Finger Flexor Tenosynovitis in Rock Climbers (Causes, Diagnosis, Treatment)

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// RESEARCH CITATIONS //

// SHOW NOTES //
Episode 118

Key Points: Flexor Tenosynovitis vs A2 Pulley Injury, How to Diagnose Tenosynovitis, How to Treat Tenosynovitis, Corticosteroid Injection, Finger Pain from Climbing, Pulley Pain

// DISCLAIMER //
As always, exercises and rehab programs are to be performed assuming your own risk and should not be done if you feel you are at risk for injury. See a medical professional if you have concerns before starting a new training or recovery program.

#trainclimbsendrepeat #climbingtraining #doctorofphysicaltherapy

[thesourlemon]

I'm literally having this problem right now. The timing is immaculate

[adrienl]

Was waiting for this video ! I Can now say confidently that I have a pulley injury (no pain in open hand but clearly during crimping, injured during a deadpoint on a small crimp in a overhang, no pain in thé forearm or during Finger extension) !

Thank you again !

[borjarevuelta]

Hi! I've had tenosynovitis 4-5 times in the last 3 years, 3 of those times diagnosed by a PT with ultrasounds. The first couple of times I experienced it, it differed from the typical pulley sprain in that the pain was not as acute and rather spread around the A2, plus I didn't hear any pop and it started hurting the day after.

All of them were the result of too much training load with insuficient rest, but ultimately triggered by cutting feet and putting my pulley system under too much preassure. The protocol I followed for the first two times was progressive overload with a no-hang device over a couple of months, it took a long time but it worked and I was back on track. When it was diagnosed, I was given the instructions of not climbing for 2 weeks at all, and wearing a Schöffl ring to support the tendon and reduce the friction with the pulley, hence reducing inflammation. Two weeks for Schöffl completely cured the problem, and I was 100% just after two weeks.

Now I'm suffering from something in between pulley sprain and tenosynovitis (it could be both). It hurst when I press on the pulley, but it barely hurts when I crimp. The pain was also located along the FDP on the dorsal side of the finger, around the methacarpal, way less than on the pulley system. My 2 cents.

[knievel]

Great video!
Unfortunately a few months too late for myself, but I think a lot of people actually mistake their Tenosynovitis for a pulley injury and risk making things worse. 
When I first felt the pain, it was pretty mild and I defaulted to the usual few days of break and then H-tape the pulley and start climbing again. With that one session I probably jumped from needing a few weeks of recovery to more than 4 months. During the session I felt fine, but for the next week even the slightest touch of the A2 pulley area of that finger was almost unbearable.
What did it for me was then a longer break, slow progressive loading and finally climbing sessions with only open-hand gripping.
Counter-intuitive but very helpful for me was avoiding jugs (as they pressed against the inflamed area) and not taping.

I've since grown a little anxious to run into the same problem again though. In hindsight I know I was three weeks into a new training plan (personalised from a professional) and did a lot more than before that. I also now believe that 2 or 3 of my past smaller injuries would have been diagnosed similarly and I might be a bit more susceptible to it.
I recently started to increase my training load again (I still want to complete the 16 week training plan that I paid for) but focus a lot more resting, nutrition and sleep and its going good so far.
Would you agree with that approach or is it likely that the plan is probably just too much for me and I'm on track to do the same mistake again?

Edit: Note that my Tenosynovitis was never professionally diagnosed. I self-diagnosed with the help of Volker Schöffl's book (which I can only recommend) after my symptoms didn't completely fit any of the injury assessments I found on my usual channels (meaning you).

[DutchBoulders]

To all the Synovitis-gang peeps in the comments. I have been dealing with swollen PIP joints and limited ROM for 6/7 years now, but am pain-free since 2 years. And the best advice I could anecdotally give is: integrate progressive hangboarding into your warm-up! Ever since I started hangboarding in my warm-ups, the pain in my PIP joints faded away. No more agony when I bumped my fingers into a door or whatever. It only takes about 10min, but saves you a lifetime of pain.

My routine looks something like:
- 10-15x recruitment pulls on 40mm edge
- 3x 3s on-off hangs on 40mm edge
- 5x 5s on-off hangs on 40mm edge
- 10-15x recruitment pulls on 20mm edge
- 3x 3s on-off hangs on 20mm edge
- 5x 5s on-off hangs on 20mm edge

And off to the races. I've tried a lot of different solutions before also together with a PT (rest, hangboard routines, icing, coban-tape, etc), but this is the ultimate solution for me. Still have my limited ROM in flexing my fingers, but that's just something to live with in order to be climbing.

[BastienAdrien]

I have put this comment under some of your videos already and I feel I'm repetitive, however I feel like it is true:
your vids/channel -> underrated/-viewed
it is well thought through, backed by science, easy to understand, funny (love the intros & especially the "like & subscribe for more super sweet vids y'all" outro got me 😅) and comes with pracital tips to apply to training & climbing
(I might be biased about all people loving science though coming from a immunobiology background)

glad to see your channel growing though, keep'em coming!

