Ultra Sound A2 Pulley Injury

General climbing discussions. Climbing, Bouldering, Mountaineering. Anything!!
**Keep the arguments to the suject, not the members!
Post Reply
Josh78
Posts: 24
Joined: Sat Sep 17, 2016 11:09 am
Real Name: Josh sowter
Location: Cape Town

Ultra Sound A2 Pulley Injury

Post by Josh78 » Fri Mar 20, 2020 2:20 pm

Hi guys

The purpose of this thread is to ask any climbers out there who have sustained pulley injuries in the past about where they went for a good ultra sound for this specialised injury?

I've heard a lot of stories of how important it is to have a radiologist who has specific knowledge about this injury to look at the ultra sound report. Can anyone please suggest someone? I would only like someone to recommend from personal experience please (or if they are a specialist)?
Please note, I'm based in Cape Town.

A bit of history behind my injury
I've been battling with an A2 Pulley injury for 6 Months now. The injury is on my left middle finger A2.

I carried on climbing but on far easier routes and toned down the amount of time I'd climb for, along with the frequency to which I would climb. I also stopped sport climbing all together and just climbed trad. This went on for a number of months, and to be honest my finger felt like it was getting a little better in these 4 months. One thing I noticed during this period is, I did not really have significant pain but rather a constant dull ache in my finger that lasted ages and would come back at the slight sniff of over use. I never really had pain in bending my finger into a fist, but there was definitely tenderness with pleasure, certain general hand activities would cause some discomfort etc. For what it is worth, I had full range of motion from the beginning of the injury.

2 Months ago, I used my hang board as a rehab tool. I removed 1/3 of my body weight using a pulley and hung on big holds for 10 second burst only 3 or 4 times. That was it. Next morning finger was not happy at all. It was aching with some swelling. This got worse as the week went on. I stopped all climbing and decided to see a specialist hand Physio to get some insight. She thought I had a grade 1 or 2 tear on my A2 pulley. Perhaps I made this worse using my hang board? From here I wore a special pulley splint she made for 6 weeks (I did not sleep with it and removed it a few times on some days during that period). I started very light rehab (using the easiest grade putty that you get) and did 10 very slow hand compression. This would cause my finger to ache the follow day. She was unable to give me an answer on why this was aching. I decide to stop all rehab for 2 more weeks. Then started the very light rehab again, same problem the following day (always a low grade dull ache). I've not done any climbing for 2 months now and my finger has not shown too much improvement (perhaps a little less achey).

Any direction to imaging would be greatly appreciated please.

User avatar
XMod
Posts: 949
Joined: Tue Jun 26, 2007 9:38 pm
Real Name: Greg Hart

Re: Ultra Sound A2 Pulley Injury

Post by XMod » Fri Mar 27, 2020 4:16 am

To be truthful I just skim read your post but it was enough to make one thing very obvious you are WAAAAAY over doing things!!!
STOP CLIMBING ON THE THING!
How on earth do you expect to heal from an injury if you keep overloading the injury site?
I am no medical expert but I doubt ultrasound will have much significant effect as healing therapy. It works for helping to liquify scar tissue in muscles but the ligament in a pulley is such dense material and is so small that it seems to me ultrasound would have little beneficial effect.

I tore my pulley some years ago. It took ages to heal and yes I too tried to carry on climbing - all that does is prolong the healing process and can lead to permanent damage! Below is what actually works:

1. REST!!! I can't emphasise this enough, you should not place any load whatsoever on the injury site at all until it is completely pain free. Cease all training and avoid using the hand at all if possible.

2. Ice and hot/cold treatment. Considering this injury is past the acute stage (and well on it's way to becoming chronic given the abuse you have been subjecting your finger to!) you can probably skip Icing and go straight to hot and cold. Fill up one basin with ice cold water (wait until ice has melted before putting your hand in the water - ice burns skin) and another basin with water as hot as you can stand without burning yourself (like a really hot bath). Hold your hand in the hot water for 30secs to one minute (until it feels really hot) then put it into the iced water for a similar period (until it feels really, really cold). Keep alternating between hot and cold for several minutes until the water temps lose their effectiveness. End with cold at first and then as the pain starts to go away completely end with hot. Repeat this several times a day. You will notice your hand turns bright red - this is exactly what you want, lots of fresh blood cells entering the area which will speed healing. WARNING!= If you experience painful throbbing in the injury during this treatment it is too soon for heat, just use cold until the hand is a bit better then start with both heat and cold.

3. Massage. Very, very gently and LIGHTLY massage the area for a few seconds several times a day. If you finger starts throbbing in the day give it a very brief very light massage. You should only be touching the injury very lightly. Do NOT use pressure and dont overdo it. A few seconds is plenty. Use massage throughout the recovery process (likely many months).

4. Range of Movement. Only when the injury site is completely or nearly completely pain free should you start with getting full mobility back. At first this is simply opening and closing your hand gently. As you progress you can very gently make a fist then lightly stretch the finger into extension using your other hand. BE GENTLE!!! There should be zero strain or pain, you want to work within the pain threshold and build more range slowly. Slight discomfort is ok - just don't push it.

5. Rehabilitation. Once you are completely pain free and have good range of movement start strength rehab. This involves using the softest putty you can get and molding it into a ball in your injured hand and then squeezing your fingers through the putty ball all the way toward your palm - try to close your fingers as much as possible. Do three times 15 reps at least twice a day. Again don't overdo it. Avoid any other type of finger 'strengthening' (read tendon wrecking) devices like spring loaded devices and definitely stay away from the weights until you are ready for the next phase. DEFINITELY NO HANGBOARDING!!! It will be many months before your finger is able to take your full weight so chill out - this is going to take a LONG time!

6. Return to climbing and training. I would advise two months of rehab at least before attempting to start climbing or training again. Ligaments have really poor blood supply so healing is extremely slow. Expect at least six months before you are 100% again. TAPE UP!!! Learn how to do a proper X tape job that fully supports the pulley. You will need to use the tape for many months slowly weaning yourself off it but reverting back to it each time you up the recovery ante. Needless to say you should stay off over hanging terrain at first and stick to comfortable jugs. Build the difficulty up VERY slowly. It is extremely frustrating but if you want to be able to pick your nose (or do anything else) when you are sixty you'd better discipline your return to active climbing. If you experience sharp pain whilst climbing you have come back to it too soon - do more rehab first. Some mild pain is ok provided it is gone by the next day. If your are still sore the next day you are overdoing things.

Best of luck - I hope you will follow this advice. It truly is the only route to full recovery. If you carry on climbing on the injury and abusing your body you will end up with a crippled finger that does not function properly - not an option in my books. If you do rehab it properly you can go on to enjoy many more years of pain free, fully functional climbing. Do the sensible thing!

User avatar
XMod
Posts: 949
Joined: Tue Jun 26, 2007 9:38 pm
Real Name: Greg Hart

Re: Ultra Sound A2 Pulley Injury

Post by XMod » Fri Mar 27, 2020 4:32 am

One last thought - if you are an idiot like me and smoke cigarettes QUIT!
They prevent the body from healing properly at all.
A healthy diet, vitamins and aerobic exercise like running or cycling (not swimming at first - it loads the hands/fingers) will speed healing.

Post Reply