rehabilitation/recoveryfinger pathologies
Written byJason Hooper
Hoopers Beta Ep. 130
INTRODUCTION
There is so little information on the subject that in this video we are going to cover the signs and symptoms of a collateral ligament injury, a test you can do to find out what the actual injury is, and the most common causes of occurrence collateral ligament injuries. possible treatments and perhaps most importantly whether you can still climb during rehabilitation.
ANATOMY
So what are these weird bands and what do they even do?
The collateral ligaments are fibrous bands of connective tissue that serve to stabilize the finger joints. In this case we will specifically address the PIP and DIP sidebands as these are the most relevant for mountaineers. Their job is to stabilize and prevent excessive varus or valgus forces, also called sideways or lateral flexion of the joint. Rather, they arise on the back (or back) of the proximal phalanx and slope toward the palm (or front) of the distal phalanx, which is important for understanding our symptoms later.
CAUSES
Now that we know the anatomy, we can more easily understand how this ligament can be injured during climbing, particularly with excessive lateral pulls. Here are a few clear examples:
Lateral pull, especially when you are in pinch, or dynamically moving to a much more distant holding point while staying in lateral pull.
Sweeping or reaching movements that cause you to deflect the wrist ulnarly or radially.
Gastons that protrude well above the head or clearly to the side.
Finger locks, especially with heavy loads due to bad feet or poor wrist positioning
You may have noticed a general trend with some of them. This ligament is more likely to be strained when the wrist is not aligned with the grip, meaning you have ulnar or radial wrist deviation.
In general, collateral ligament injuries are more likely to occur during dynamic movements than static movements because you're more likely to experience uncontrolled movements, higher acute forces, and/or less time for your body to respond. However, intense static movement can cause injury.
Of course, there are other causes of collateral ligament injuries, such as acute trauma. For example, a dislocation of the joint can result in damage to the collateral ligament and should be evaluated by a specialist to determine if further evaluation or imaging is needed.[1]
TESTING & DIAGNOSTICS
If you suspect your collateral ligament injury, here are some common signs and symptoms. Be sure to use only light to moderate pressure during the self-test; You should never have to exert a lot of force or endure more than mild discomfort, if any. Pressing hard enough anywhere on the body can cause pain. So be careful.
Pain on one side of a single joint (DIP or PIP).
Pressure pain here too.
Possible swelling, redness and inflammation.
Loss of mobility and/or pain reproduction on joint flexion.
Hypermobility or pain when performing a lateral stress test.
The latter is very important as it can help differentiate between the severity levels and the seriousness of injuries.
It should be performed with about 10 degrees and 30 degrees of joint extension to test both collateral ligaments.
If these symptoms apply to you, the next step is to determine the severity of your injury. This will help us make more informed decisions about rehabilitation. Unfortunately, with collateral ligaments, it can be quite difficult to determine the severity yourself. We will continue to provide you with a small guide, but it should help you further. However, if you experience instability during the lateral load test, you should consult an experienced professional for further evaluation.
In a mild or grade 1 injury, there may be swelling and tenderness, especially over the affected collateral ligament, and may even cause discomfort on the lateral stress test, but there is no instability on the test.
With a moderate or grade 2 injury, there is usually more swelling, perhaps now throughout the joint, and instability on the lateral stress test. BUT it will eventually have a fixed end point and usually the deviation is small, less than 20 degrees.
A severe injury (grade 3) is of course accompanied by swelling, but now leads to a significant slackness in the lateral stress test. The temperature is more than 20 degrees but still feels solid at the end.[1]
Now, before making a final decision and proceeding with treatment, we should do our best to rule out other possible causes of these symptoms besides collateral ligament injury.
EXCLUSIVE OF OTHER DAMAGES
The most common injury, which we must rule out due to its similarity to collateral ligament injuries, is joint synovitis. Synovitis presents with similar symptoms such as swelling, pain and/or limited joint mobility and pain when pressure is applied to the joint. But synovitis has some distinct differences.
In the case of synovitis, there is no instability on the lateral stress test, although slight pain may be present
Synovitis is usually associated with more diffuse pain and can occur on both sides of the joint or even on the top of the joint at the same time. Contrast this to a collateral ligament injury that is unilateral in nature (unless, of course, you've somehow damaged both collateral ligaments on either side of the joint, which would likely only happen with a traumatic injury).
