1. Finger Injuries
SUMMIT MAGAZINE
Humphrey Bacchus CMT
Overview
As most of you reading this have probably experienced, finger injuries are the most
common affliction of the climber. They can range from being acute and devastatingly
debilitating through to frustrating chronic long-term injuries. Each stage of a climber’s
technical ability or battle with different rock formations brings separate challenges to
the hands and it is these that place the heavy strain on the tendons, ligaments and
musculature of the climber. It is important that we determine what type of injury has
occurred, what severity and how to rehabilitate the affected area. Here is a very brief
overview of some of the injuries that we should be aware of in climbing.
Joints
There are three main joints that we are concerned with when considering finger injuries.
Firstly we have the MCP joint [metacarpophalangeal] which is the knuckle. Then next
along is the main flexion PIP joint, proximal interphalangeal, in the middle of the finger.
Finally we have the DIP joint, distal interphalangeal, which is last joint before the
fingertip. Different grips exert varying pressure on the joints and these can determine
the type of injury or strain that occurs at each of the junctions. [Insert anatomy picture
of hand with reference to the joints above]. The joints are joined by ligaments and
mobilised by the tendons and muscles.
Tendons, Ligaments & Muscles
The tendons, ligaments and muscles make up a complex system of support and
movement thorough the fingers. The most important to consider are: the collateral
ligaments which are key in maintaining structural integrity; they literally hold the joints
together whilst the tendons attach the muscles in the forearms; Tendons that are held in
place by a pulley system. These are ligament structures, like rings, that run the through
the whole finger. These pulleys take huge amounts of force when we consider some of
the moves accomplished when climbing; and the muscle finger flexors that are of
primary importance in climbing; include flexor digitorum superficialis, flexor Digitorum
profundus, palmaris longus and flexor pollicis longus; and the tendons which bring
movement to the joints. Each of these tendons, which attach the muscles, runs through

2. a lubricated sheath, which keeps it moving smoothly and consistently. These all work
simultaneously to provide fine and controlled movement.
Common Injuries
Any or all of these joints, ligaments, tendons or muscles can be damaged during
climbing. Some injuries are much more common than others and as was mentioned
above, it is paramount that the injury is determined so that a route to recovery is
mapped quickly. In one major study of climbers it was found that three quarters of the
most frequent injuries occurred in the fingers; Pulley injuries being the most common.
These pulleys injuries can be graded from 1 to 3. Grade one is a simple strain; Grade 2 is
a serious sprain or partial tear and Grade 3 a complete rupture. Symptoms can include
hearing a snapping sound, swelling round a joint, pain with flexion of the fingers,
inability to maintain a pinch grip and localised pain. The severity of the injury is often
made clear by the number of accompanying symptoms following the injury. Other
common injuries that require attention are what some might call trigger finger as well as
damage to the collateral ligaments. Trigger finger is known as stenosing tenosynovitis.
This type of injury occurs when a hard nodule appears on the tendon that travels
through the tendon sheath. This causes the tendon to move less freely through the
sheath and is sometimes accompanied by a feeling of the finger getting trapped in
movement or the tendon catching during movement. This can be a cause of both pain
and inflammation. Collateral ligaments can also be damaged around the PIP and MCP
joints of the hand. These like pulley injuries can be anywhere from a mild sprain
through to complete rupture. Other injuries include stress fractures (thought less
common) and arthritis that can develop due to the frequency of ligament strains.
Rehabilitation
Like any other athlete climbers want to return to climbing as soon as possible we need to
know what’s happened as soon as possible. As climbing is such a specific sport its
unlikely that the local GP is going to be able to deduce exactly the type of injury that has
occurred in a finger. Mild strains of the tendons, ligaments or pulleys seem to respond
well to conservative treatment. Decreasing the inflammation immediately with ice,
taping damaged finger to a fully working one (often the ring and middle fingers) and
going easy on the climbing. This means doing routes well below your level for a couple of
weeks. There might be low-level discomfort, but no aggravation to the injury should be
noted and no increase in pain. Be sensible and your will recover fast. Grade 2 strains
require more care. If a grade 2 strain is suspected, stop climbing immediately. Stopping
inflammation in the initial phase is important, before starting on rehabilitation after
10-14 days. This can include theraband hand exercises or theraputty. In each instance
“going slow” is the order of the day. If you suffer grade 3 injuries, then you’ll know it!
This type of severity often needs local surgery to repair and can take a slow going
possible 3 months before returning to full climbing again. Trying to get too far too quick
will result in going backwards and a compromise of the joints and soft tissue again.

3. Trigger finger needs to be treated on a case-by-case basis, sometimes requiring surgical
intervention but can also respond well to conservative therapy treatment.
Most climbers I know seem to want to run before they can walk on when
recovering from finger injuries; not able to be patient with the knowledge that slow and
steady recovery will in fact make them stronger. If you damage your hands, seek
professional help. It’s pretty hard to climb without them and long-term damage can
cause long-term pain. Don’t second guess what you’ve done to your fingers, rest up take
a few days off climber and get a plan in place for getting you back fit and strong. You’ll
thank yourself for it.