Middle finger pip woes

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 SaraB 01 Jul 2019

Hi everyone, I hope this is the right place to post but I'm desperate for a bit of advice if anyone has experienced this. 

The PIP joint of my middle right finger is sore and swolen. After a climb it often looks bruised but the colour tends to go away the next day. It doesn't hurt whilst climbing; it's always afterwards and when I bend or manipulate it such as use a spanner. I notice it when I'm doing day to day things like picking something up, opening a door. This started about 4 months ago. It's not awful, more uncomfortable, and it's an ache more than a sharp pain. I can't bend it fully after climbing.

The history is that it got gradually sore and I also bashed it a couple of times both indoor and outdoor. I can't really work out if it's originated from a bash.

The pain is inside the knuckle and on the top of the finger. There is a hard swelling below the knuckle. This is tender to massage, as is the area slightly to the left on the top edge of the side of the finger towards the hand. When I bend it the pain extends to the top of the finger above and below the joint. 

What I've tried:

- I've just rested for 2 months.

- I started climbing again two weeks ago (after recommendation from both the doctor and the consultant) and have been bouldering lightly twice a week. It's been OK I was feeling relieved. Today I climbed outside and then went to the gym for a little bit (I climbed easy) and it's bad again. See pic.

- had an xray (thought cracked knuckle at first) and ultrasound. The latter showed no pulley or tendon damage, but fluid inside the joint. The doctor said it was soft tissue and swelling of the tendon sheath from the bash. 

- I've been taping it above and below the joint. Doesn't seem to help and almost seems to make it worse.

- Little bit of icing and cold water baths but very little if I'm being honest; I thought that inflamation was part of the healing process so have been worried about interfering with this.

- applying ibuprofen gel twice or three times a day.

Can anyone help? I really don't know what to do; some people say climb often and easy to promote healing, others say rest completely. The rest hasn't really fixed it.

Cutting out climbing completely is having a really negative affect on me in several ways. I'm a pretty novice climber so not doing anything above VS outdoor and leading 6b+ indoor but it's a big part of my life. 

Some advice/shared stories would be great as I am getting conflicting advice from both doctors and climbers and I'm in a bit of a mess about it. 

Thanks everyone.

Post edited at 13:40
 balmybaldwin 01 Jul 2019
In reply to SaraB:

I have something similar in my finger joints (specifically in my ring fingers on both hands, most severe on the left hand).  Sadly it has stopped me climbing like I used to and now potter about on vdiffs and not very often. Like you I feel no pain while actually climbing (or doing anything else), it seems to come on a few hours later and last a week or so depending on how much I've aggravated i(for instance I can't make a tight fist or touch my palm with my finger tips)

I went down the route of a GP appointment followed by consultant referral which lead to x-rays, MRI scan and ultrasound.... The conclusion being that previous damage to my pulley tendons had healed in such a way to produce a nodule on the tendon which after use becomes inflamed.  Surgery is an option but it's relatively high risk, therefore I decided to now climb sparingly so as not to ruin other sports (mountain biking) however it's getting to the point where I think surgery might be the way forward.

I have noticed that any kind of gripping exercise can now bring it on, from wielding a hammer and chisel to remove kitchen tiles, to holding a tablet when reading to riding my bike. (None of these things are really high impact or involve squeezing particularly hard)

I'm currently in quite a lot of pain from simply squeezing an orange this morning

I would recommend getting someone qualified to look at it - hopefully your issue isn't as severe as mine, but I am pretty sure my lack of taking it seriously at the time didn't help, and things like strapping it up just meant I ended up doing more damage which may not be reversible.

 yoshi.h 01 Jul 2019
In reply to SaraB:

Get advice from a good physio with climbing specific knowledge. Doctors can only offer very generic advice. Cristiano Costa in London is supposed to be one of the best climbing physios in the business, and I have only heard good things about him. (Instagram: @cristianocosta11)

OP SaraB 01 Jul 2019

Thanks. I'm in Sheffield - any recommendations up here?

Strapping and splinting it makes it worse. 

I'm going to try voodoo flossing as I have bad circulation in my hands and this may be partly why it's not healing well. I almost wish it was a pulley as then I would know what to do.

What do you think of climbing easy regularly? That seems to be the advice I'm getting now but from fellow climbers. Someone suggested resting until the end of August but I just can't imagine another 2 months, like I said it's seriously affecting my mental health and that's almost worse for me at the moment.

Might just have to go to the crag and drink tea

 yoshi.h 01 Jul 2019
In reply to SaraB:

He's got a reputation of being a miracle healer of sorts so it might actually be worth contacting him and doing an online session which is something I was told he does.

If you are serious, my honest opinion is that you stop trying random things in high hopes and get the right instruction. It will save you months of anguish and potential further damage as I have learnt the hard way over the past years.