The swelling in synovitis is typically more severe and more chronic or progressive in nature than in a collateral ligament injury unless the collateral ligament injury is severe
Synovitis typically evolves into a chronic injury over time. Collateral ligament injuries can be more traumatic or related to multiple attempts at a single problem or climbing style.
Synovitis typically involves increased swelling on BOTH sides of the joint rather than unilateral swelling from a collateral ligament injury.
Joint synovitis and collateral ligament injury can also occur simultaneously. So if you're having trouble distinguishing between the two, you may have both problems or you simply need to enlist the help of a professional for an accurate diagnosis. I recommend seeing a qualified physical therapist or doctor with some climbing experience if possible. If you wish, you can book a virtual or face-to-face appointment with me through our website: link in the description.
Technically, there are other injuries that can produce similar symptoms, such as: B. Extensor muscle injuries and avulsion fractures, but they are slightly less likely and require diagnosis by a professional.
REHABILITATION
As for rehabilitation, let's discuss some rules of conduct when treating this injury, as well as my recommendations for specific types of rehabilitation activities.
Can I still climb?
First, everyone's main question: "Can I still climb with this injury?" The answer, of course, depends on the severity of the disease. If you think you have a Grade 2 or 3 injury, are experiencing significant instability in your finger, or experience more than 3/10th pain at onset or with basic range of motion, you should probably wait until your symptoms improve or until You will experience improvement from an experienced professional. However, if you don't have instability and the pain is manageable, here are a few things to avoid and do when climbing.
Things to avoid:
Lateral pull that cannot be grabbed with a straight line of force
Broad or far-reaching hold
Dynamic moves to or from smaller teams (pitchers are usually fine)
Fingerschloss / Ringschloss
Generally, positions that cause ulnar or radial wrist deviation when climbing. (This is typically the cause of the lateral forces on your fingers, which can make your symptoms worse and potentially slow healing.)
Things to do:
Try to keep your wrist pointed in the direction you are pulling to avoid lateral forces on your fingers.
Reduce dynamic climbing. Use controlled finger loading and stop if the position causes you pain.
Use this as an opportunity to work on technique and try to offload more fingers by using your feet more effectively and finding a balanced body position. This is especially important when fingers are loaded at non-linear angles.
Things to consider:
Taping could be used for support, simply to strengthen the joint and help reduce exposure to lateral forces when climbing. Or you can consider buddy taping to further stabilize the joint and reduce unwanted forces.
Treatment
Unfortunately, as far as specific treatments go, there isn't much that can be done about this injury other than waiting and not making it worse by climbing. Unfortunately, face pulls will not save you in this situation 😡. But there are a few things you can do.
Note: Most of this is based on expert opinion only. Research is limited to the best approach and decisions should ultimately be left to the individual and their response.
Active range of motion
Maintaining healthy joint movement is important because, among other things, it improves outcomes in these injuries by preventing adhesions from forming and promoting proper organization of healing tissues. [2]
To achieve this we can use the sliding of the tendon. Just think of the middle of your palm and the bottom of your knuckles as two lines, with the middle of your palm being lighter (less joint flex) than the bottom of your knuckles. Touch these lines with your fingertips, open or fully extend your hand in between, and repeat the process. If this is painful, stop or before the pain rises above 2/10. If you can only touch the middle row without pain, that's fine for now, but gradually work on touching the knuckle row as well over time. This healthy movement can help gently stimulate the collateral ligament without directly irritating it. Perform 6-10 repetitions several times a day.
Exercise and BFR
It's important to stay active and keep your body moving, especially your upper extremities and hands! This is a good time to add more exercise to your program while reducing climbing. Consider introducing compound movements into your training to fill in any weaknesses that you have been neglecting. You can even do safe finger strengthening if you have a minor injury. Essentially anything that doesn't cause pain in the finger is encouraged (except, of course, exercises that apply direct lateral forces to the fingers).
You may also consider doing blood flow restriction training at this time to potentially increase tissue response without major stress.
