Fingers: Blown Tendons

I had pain about halfway down my forearm on the biggest and outermost tendon that connects in the middle right at the base of the palm. I think it happened after hanging too hard on my middle and ring fingers.

By Rock and Ice | October 20th, 2009

I had pain about halfway down my forearm on the biggest and outermost tendon that connects in the middle right at the base of the palm. I think it happened after hanging too hard on my middle and ring fingers. I used to wrap tape around my wrist when I climbed, and that seemed to help a bit (since I couldn’t dream of resting it for months!). It would hurt both during and after climbing, and I don’t think it swelled. The pain is gone now, but

I’m wondering if it will come back after an especially difficult climb, or if I start getting into crack climbing, and in that event what I should do?

PAUL BLUMER, DETROIT, MICHIGAN

Oh, another good one. Though I see it often, I have never seen this injury documented and, if I knew exactly what it was, I’d name it!

Unless you carry very heavy shopping bags with one finger, this is 100 percent a climber’s injury. And even better, although it feels sharply debilitating, you can climb as much as you want. Here’s the deal.

The two prime movers of grip force are flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP). FDP is the stronger of the two. Each muscle differentiates anatomically and functionally into four separate slips, each attaching to the end of a finger. Hence you can control each finger with varying force. When you split your fingers under heavy load, the trouble begins. Mostly that involves the ring and middle finger in either one — or two-finger pockets.

Let’s take a standard pocket using the middle two fingers. Once you start pulling, the little and first fingers curl into your palm. Now the middle two slips are long and pulling hard, and the outer two have contracted, are hence considerably shorter, and are also pulling hard. This creates a tearing force at the junction of the little- and ring-finger slips, and the middle- and first-finger slips. Typically I see tears at the former rather than the latter sites in my climber patients, but I am not sure of the pathomechanics involved. My experience suggests that the tear usually occurs in FDP, but without a lot of expensive imaging, the site of trauma and biomechanics involved in your case are an educated guess.

To test for this injury (hereafter known as the Dr. J test), pull on each finger (gently!), curling the other fingers into your palm. Pain that exists in the mid forearm when the finger is pulled on separately, but not when accompanied by a neighboring finger, is virtually pathognomonic for this injury. Splitting your fingers in the next few weeks will be like pissing into the wind-  not only are you doing yourself a disservice, it will get messy. Avoid it and you can probably climb as much as you want. Silly as it may sound, avoid pain! Split them and you will squeal. Taping can be simultaneously very helpful and very bothersome. Where possible, if you need to pull on a pocket, don’t curl your unloaded digits into your palm. The force summation will feel less, but so will your propensity for injury.

All the usual shenanigans like heat, massage, ice cream and shagging will facilitate the healing process.

 

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