flexor digitorum superficialis, joins onto the finger bone at the middle knuckle, the other the flexor digitorum profundus, joins onto the finger at the far knuckle.
As the tendons run up the finger bones they pass under tunnels of fibres which are called pulleys. The pulleys hold the tendon flush against the bone. If the pulleys were not present when the finger was bent the tendon would bowstring away from the finger.
Because of the forces that pass through the finger when climbing a finger pulley injury is a common climbing injury. In particular the A2 pulley which is in between the 1st and the middle knuckles.
As climbing increased in popularity in the late 1980's Steve Bolland, writing in the British Journal of Sports Medicine, was the first to identify the phenomena of A2 pulley injuries in climbers, and specifically that the mechanism of injury was often during a crimp hold because in this position the end knuckle is straight and the first and middle knuckles bent which puts the flexor digitorum profundus at a mechanical disadvantage.
Typically an A2 pulley injury is sustained when climbing in one of two ways;
1. A single traumatic incident, frequently when the fingers are crimping and the foot slips. The climber may feel a popping sound, and can experience immediate pain and swelling.
2. A build up of repetitive trauma over time, a more chronic injury which occurs over a few days or a seasons climbing this is a culmination of micro trauma to the pulley which eventually begins to give pain and discomfort on activity.
Climbing Finger injuries Symptoms of an A2 Pulley Injury
- Pain at the base of the finger
- Swelling at the base of the finger
- Strength of the finger largely unaffected. If the finger is very weak a tear or rupture of the tendon itself as opposed to the pulley system should be suspected
- Bowstringing, if on bending the finger there is contour change at the inside of the finger the tendon could be bowstringing indicating a pulley rupture.
Climbing Finger Injuries, Treatment of a Finger Pulley Injury
Treatment depends largely on the severity of the injury. Most authors now agree that a complete pulley rupture, usually diagnosed by ultrasound or MRI scan, will have the best long term recovery if treated with a surgical repair. Milder sprains of the finger pulley are treated without surgery in these cases treatment should include:
- RICE. The use of ice in the early stages post treatment decreases swelling and promotes healing. This can be combined with the use of anti inflammatories where appropriate.
- Graduated return to exercise including an eccentric strengthening progarmme
Treatment of finger Pulley Injury, When to Return to Climbing?
It is important in order to prevent re injury that return to climbing is handled in a progressive manner. Less pressure is put on the A2 pulley when using larger handholds, avoiding crimping, and keeping to less steep routes thus facilitating more weight being distributed through the legs. Additionally it is important to warm up well and not to climb to the point where the finger becomes fatigued.
A2 Pulley Injury To Tape or not to Tape?
For many years when returning to climbing after an A2 pulley injury, or in an attempt to prevent injury, climbers would apply circumferential tape around the finger, the theory being that the tape works in the same manner as the pulley, restraining the tendon across the finger bone. Two studies are now widely quoted to argue that taping to prevent A2 pulley injury is ineffective.
Warne in the American Journal of Sports Medicine 2000 reports their study where in 72 cadaveric fingers no difference was seen between fingers which were taped and those which were not taped as to the force that needed to be applied to make the tendon rupture. The conclusion of the study is that tape is ineffective. This study however throws no light on whether taping has any effect on micro trauma and cumulative tears, only on the prevention of complete rupture. Schwizer, in the European Journal of Hand Surgery (2000) showed that taping just below the middle knuckle was more effective in presenting bowstringing than tape which was applied closed to the base of the finger. However the tape still only decreased bowstringing by 22% and absorbed 12% of the force and thus the article concludes that taping would probably be ineffective in preventing rupture.
The conclusion from the above two articles is that a piece of tape cannot combat the size of the forces that go through the finger on dynamic weight bearing movement and thus cannot prevent rupture. Many have therefore extrapolated that taping therefore has no role to play in climbing finger injuries.
However whilst clearly the available evidence is that tape will not prevent rupture, I don't think any physiotherapist would have ever argued it could. We regularly tape ankles for return to sport after ankle sprain, no physio would argue that a taped ankle is immune to further sprain or even ligamentous rupture, but it is well evidenced that tape increases proprioceptive feedback, increases confidence and decreases re injury rates. The research has not been done, but is seems a reasonable supposition that the same may be true for finger taping.
Disclaimer: The information on this page is written to help you understand your injury. There are several possible causes for finger pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.