Manual therapy
Gentle cross-friction massage techniques can be used in this area to try to stimulate the tissues. Simply use your other hand to gently press on the affected area, moving up and down, left and right in small movements. Do the application for 2-3 minutes daily, or even up to 2-3 times a day.
Gentle joint mobilization
Gentle joint mobilization may be beneficial in a Grade I injury. Simply grasp the finger directly in front of the injured joint while the joint is in a neutral or straight position. Then carefully pull straight away from the joint. This gentle mobilization can be helpful for the joint itself, but can also provide gentle loading on the ligament, which when done properly can aid in healing. For our testing section, keep in mind that we don't want to cause too much pain with this, so just pull gently.
If you have a grade 2 or 3 or suffer from general laxity or instability you should not undergo this treatment. Otherwise, do this up to twice a day until your symptoms subside. If your range of motion is limited, do this in conjunction with your active range of motion and then stop when your range of motion returns to normal.
rice bucket exercises?
This can be a rare case where working with rice containers *might* help. Gentle side loading may be appropriate for a less severe injury (Grade 1) because it can stimulate tissue without irritating it. I still wouldn't say it's worth buying a rice bucket just for this, but if you already have access to one feel free to use a few gentle strokes to see how your finger feels with it. If it feels better, great! If not, stop and stick to the basics.
ice and heat?
Ice would be appropriate in the acute phase of an injury (first few days) or when there is excessive swelling or discomfort. If you don't meet those criteria, I would personally stick with the frosting unless you genuinely love it and have had good results in the past. In general, we don't need to stop the inflammatory process unless it becomes excessive.
Heat can improve your mobility and increase blood flow to the area. However, there is no reason to believe that this will ensure that the blood is then directed into your healing collateral ligament.
Personally, I've never been a huge fan of ice or heat, but since there aren't many specific treatments for this injury, and ice and heat pose little or no risk, it might be worth trying it yourself to see if it is helps!
patience
The most important exercise: patience. Since it is a piece of connective tissue, it will take time and there is no magic bullet that will speed up the process. But as with any injury, sleep, hydration, diet, and stress can all play a big part in recovery.
Operation
Surgery is advisable only for grade 3 injuries. Conservative caring (and patience) should be the first line of management in most cases.
FORECAST
The prognosis for a Grade I injury is fantastic. As long as you reduce aggravating factors and are patient, you will have no problem getting back to the full previous level. However, it may still take 8 to 12 weeks for the tissue to return to normal as healing of this tissue can be slow.
If you have a Grade II injury, the prognosis remains good, but you will need to be more patient and may need to work with an experienced therapist to work on additional stability. It may take 12 to 16 weeks before you feel most of your strength returning.
If you have a Grade III injury and are having trouble with your daily functions, surgery may be necessary, but again, the prognosis is good if you receive adequate rehabilitation afterwards.
DIPLOMA
If you are still unsure about your injury or feel you want a more personalized treatment plan, be sure to consult an experienced professional, ideally with some rock climbing knowledge. If you wish you can use the link in the description to make an appointment with me. Until next time: train, climb, send, repeat!
RESEARCH
[ PubMed ] Kammerdnakta S, Huetteman HE, Chung KC.Complications of proximal interphalangeal joint injury: prevention and treatment. Hand clinic. 2018;34(2):267-288. doi:10.1016/j.hcl.2017.12.014
Rosemary LM.The Collateral Ligament of the Fingers of the Hand: Anatomy, Physiology, Biomechanics, Injury, and Treatment.J Hand Surg Am. 2017;42(11):904-915. doi:10.1016/j.jhsa.2017.08.024
Carruthers KH, Skie M, Jain M.Fingerpick Injuries: Diagnosis and Treatment of Interphalangeal Joint Injuries in Various Sports and Experience Levels.sports health. 2016;8(5):469-478. doi:10.1177/1941738116658643
DISCLAIMER
As always, exercises should be undertaken at your own risk and should not be undertaken if you feel there is a risk of injury. If you have any concerns, consult a doctor before beginning any new exercise.
Written and presented by Jason Hooper, PT, DPT, OCS, SCS, CAFS
IG: @hoopersbetaofficial
Film and editing: Emile Modesitt
www.emilemodesitt.com
IG: @emile166
Jason Hooper