[arthuralves]

Mna, I just do training in the gym, and have been feeling this pain in my midle finger for years at the very same position that you pointed out on the thumbnail of the video. I've avoided doing a lot of training sessions because the pain was unbearable. Thank you for the information!

[cantfindabadassname]

I started climbing a month and a half ago and fell in love with it. Where I live there are a lot of outdoor climbing spots, a couple of them you can climb horizontally. At every chance i got i went climbing. Little did I now I was "that guy".. Definitely overdid things and am currently healing from what I now know is called tenosynovitis. Thank you for the informative video 👍🏻

[imtoolazyyyy]

Great video! Can you cover capsulitis as well? I know at least a few climbers (myself included!) with this diagnosis, but hand doctors often don't have a recommendation for whether or not to keep climbing, or how to adapt climbing to reduce aggravation.

[valeriomazzaglia]

Great video and amazing in depth description. I'm having the exact simptoms that were just described after a hard sloper session some 5/6weeks ago. Still having simptoms despite a 2 weeks rest...I just want to point out that the pain radiates trough the wrist too. Hope your advices will help

[skethoo]

Spent too many sessions on kilterboard recently and I think that was the cause. All symptoms just as you described in your video. Taping only prevents from overcrimping but also increases the pain while climbing. Can't hold jugs because it hurts. But small crimps don't hurt at all. So, I can't climb on easy routes with jugs. But it is completely fine to climb on vertical hard routes with tiny crimps and edges. Just avoiding overloading. Can go full power on big slopers as they don't engage fingers that much

[sachabk]

Had a tenosynovitis 2 months ago due to a too hard session after 4 weeks of inactivity.
No physician could actually tell me what was happening to me and no one wanted to check this with ultra sound
I checked on internet and a doctor told me that it was a tendon inflammation
So I just put ice and squeezed a ball every day to rehab
Your video would have been very useful for me 2 month earlier
Btw I really love your work
Thx from France

[erwinsokolski]

Thank you for this material! I'm having problem with distinguishing Flexor Tenosynovitis and Pulley strain. I'm having this problem with my middle finger for more than 4 weeks. USG has shown increased fluid in tendon sheath (At the same time, it showed the same increased fluid in the sheath in the other hand, where there is no pain). I had no swelling and no traumatic mechanism of injury. I have pain on slopers and pinches and pain with palpation over A4 region. I have no pain with passive extension, no pain while crimping and no pain while open grip. Is it Flexor Tenosynovitis or Pulley strain? The specialist couldn't tell during the ultrasound examination, he only noted more fluid...

[idobenbassat]

really liked that one. Very informative as always!
Can maybe make a video about the thumb?
Thanks and love your channel 😎✌🏻

[grantnorman]

Perfect timing! I'm currently on rehab week 4 for this, following a very similar protocol. The cookie cutter rehab plan I'm following suggests half crimp 4 sets of 30 seconds with 3 minute rests (for weeks 3-8). I'm curious about the motivation to do 6-10 sets of 30s on 30s off, rather than longer rests

[daria]

Had this problem in the last month. What I've done: had a 4 weeks break in climbing, after a week started to use acupressure ring to increase blood flow. Tried also local antiinflammation ointment and non-steroid antiinflammation pills. After a month of a break started to climb without any taping, but tried to avoid crimps and other aggressive holds.

[nbkars]

Algogogogo. Been waiting for this one. You guys are awesome!!!

[florvermassen]

Dear Hooper

Amazingly informative videos, brilliant work. Could you do an episode on Dupuytren's contracture ("Viking's disease")? There seems to be quite a lot of cases (or at least similar symptoms) in the climbing community and not much info out there. Especially here in Scandinavia there will be a large interest due to genetic predisposition, although it appears that climbers all over the world have reported cases. Would be amazing, thanks.

[evanmendes]

What a great video!
I´ve just came back from this injury and I´ve done pretty much everything you mentioned!
Sadly, after my finger swelled up in mid-May, it took me a while (and 3 different PTs) to understand what was the story. Your vid would have defo helped!
Went home and did the low intensity hangs, loading slowly (on top of antags and climbing specific trainings that did not put pressure on the finger) for around 6 weeks before another climbing trip.
The results were amazing!! Finger is actually stronger than before and I only feel a bit of discomfort atm (1 out of 10 in the pain scale).
I have a question though. I did the low intensity hangs everyday during that period, to ensure that I would increase blood flow and help healing. Also, I´d take collagen 30 mins before the "finger loading" sessions.
Would that be ok for everyone or I was lucky I did not get any worse?
Thanks for your amazing content! A friend recommended in spring and I can´t stop watching and learning! Really appreciate beast!

[aries_]

Please mind that I did not get a professional diagnosis, but am fairly certain that my "pulley injury" actually was a case of tenosynovitis - I felt that H-/X-taping did absolutely nothing to heal the injury which overlaps with your statement. I would even go as far as to say that in unnecessarily prolonged it. What helped me in the end was to reduce volume, avoid extremely crimpy boulders and focus on using the open handed grip more.