Tenosynovitis (aka: tendovaginitis) Ring finger

[injurysminjury]

Here's another one for you guys...

I believe I have tenosynovitis in my RH ring finger but wanted to hear other's thoughts so i wrote my account of what happened below. 

If it is in fact tenosynovitis, what's the protocol for rehabbing in the early stages? I can't seem to find anything other than doing some light HB work as mentioned in some other posts on the forum.



Background info:

I started climbing again during the first week of January after a 2-3 month long break due to an a2 pulley strain on my RH ring finger which is now resolved. I climbed 5.9s and by the end of January moved on to 5.10s. I then added a 5.11- at the end session during the beginning of Feb. Sessions lasted between 1 and 2 hours as the focus was rehabilitation and warmups were long and extensive. I always took 2 days off between session.

The issue at hand:

7 days ago, I did an up-down-up on a steep 5.9 (40') which got me pretty pumped. After getting off the wall I noticed a pain in my LH Ring finger this time and in the a2 pulley area. It didn't quite feel the same as an a2 pulley strain and in fact the pain quickly went away by massaging the pumped forearm. it seems that the tense and pumped muscle was a contributing factor to the pain felt in my finger.

The area around the a2 pulley is not visibly swollen but it can be felt with palpation.  It almost feels like the A2 pulley raised or swollen but after some more prodding it feels like the tendon is swollen and pushing the pulley up. 

Like I said, the swelling is not visible and the pain is near non existent and i have full ROM. It doesn't hurt when i press the area with my thumb. It does ache when I squeeze something like a racquet handle or free weight. 

About me:

I'm 30, have been climbing for 7 years with a few injuries here and there which have always been from overuse and becoming turning chronic. So far, i've never had any acute injuries (ie. complete pulley rupture). Used to climb high 12s and boulder v7-9

*I seem to be prone to tendon inflammation or at least it appears this way compared to my fellow climbers at the gym.

[MarkAnderson]

At the top you say RH, in the middle you say LH. Is it right or left? If it's in the same spot as your A2 strain it could just be that you aren't healed.

Anyway, It does sound like inflammation. Do you stretch your forearms/fingers (along the lines of what is described in Ch 9)? I wonder if your flexor muscles are overly tight, and that is causing inactive joint stress on your pulleys. In any case, step up your stretching routine.

As far as rehab goes, I find that rest tends to make these types of injuries worse. I have the best luck with regular hangboarding. You could probably get away with regular climbing too, but if you do, make sure you warm up really well and don't do anything haphazard.

[injurysminjury]

Feb 21, 2016 8:43:13 GMT -7 MarkAnderson said:

At the top you say RH, in the middle you say LH. Is it right or left? If it's in the same spot as your A2 strain it could just be that you aren't healed.

Anyway, It does sound like inflammation. Do you stretch your forearms/fingers (along the lines of what is described in Ch 9)? I wonder if your flexor muscles are overly tight, and that is causing inactive joint stress on your pulleys. In any case, step up your stretching routine.

As far as rehab goes, I find that rest tends to make these types of injuries worse. I have the best luck with regular hangboarding. You could probably get away with regular climbing too, but if you do, make sure you warm up really well and don't do anything haphazard.

Hey Mark. Thanks for the reply.

To clarify, the RH A2 injury at the beginning of my post is a separate injury from the one I'm currently having on my LH. It's in rehabbing my RH A2 pulley strain that I ended up developing this new injury on my LH ring finger. So separate injuries.

I do stretch my forearms but maybe not as much as I should. I do feel like this last climbing session left me more pumped than any previous climbing session though.

Stretching - check!

That's reassuring to say the least. How would you approach rehabbing through HB? 

When climbing, are there certain guidelines I should follow? Avoid crimps? Open hand grip only? Limited steep climbing?  Should I focus more on easy climbing? moderate with some pump? etc..

I'm usually pretty good with injuries as I've had a few but this is a new one for me so thanks for the help.

[injurysminjury]

Feb 21, 2016 10:15:12 GMT -7 injurysminjury said:

Feb 21, 2016 8:43:13 GMT -7 MarkAnderson said:

At the top you say RH, in the middle you say LH. Is it right or left? If it's in the same spot as your A2 strain it could just be that you aren't healed.

Anyway, It does sound like inflammation. Do you stretch your forearms/fingers (along the lines of what is described in Ch 9)? I wonder if your flexor muscles are overly tight, and that is causing inactive joint stress on your pulleys. In any case, step up your stretching routine.

As far as rehab goes, I find that rest tends to make these types of injuries worse. I have the best luck with regular hangboarding. You could probably get away with regular climbing too, but if you do, make sure you warm up really well and don't do anything haphazard.

Hey Mark. Thanks for the reply.

To clarify, the RH A2 injury at the beginning of my post is a separate injury from the one I'm currently having on my LH. It's in rehabbing my RH A2 pulley strain that I ended up developing this new injury on my LH ring finger. So separate injuries.

I do stretch my forearms but maybe not as much as I should. I do feel like this last climbing session left me more pumped than any previous climbing session though.

Stretching - check!

That's reassuring to say the least. How would you approach rehabbing through HB? 

When climbing, are there certain guidelines I should follow? Avoid crimps? Open hand grip only? Limited steep climbing?  Should I focus more on easy climbing? moderate with some pump? etc..

I'm usually pretty good with injuries as I've had a few but this is a new one for me so thanks for the help.

So, I did some stretching as you mentioned and felt some pain radiating down my palm which I thought was odd. I did a little more research and now feel like my injury might be flexor unit strain after reading up on the symptoms. Mainly, my ring finger/palm hurts when I grab a hold and drop my pinky.

I most definitely could be wrong but I decided to go test this hypothesis by buddy tapping my pinky and ring finger while climbing to avoid my pinky from dropping.

Result: no pain whatsoever. 

Is this common in your experience regarding flexor unit strains? Can flexor unit strains cause light swelling around the a2 area like I'm experiencing?