UKC

Managed to twang a finger at the wall yesterday - including the dreaded 'pop'! I suspect A2 partial rupture but wonder what people's experience has been getting a more precise diagnosis on the NHS - i.e via MRi or similar. I am happy with the various methods of rehab and online resources but would like to know how bad the rupture is, I don't think (hopefully) it's a complete rupture (no bow string, significant swelling or bruising) but certainly worse than previous finger injuries.

Can you get access to an MRI on the NHS easily or any other suggested ways to get a proper medical diagnosis welcome.

just that you'd better get it seen to as I have known it to end with a complete surgical rebuild of the finger and I telling off by the surgeon. It's pretty obvious though when the pulley pops. It sticks out like an alien trying to escape. I guess a gp will know what to look for. there isn't really a lot in the way. Good luck with it.

A trip to A and E and the on call doctor there should refer you to an orthopaedic clinic appointment with a consultant specialising in hands. That's what happened with me. Definitely get it assessed ASAP though as if it needs surgery you don't want to delay. Good luck with it. 

As above, I would go to A&E and have it assessed. They can then refer on to orthopaedics if needed who can arrange any investigation that you may need. Ultrasound scans are normally quicker to arrange than an MRI. If you're lucky the A&E department may have someone who is trained in musculoskeletal ultrasound. 

I wouldn't go to the GP as this is a recent injury.

Thanks- was yours a full rupture- what where the symptoms?

Definitely go to A and E. I recently popped a pulley or two or three, by the time I saw a physio to get a diagnosis it'd been a week or two (who said it seems fine go climb on it). Took me over a month to get Infront of a surgeon who said he had a bad finger too from decades ago and that he had no idea what would be required to sort it. Finally got to see someone at a hand clinic in Coventry who said well it's been 2.5 months now and seems kinda healed. 

I got a diagnosis (triple rupture) with an ultrasound privately in Sheffield about two weeks in but it didn't help anything happen quicker. 

My symptoms were 3 or 4 loud pops, then my finger swelled up a lot. I got a 'frog' finger splint, cut the arms off and rigidly strapped it to the back of the finger for the first two or three weeks to hold the pulleys in place. Bowstring was quite noticeable too under the swelling. Then I started losing motion in the PIP joint, I couldn't get it straighter than 45°, or close into a fist. Started regularly doing pulley glides and massaging the finger as soon as it didn't hurt too much to do so. 

If you have the means to do so, I'd recommend getting a consultation/diagnosis with Mike Hayton in Manchester - he gave me some excellent advice, and has worked with team GB climbers with finger injuries. Molly Thompson Smith quite recently. 

I should add, it has healed very well, and seems to be catching up to the rest of my fingers now I've been back climbing for around a month. Still doesn't straighten out 100% and hurts on small holds, or sharp jugs. 

A specialist hand physio made me do this:

Place back of hand flat on a table, fingers straight.

Hold the tip of the affected finger down on the table with the other hand. 

Try and raise the tip of the affected finger against the pressure from the other hand.

If it hurts - tendon.  If it doesn't - pulley

If pulley: raise the tip of the finger slightly and try and push it down.  If it hurts, it's that pulley.  Bend the finger and try and straighten it with the other hand - if that hurts, it that pully (I always get muddled over A1 and A2)

Thanks for the info. What do you think would have been different if you had gone to A+E - in terms of treatments and rehab?

A and E can get you to specialists far quicker. I had to jump through hoops to get a referral to a hand surgeon. Obviously this will be very dependant on your GP and local doctors etc. By the time I got to see anyone useful I'd basically treated and rehabbed it myself - think I got a bit lucky on how well it healed. At one point I couldn't get it into my jeans pocket the finger was so stiff/bent. 

I did a full rupture of A2 and partial 1 and 3 last year. 3 loud pops. Got private physio at the time then saw a specialist surgeon a couple of months ago with US scan, as the finger doesn’t straighten any more. He said continue climbing hard if it doesn’t cause any issues as surgery likely to make things worse (complex procedures and around 3 months off). Did this privately and the appointments were within the week.

finger will remain partially bowstringed but still functions. I just don’t pull hard on small holds anymore as very aware of injury now. The A2 area sometimes aches a little if I pull hard or push it after a hard pull but it’s fine to climb on now. I used tape for several months.

I have previously injured A2 on 2 fingers on the other hand, only sprains though so not too bad, there’s an obvious ridge that can be felt inside the finger now. I think the key is to make sure fingers are properly warmed up, avoid silly small holds (particularly indoors as it’s easier to do lots) and don’t keep trying the same move, 2-3 tries then move onto something else. Also proper test between sessions and don’t climb dehydrated is key.

Yes mine was a full rupture of A2 pulley. Loud crack like a gunshot sound when I did it. Immediate severe pain very localised to that joint. Swelling and bowstringing. I went straight to A and E on recommendation of my climbing partner who's a physio. Was referred to orthopaedic clinic next morning and lucky enough to see a brilliant consultant who specialises in hands. He said for a full rupture surgery to repair is only option. It's been fab ever since (several years). 

Thanks for all the advice and sharing your stories.

I went to the local 'Urgent Treatment Centre' - Kendal doesn't have an A+E any more but in some ways that was better as I didn't feel like I was getting in the way of 'proper' emergencies. Had an X-ray on their insistence (nothing showing) and then came back later in day for an ultrasound on on brand new machine. Diagnosis no full rupture and difficult to see any damage, so partial rupture or bad sprain. Good news, although I don't think Ill be climbing before New Year. Ironically there was another climber in the waiting room with exactly the same injury - if you are reading this I hope you heal quickly -although probably not before your January Spain trip : (

Good news that it's not too serious. Take the rehab steadily though. Don't rush the return. Good luck with it.