What is Climber’s Finger?
Finger injuries is no stranger to any climber be it indoor or outdoor. Climber’s finger is the most popular climbing injuries within the sport of rock climbing. It can be due to overuse injury or when a climber tried to withstand and support their body with one or more finger hooked onto a hold. This particular action may injure the flexor tendon sheath, hence named “Climber’s Finger”. The middle finger and the ring finger are commonly the victim for this injury.
Our fingers consist these little sheaths that hold the finger tendons close to our bone when it bends. These sheaths are called A1, A2, A3, A4, and A5 annular pulley. The A2 and A4 pulley are prone to injury.
If multiple pulleys were rupture during the event, a bowstringing will be visible. The A2 pulley is susceptible to sprain and rupture due to overloading the tissue. An excessive amount of stress is placed on the A2 pulley when a climber is holding to a crimp. It showed that a crimp grip places 31.5 times more force on the A2 pulley than an open-hand grip.
A climber may hear an audible “pop” sound and feel immediate pain, followed by swelling and bruising on the finger, and usually localized pain. Climber also experience pain and/or stiffness when bending the injured finger. The injured finger will be tender to touch.
Management for Climber’s Finger
The severity of the injury affects the recovery period for the climber.
Grade 1 – Pulley strain
For a pulley strain, returning to full climbing activities required a period of 6 weeks with treatment. The treatment focuses on range of motion exercise, functional therapy, and gentle climbing. This is to regain strength, coordination, and body awareness. Climber is advice to wear tape during to period of recovery (up to 3 months). No immobilization required.
Grade 2 – A4 rupture or partial A2 or A3 tear
Climber with these injuries mostly need 6 to 8 weeks recovery period with treatment to return to full climbing activities. To protect the damage tissue, immobilization is necessary approximately up to 10 days. Once the immobilization phase is over, passive range of motion exercise begin. Tape is still required during the functional therapy for 2 to 4 weeks. Gentle climbing is implemented after 4 weeks. Tape is still required up to 3 months during climbing.
Grade 3 – Complete rupture of A2 or A3
Returning to full climbing activities recovery a recovery period of 3 months. In this grade, the injured finger is immobilized for 10 to 14 days. Instead of tapes, a thermoplastic pulley ring is given by a doctor. After the immobilization phase, passive range of motion exercise will commence follow up by functional therapy. Gentle climbing begins after a 6 to 8 weeks from the onset of injury. Pulley ring to be worn during climbing session for at least 6 months.
Grade 4 (surgery indicated) – Multiple ruptures, or single A2/A3 with trauma to lumbrical muscles or other ligaments
At least 6 months of recovery period is required to return to full climbing activities due to surgical implications. Immobilization for approximately 14 days post-operation. Passive range of motion exercise begin after immobilization up to 4 weeks before commencing functional therapy. Throughout the recovery process, a pulley ring will be used. Returning to gentle climbing required at least a full 4 months while full climbing required 6 months period post-surgery. The taping or the ring may be utilized during climbing session for at least a year or more.
Article by Jene Teo
Physiotherapist from Your Physio