OP SaraB 01 Jul 2019
In reply to yoshi.h:

Thanks, I'll drop him a message. 

It's not that I'm trying random things, it's that lots of trusted professionals seems to have a different opinion that they swear by, e.g. rest vs regular light work, and they often directly contradict each other. I don't know who to listen to. Did rest not work or did I not rest it enough? Did I climb too hard? I'm a novice so I find these things hard to judge.

Anyway you are right that I should go to a climbing specific physio and thanks for the recommendation. It seems like a complicated problem that no one can pinpoint and I'm not sure the NHS is giving me the right advice. It doesn't help that I can't identify exactly what caused it. 

OP SaraB 01 Jul 2019

Sorry, that came over as quite defensive; I apologise. I'm just really upset and frustrated as I thought I was making progress. I thought the soft tissue damage had healed but perhaps the scar tissue is now an issue. I feel like I'm back to square one after easy climbing. 

Post edited at 16:45
 yoshi.h 01 Jul 2019
In reply to SaraB:

No offense taken whatsoever. All advice you seem to have followed seems reasonable within general climbing rehabilitation lore!

However what you won't get from an online forum is personal attention and instruction for a well informed rehabilitation programme suited to you and your injury, which is exactly what a good physio with a lot of climbing knowledge will give you.

Sadly I was not able to receive the same treatment or level of insight from any other regular physio or doctor under the NHS. Feel free to DM me if you need any more info. Otherwise I sincerely wish you make quick recovery.

 Elsier 01 Jul 2019
In reply to SaraB:

Hi Sara, 

Agree with the other comments on here, worth speaking to a physio and getting some rehab advice. 

Also really recommend getting Dave Macleods book Make or Break. I bought this book when I had a stubborn finger injury which seemed to be healing painfully slowly and found it had some great advice about lots of useful things around injury including rehab, prevention, and the psychology of being injured. 

Also there are likely things you can be doing to relieve the frustration you are feeling from not being able to climb. Even when I couldn't use my finger at all, I still managed to climb (just did lots of one armed climbing on slabs which I am sure was good for my balance) and since a lot of my social life revolves around climbing it also meant I could go to the wall and see my friends. And if you really can't climb at all then there might still be other stuff you can do like focus on flexibility or strength training so that you'll be able to climb better when you get back into it.

Also am sure there are exceptions but think general advice around injuries particularly if tendons and ligaments are involved is that returning to your sport is an important part of the healing process, they require a certain amount of stress in order to remodel fully, so likely especially if you have already rested for two months doing some easy climbing would be beneficial to the healing process. Also fingers have very low blood flow so healing is slow. But please don't take this as advice, see a physio, I am not an expert.

Good luck! 

Post edited at 17:49
 Gear Lover 01 Jul 2019
In reply to SaraB:

Another climbing specific physio to consider is Uzo from Inside Edge Physiotherapy. He is based in Birmingham, and I travel from London to see him after getting fed up of general physios who didn’t understand my climbing-related issues. 

good luck

OP SaraB 01 Jul 2019

Thanks everyone. I've booked into the Sheffield Climbing Clinic for a physio, hopefully I'll get some answers. Guy sounded very good on the phone so we'll see. I'll get in touch with those other folks too. Fingers crossed or not as the case may be. 

 sheppy 02 Jul 2019
In reply to SaraB:

Worth considering Capsulitis as well where fluid leaks from the joint capsule. Both of my middle fingers suffer to a degree but only after a very intensive fingery session. Started in my late forties, a friend of a similar age also has something similar developing.

Volker Schoffel one of the acknowledged finger specialists in the world covers the topic in his excellent injury text book, "one move too many"

 MountainGoat82 02 Jul 2019
In reply to SaraB:

From the title of the thread I totally expected this to be about road rage hahaha

OP SaraB 04 Jul 2019
In reply to sheppy:

Thanks, I think that's something to consider, or tendosynovitis? I hoped that the ultrasound would have picked up what it is; there's definitely fluid in there. 

My middle finger on my other hand also feels a bit tweeky today. Weird. I have a risk of developing osteoarthritis and I know that one of the symptoms of that is middle finger knuckle stiffness so I'm a bit worried. Maybe I'm getting paranoid though and just pushed it too far. 

I'm trying voodoo flossing and have a physio on Monday with the Sheffield Climbing Clinic at Whitehouse if anyone has any experience with them? My friend also put me in touch with Cristiano but he's pretty busy and I'm not sure if I can fit a London visit in. He's in Sheff at some point though so I'll see if I can get to see him. 

I don't think the steroid injections are a good idea from what I've heard.

I think the course of action is going to be some training rehab. At least I'll be able to go to the wall. 


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