Hand Injuries: when is it time to see a doctor?
I see a lot of rock climbers with hand injuries in my practice. This isn’t very surprising since these are the most common injuries in the sport. What does concern me is that many climbers have old hand injuries that have been neglected or unrecognized. The most obvious signs are finger deformity, a history of persistent swelling, and limited range of motion. Climbers often assume these symptoms are related to arthritis when they actually may be signs ofa joint fracture or a ruptured tendon–both of which can be easily diagnosed. Since climbers experience frequent joint and muscle pain, and usually have suffered from periodic bouts of persistent tendonitis, they sometimes assume their current injuries are the same as the ones they had before. A lot of the time this may be true. However, when this is not the case, these assumptions can cost precious recovery time, prevent proper healing, and even lead to permanent damage. I hope the information in this article will help you identify early signs of injury that require medical attention and provide you with management guidelines that will assist you toward a quick recovery.
If you are new to climbing, learning proper training techniques from experts and applying the correct form during transitions between holds is essential in preventing hand injuries. It is also important to slowly increase the frequency and duration of climbing sessions so that your bones and soft tissues (ligaments, tendons, muscles, fasciae) have time to reinforce their strength.
However careful you are, though, every climber will experience hand and wrist injuries. So what’s most important is trying your best to prevent them and, when they do occur, applying the appropriate treatment in order to completely recover and return to full activity as soon as possible.
When should I stop climbing?
It is ideal to avoid climbing for at least 2-3 weeks for most joint, ligament, and tendon injuries before returning to weight-bearing activities. This does not mean you need to stop all physical exercise during the healing process. Just modify what you need to in order protect your hand, and spend time conditioning the rest of your body so that you’re ready to climb when your injury is stable.
When can I return to climbing?
Once you are able to perform passive, active and resisted range of motion exercise without pain and do not experience numbness, tingling, or weakness—you can begin a graduated strengthening program. Consult a qualified chiropractor, physical therapist or hand therapist if you wish to receive specific progressive rehabilitative exercises for each stage of your recovery. And, at the gym, consult an expert climber/personal trainer to help structure a graduated climbing program.
How should I modify my training while recovering from an injury?
It is best to be conservative and reduce your climbing duration, frequency, and intensity of climbing sessions to a level that does not produce pain or aggravate your injury. Depending on the joint, tendon, or muscle involved, you can use taping or bracing techniques to off-load some of the strain while climbing. Consult your local climbing expert for a customized graduated training program.
Additionally, in order to reduce inflammation you should apply the P.R.I.C.E. protocol several times per day and receive supportive treatments from a qualified chiropractor, physical therapist, or hand therapist.
• P is for Protection – Protect yourself and protect any injury from further damage.
• R is for Rest – Allow an injury time to heal.
• I is for Ice – By applying Ice to reduce the pain and inflammation
• C is for Compression – Compression of the swollen area will help to reduce the swelling.
• E is for Elevation – Elevating the injury reduces the swelling
The following are some basic guidelines for when to consult a doctor or a hand specialist:
• For pre-teens and teenagers, all finger injuries should be evaluated by a professional and receive an X-ray. This age group is more prone to fractures due to their immature skeletal structure and high risk of permanent damage if they don’t receive appropriate care.
• For people of any age, all finger dislocations and all suspected pulley injuries require x-rays.
• If there is deformity—misalignment of your finger or change in the structure of your bones—you need to consult a hand specialist.
• If you heard a pop or snap and experience severe pain, swelling, and instability or can’t voluntarily move your finger joint throughout the entire range, there is a high probability that you have a fracture or complete tear of a tendon or ligament.
• In addition, you should consult a doctor if and when any of the following symptoms are present:
- persistent pain, swelling, or restricted range of motion
- numbness, tingling, weakness, spasm, or radiating pain
- failure of the injury to recover after 4-8 weeks of rest
- open wounds have become inflamed or change color
Why do so many hand injuries require x-rays?
• The fingers are small bones and are susceptible to fracture during high compressive loads, dislocations and pulley injuries.
• When pulleys tear, the flexor tendons often avulse a small piece of bone at the attachment site, and/or the tendon separates from the bone (tendon dehiscence). So, in order to apply the best therapy and expedite recovery, you need to rule out a fracture with an x-ray and, in some cases, determine the severity of tendon injury by having a musculoskeletal ultrasound or MRI.
• Failure to apply the appropriate type of bracing or splint can prevent healing, lead to permanent damage, or predispose you to early arthritis.
And that’s it! Please don’t be too overwhelmed about all the talk of fractures and x-rays–and remember that these recommendations are only for injuries of the hand and finger. If you are a climber in San Francisco you can find me at the Planet Granite Gym the second Tuesday of every month from 6:30-8:30PM where I provide free injury screening for members.
Rachman Chung, DC, DACNB, FACFN
Board Certified Chiropractic Neurologist
Fellow of the American College of Functional Neurology
References.
- 3pointproducts.com
- 5minuteconsult.com
- cimbinginjuries.com
- emedicine.com
- orthopod.com
- Hand Pearls by Mathew J. Concannon, MD, FACS and Jack Hurov, PhD, CHT
- Sports Medicine Secrets by Morris B. Mellion, MD
Dr. Chung is a board-certified chiropractic neurologist and fellow of the American College of Functional Neurology. He is an expert in physical and neurological rehabilitation and has helped numerous patients recover from sport and spine injuries, migraines, dizziness, vertigo, concussion and complex conditions. Follow Dr. Chung on Twitter and join him on Google+