Page 20 - 2008 AMA Summer

Common climbing injuries: the hand
The most common injury
site for climbers is obvi­ ously the hand. The stresses and pressures trans­ mitted through our hands when crimping, finger jam­ ming, twist locking or monos
are immense. This has led to a
type of injury that is almost exclusively seen in climbing.
The dreaded ‘finger pulley rup­
Self Treatment
We will suggest only general advice to follow until you see a physio or surgeon. As soon as you suspect that you have damaged your pulley you must stop climbing at once. If you try to do just a couple more problems you WILL make the damage worse, quite possibly causing a partial tear to become full. If that is the case
By Rob McAfee and Andy Lewis (RM Reserve)
ture'. We appreciate that few
climbers are prepared to wait
long enough to allow a pulley
injury to fully heal and for that
reason we will suggest the
minimum guidelines for safe, if
not optim al recovery. As
always it is important to see a
Physiotherapist for an accu­ and protect it from friction rate diagnosis and tailored
treatment plan. We must em phasize these are only guidelines and longer rest is the best approach.
Anatomy
The forearm m uscles exert their pull on the fingers by a series of long tendons. To enable the tendons to pull effi­ ciently when the fingers are bent and protect them from damage, the tendons travel through thick ligament type tunnels. These tunnels are
caused by the finger bones or pulleys (see pic 1). Pics 2 & 3 show the location of the pul­ leys (red) in the hand, the ten­ don (yellow) and the abbreviat­ ed names of the joints. For clarity this is also reproduced in Photo 1.
Mechanics
As can be seen from pic 3 of a normal flexed finger, the only real change of direction in the tendon is between A2 and A3. It is where the direction change occurs that most force (F) is generated on the pulleys. This clearly puts most strain on the top of A2 and bottom of
A3. When you add to this hyperextending DIP. as in a crimp, you increase the stretch to an already tight tendon, multiplying the force on the pulley system. This increases the loading of force F making pulley damage or rupture (pics 4 & 5). This is why crimping is almost always the cause of a pulley tear. The ring finger is
If you do not get this seen to by a professional you could then start to overload pulleys A1 and A4 putting them at risk too.
Diagnosis
This is usually from the history of the injury. Often the person will be crimping at or beyond their limit when a foot slips. This im m ediately puts a greater percentage of your bodyweight through that fin­ ger. The pulley will tear or just partially rupture and you may hear a popping sound. Pain will be over the MCP to PIP area on the palm side of the
effected finger. It may swell slightly compared with the same finger on the opposite hand. You can also expect pain. The only way to truly diagnose it is with a scan and few hospitals will bother due to the expense. Some private and NHS physio teams now have ultrasound imaging machines that are the best diagnostic tool for this injury, however, the clinical picture is usually enough for pretty accurate diagnosis.
To give the injury support you should immobilise it by taping it to the next finger. Don’t tape to the little finger for support as it is fairly weak and the dif­ ference in length would mean you are taping over joints, which restricts movement. When taping you should sup­ port each bone between the joints with tape so that limited movement is still possible (photo 2). If the fingers become warm, numb or very red remove the tape at once, its too tight. See the table below for how long to keep it
immobilised.
Photo 1
Photo 2
18 ARMY MOUNTAINEER
pulley
bone
tenosynovium
t e n d o n
more commonly affected as it
is shorter so when a shock
load is applied that finger is climbing by a full month, loaded first and so fails first.
called annular pulleys and there are five per finger. They are numbered A1 (nearest the hand) to A5 (nearest the finger tip). The tendon itself is encased in a sheath (tenosyn­ ovium) that helps to nourish
those few extra moves could delay your return to hard
DON'T BE AN IDIOT!