A2 Pulley Rupture (Rehab part 1)

This summer I had a 5 week bouldering trip to the Rocklands in South Africa booked. It promised to be the trip of a life time.

I had prepared well with my training. I was feeling fit, strong and healthy. For the first 6 days of climbing I was on great form, ticking off hard classics quickly. I had high hopes for the trip, until this happened:

In the video you can hear several different loud cracks and pops. On the first hold I move to you can hear a faint crack and then whilst swapping hands on the fiddly match there are two loud popping sounds. I now believe that the first crack was a partial tear of my A2 pulley and then whilst bumping around on the match with with poor feet the pulley ruptured fully.

Initially I had no pain in the finger and there wasn’t much swelling. There was just a strange fuzzy tingling feeling and the finger had absolutely no strength.

It was a 40 minute walk back to the car, during this time I kept my hand raised above my head, the cold wind helped to keep the swelling down. Arriving back at the house I iced the finger to keep the swelling away.

The icing technique I use is the one suggested by Dave Mcleod. I put 5 to 10 ice cubes in a bowl of cold water and leave my hand in the bowl for 10 to 15 minutes. At first my hand goes white but after about 10 minutes it it starts to flush with blood. You can tell when this happens because you will feel a nice warm throb in your hand. It will also be a nice pink colour. I believe this a trained response and you get quicker at flushing the blood to your hand the more you do it.

At first we thought I may have just dislocated my joint. I theorised that the two pops could be the joint dislocation and relocating and I hoped it would heal up fast.

I went to the local hospital in Clanwilliam to see a doctor. He sent me for an X-ray.

Xray

Xray

The Xray showed that there was no damage to the bones in my finger but couldn’t give me any information about the pulleys. He just vaguely told me to rest and not climb for “a while”.

Finger pulley system

Finger pulley system

Pulleys are ligaments that hold the finger flexor tendons (FDP and FDS) onto our finger bones. There are 5 pulleys, A1-A5.

The pulleys experience extremely high loads during rock climbing, especially when crimping. and I suspected I had done damage to one of these.

From previous pulley strains I have suffered I know that when pressure is applied to the palm side of the suspected injured pulley there is localised pain/discomfort.

Testing for pulley strain

Testing for pulley strain

With this injury I had no pain just a dull sensation where the A2 pulley should be.

Not satisfied with the local doctors vague advice I decided I was in need of an MRI scan to give me a proper diagnosis for the injury. Fortunately I had travel insurance for the trip which was provided by Sports Cover Direct. They organised and paid for my scan without any hassle at Durbanville Mediclinic in Cape Town.

The results of the MRI scan were conclusive:

MRI scan showing bowstring of the tendon

MRI scan showing bowstring of the tendon

MRI scan showing cross section of the fingers. Note bowstring of tendon and remains of A2 pulley

MRI scan showing cross section of the fingers. Note bowstring of tendon and remains of A2 pulley

This scan shows the palm side of the hand. The tendon in the ring finger is more visible because if is bowstringing away from the bone

This scan shows the palm side of the hand. The tendon in the ring finger is more visible because if is bowstringing away from the bone

I had suffered a full rupture of the A2 pulley in my right ring finger.

Whilst I knew a full rupture meant having a substantial amount of time off climbing my head was still full of questions:

“How long will I need off climbing?”

“Will my fingers ever recover back to full strength?”

“Will I need surgery on the injury?”

“What rehab should I do to maximise my recovery?”

When I returned home I booked an appointment with a hand surgeon. I wanted to know if surgery was needed or if a conservative approach to rehab could be taken.

The surgeons recommendation was that surgery was not needed for a single pulley rupture and that conservative rehab would be the best option. He referred me to Dr Schoffls paper on finger injuries which gives a nice timeline of the rehab process.

Table for scoring pulley injuries

Dr Schoffls table for scoring pulley injuries

Table showing recommended rehab schedule

Dr Schoffls table showing recommended rehab schedule

I had a grade III injury so a non surgical rehab was recommended. I was overjoyed with his news and I booked in to see Nina Leonfelner. Nina is a physiotherapist who has worked with climbers that have suffered  from pulley ruptures in the past.

She built me a rehab program taking Dr Schoffls tables into consideration.

So for the first three weeks after my injury I had rested and iced the injury twice a day. I used tape as protection whenever I had to do anything physical with my hand. I also did some very gentle mobilisation of my fingers.The idea of this was to stop scar tissue building up and attaching to the tendons which could lead to a poor range of movement in future.  These mobility exercises included:

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For the following month I did some very light resistance exercises to promote healing of the damaged tissue. These included using the rice bucket, squeezy balls, putty.

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I also did a lot of antagonistic forearm work these included wrist curls and lots of work with the powerfingers.

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I had a  30 minute routine using these that I would do three to five times a week.

After this stage of the rehab my finger was feeling much stronger and my finger had almost  returned to full range of movement. It was time to move onto the next stage.

The mid stage rehab that I was given was a bit more intensive. It revolved around doing weighted finger curls. The idea is to start with multiple fingers with a low weight. I then increased the weight until I reached about 5kg’s without any discomfort. I then reduced the number of fingers being used and started back at a low weight until finally, after about a month, I could finger curl 4-5kg’s on one finger without any pain.

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This is the rehab stage that I am currently working on. I am really happy to be seeing real gains in my finger strenght and feel confident that I am well on the way to making a full recovery. Nina tells me there is one more rehab stage to complete before I can get back to the climbing properly.

You can find the next stage of my rehab here.

In the mean time check out this great article written by Robin O’Leary and Nina Leonfelner on ukclimbing.

 

 

 

 

 

3 thoughts on “A2 Pulley Rupture (Rehab part 1)

  1. Thanks so much for sharing your recovery plan and progress. Last week I suffered a complete rupture of my A2 pulley in my little finger (unusual!). I am kind of anxious because in my mind I can’t conceive how the two sides of the ruptured pulley can re-join without surgical assistance. But I guess the body does miracles if you do things properly… so I’ll follow the protocol you’ve described here and keep you posted in return if you’re interested.

    • Hi Thomas,

      It is my knowledge that a ruptured pulley will not rejoin properly without surgery but that surgery will cause damage and scar tissue. For a single pulley rupture I have been advised against surgery because the surgery damage outweighs the benefits. Surgery is advised for multiple ruptures.

      I hope you recover soon