Thumb injury rehab

[sambedell]

I was almost done with my base phase, transitioning to hangboard/strength when I injured my thumb. It was not a climbing injury, I was playing tag with some kids and hit my thumb head on while fully extended. There was pop and it swelled up. The next day while gently massaging it at the base of the metcarpal bone something popped back into place, based on the level of pain and ease of the relocation I think it was a tendon and not the bone.

I continued to do some strength training and climbed on it while avoiding thumb specific grips like hand jams and full crimps. I also iced and wrapped my thumb during the day. After two weeks the inflammation was mostly down and it was feeling "okay" so I did some crack climbing, felt okay, tried a face climb and moved my hand quickly going to a pocket and stupidly smacked the back of my thumb on a mini roof at the base of the proximal phalanx (heard another pop). It swelled up again but I figured it had been in the opposite direction of the original "pop" so hoped it wasn't too bad. Iced and wrapped for three days and it seemed like it was okay again so I started doing range of motion exercises and ice massaging the specific tendons in the evening. However, small things keep setting it off and causing it to swell up again. Exercise such as ARCing and general strength exercises seem to reduce swelling and leave it feeling good but often lead to more inflammation the next day. Hangboarding seems okay but I can't avoid involuntarily contracting my thumbs while doing things like half-crimp, open hand, and pockets. The things that really bug it are small motor functions like unscrewing jars in the kitchen or handwriting which set it off immediately.

One day it will be feeling fine and the next its all swollen and a pain in the butt. The swelling is almost all in the the joint between the proximal phalanx and the first metacarpal (MCP), as well as the muscles of the palm at the base of the thumb. Pain is focused on the outer edge/processes of the MCP joint and on the outer edge of the thumb along the proximal phalanx, and also on the flexor tendon at and on either side of the MCP. I have also noticed that the flexor tendon at MCP joint seems to not be as "tight" into the joint as on the other hand, but then again I could just be noticing the inflammation.

My questions are:

a. Does this seem like an injury that requires a doctor i.e. an xray/mri/etc to diagnose properly or a surgery?

b. Does continued climbing and strength training that utilizes non-thumb grips help or inhibit rehab?

c. Does anyone have experience with a related injury? Is this comparable to a popped pulley strain or should I view it differently?

Thanks for your help everyone!

[sambedell]

Update on this... went to the doctor and had xrays taken, bones are all good. Diagnosis is a sprain of the MCP joint. Protocol is to rest thumb for two more weeks and do range of motion exercises plus RICE for inflammation.

Doctor couldn't answer what I can/can't do as far as climbing specific exercises so maybe someone on here with a better understanding of the anatomy and physiology can help me: can I hangboard/ARC/climb with certain grips without compromising my recovery? Obviously anything where I have to yard on the thumb is probably not a good idea but I imagine that if I can exercise the hand without tweaking the thumb it will improve recovery. Thoughts?

[MarkAnderson]

I think it would be possible for someone with this injury to train in a limited fashion, but that person would need to be very careful and exercise restraint. From what I've read here, I get the impression that you may struggle with those things. If you insist on training, be very careful. Be obnoxiously careful. Sue less resistance, take more rest days, and don't try so hard that you are forced to contract your thumb.

When you're not training, don't use your thumb. For anything. I think it's wise to do ROM. Once the pain and swelling subsides, then you can start some light rehab. It's a trial and error process, which means you have to start out slow, see how you feel the next day, then adjust the intensity/frequency up (or more likely down) based on how your thumb responds. Take your time and go slow.

[sambedell]

Thanks Mark. It always helps to hear from someone else who has an objective perspective. I decided to just avoid any climbing training on my injured hand for two weeks after reading your post. It's my dominant hand anyway so it's a good opportunity to work on strengthening my other side.

Next question: I've been doing the Scott's Killer Core routine from the House/Johnston book but several of the exercises are no longer doable with my thumb, such as hanging leg raise and gymnast L-sit. Anyone got alternative ideas fro these exercises that don't require weighting/hanging from my hands?

[MarkAnderson]

Not familiar with the Scott's Killer Core routine, but I imagine you could do Ab Roll From Rings of hanging leg raises from a "power tower".