Understanding Climbers Finger and Climbing Injuries

Climbing is becoming more popular with those who enjoy a challenge and the thrill of adventure and risk-taking. Generally, indoor and rock climbing tests the climber’s physical flexibility, control, strength, mental endurance, and problem-solving. Perhaps it is the perfect sport for some. However, like any sport that tests your abilities, it exposes you to various potential injuries. More commonly, your fingers take the brunt of the injuries, also known as finger pulley injury or rock climber fingers. So, what is climbers finger, and what other injuries are common in climbers?

Finger Pulleys as a Cause of Climbers Finger

Three bones and three hinge joints make up the finger. Ligaments attach the bones, and the tendons connect the muscles in the arm to the bones in the finger. Generally, the flexor tendons bend the fingers and allow us to crimp during climbing. Special pulleys -numbered 1 to 5 – lock the flexor tendons in place while the finger bends. Unsurprisingly, these pulleys are prone to injury in climbers.

Climbers finger injuries

Overall, climbers finger injuries are the most common climbing injuries. Excessive use of the crimping grip puts a high load on the finger’s pulleys and tendons, leading to potential damage. In addition, using a fully closed crimping grip where the thumb is placed over the index finger increases the load further.

The most common finger injury is a finger pulley injury. A finger pulley injury often occurs suddenly with pop and immediate swelling and pain. However, sometimes, ruptures can present more gradually, with pain, swelling and weakness occurring a few days after climbing. Generally, the A2 pulley is more commonly damaged, although the A3 and A4 pulleys are also potentially damaged. Pulley ruptures occur during intensive training, especially when performing repeated manoeuvres on a challenging route. Ruptures are also caused by training sessions on ‘hanging boards’ or ‘campus boards.’

Examination often reveals swelling, bruising, and pin-point tenderness at the ruptured pulley. Your doctor will perform a ‘bowstring test,’ in which the forced active finger flexion in the crimp position leads to the tendons bowing away from the bone. The tendons can be readily palpated under the skin. Bowstringing indicates a severe or complete rupture.

If we suspect a finger pully injury, an ultrasound is used to confirm the extent of the damage. In partial ruptures of the A2 pulley, the flexor tendon moves less than 3 mm away from the finger bone. However, this distance increases to 3-6 mm in complete tears.

Climbers finger A2 pulley injury treatment

When a rupture is suspected, a climber should stop climbing immediately. Simple measures should be started, including rest, ice and elevation.

Typically, partial pulley tears are treated by resting in a thermoplastic splint for 2-3 weeks and gradually returning to climbing over 8 weeks. Strengthening the tendons using a soft stress ball, pinching the fingers, and rubber band finger exercises is essential. Weighted finger bends and pull-ups help toward the end of rehab.

Surgery for rock climber fingers is only recommended for complete ruptures with bowstringing or when more than one pulley is torn. Generally, the ruptured pulley is excised, and a new pulley is reconstructed using an extensor retinaculum graft harvest from the fourth compartment.

Other finger injuries include inflammation of the tendon lining, also known as climbing tendonitis, sprains of the ligaments of the joints, and trigger finger climbing. These rock climber finger injuries require ice, anti-inflammatory gel, and hand therapy.

Other climbing injuries

It’s not all about fingers in climbers. You’re also at risk of other upper and lower body injuries in climbing. In general, injury rates in the lower limb are low and related to a fall or trauma. Moreover, females are more likely to suffer an injury to the arm or shoulder.

Some of the other common injuries in climbers include:

Climbers elbow

Climbers generally overload the elbow’s outside tendon, which is also known as tennis elbow. Treatments typically include physiotherapy, strengthening, bracing, shockwave therapy, and injections.

Climbing shoulder injury

Given the high stresses on the arm and shoulder, it’s no surprise that climbers develop rotator cuff tendonitis and a SLAP tear injury. Generally, conservative treatment includes anti-inflammatory medication, physiotherapy, and a cortisone injection.

Knee meniscal injuries

Typically, the cartilage in the knee can be damaged by a fall from a height or overuse. For example, toeing down or edging on small holds places high loads on the knee.

Prevention of Climbing Injuries and Climbers Finger

For climbers finger, we suggest the following measures to help stop them from coming back:

proper warm-up before climbing

reduce the use of the closed crimp position and use an open position

vary types of handholds

make sure you keep fit and strong in your upper body, trunk, and legs

Final word from Sportdoctorlondon about Climbers Finger

While climbing is generally safe and great for keeping you in shape, we suggest you see an expert in climbing injuries for a correct diagnosis and treatment plan. Unfortunately, most physiotherapists, doctors, and even hand surgeons do not have the sports-specific knowledge required to treat these injuries correctly.

Understanding Climbers Finger and Common Climbing Injuries