Avulsion Fracture @ PIP joint

[Matt McCormick]

I've been diagnosed with my 2nd avulsion fracture this year at my Right Middle PIP joint. I had almost the same identical injury back in October 2014 and rehabbed to have a great spring 2015 season. I've been doing an abbreviated training cycle to prep for my summer trip and started to have familiar pain so I went and got an x-ray. I was told that I have another avulsion in the same area. I was wondering if anyone has any experience with this? 

Thanks for any incite anyone might have. 

Matt

[MarkAnderson]

Same location in same finger?

I don't have any experience with that injury, so unfortunately I have nothing to offer except sympathy. Is it a stress fracture (as opposed to an acute avulsion fraction)?

[Matt McCormick]

Thanks Mark,

Yeah. I'm still waiting to hear back from an orthopedist but the preliminary radiology report says that it's a new avulsion in the same area (bottom/lateral side of the joint). It's an acute avulsion according to the x-ray. The first one from October was more obvious with a small fragment that you could see in the x-ray. It's weird because I can climb on it with just slight discomfort at most. There is a distinct feeling on weakness though and occasionally sharp pain. Frustrating!

[ericg]

Hi Matt,

I was just diagnosed with avulsion fracture at my pip joint. How did your rehab go? My pcp is sending me to a hand surgeon but it doesn't seem like I need surgery.

Also, is this the Matt McCormick from the New England area? If so, do you know a good Ortho/hand doctor I should see?

Eric

[Matt McCormick]

Hey Eric,

Yes. This is Matt from Vermont. Bummer to hear about your finger. This was actually the second time I had been diagnosed with this injury. I also saw 2 hand surgeons in the Burlington, VT area who both gave me differing opinions. Generally I would say I was pretty frustrated with experience I had with PT and hand surgeons. I did do a Skype call with Julian Saunders who gave me some effective PT exercises (https://www.youtube.com/watch?v=IMO__OrzM_U). I didn't so these exercises until about 5-6 weeks after the injury. The PT I saw here in Burlington was not very helpful mostly due to her lack of understanding of climbing.

My friend Nick Lee who is a PT recommended I see Dr. David Ring at Mass General in Boston if I wanted a 3rd opinion but I haven't moved on that yet. With both incidents it seemed to take around 3-4 months before I could really try hard again. Once they clear you for range of motion exercises I would start as soon as possible with those and then transition into very light hang boarding. As discussed elsewhere in this forum, I think hang boarding is the most effective rehab as long as you're cleared to load the finger.

I've been doing some research lately and it seems like the foremost finger speRCTMkicksAssts who understand climbing are in Europe. Dr. Volker Schoffl in Germany and Andreas Schweizer in Switzerland both have written a lot of papers on finger injuries in climbing.

How did you injure your finger? The good news is that bone actually heals faster and more securely than ligaments.

Best of luck,

Matt

[ericg]

Thanks Matt,

I'm pretty sure I did it hangboarding. But there wasn't a moment that made me think I screwed something up. I have been climbing on it for the past 2 months basically experiencing the same symptoms you described.

I just had a skype with Lisa Erickson which was useful because told what to look out for when talking to the hand doctor. Basically, you want them to do a stress test of the joint for stability. She uses diagnostic ultrasound but you can also have xray's or an MRI taken with and without stress. My understanding is that this will tell you if the avulsion is attached to the tendon or not.

She also recommend taping with kinesio tape to push the avulsion up against the bone and increase the likely hood of reattachment.

Thanks for the Dr. recommendation I'm going to wait to see what my guy says on Wednesday but will most likely see him as well.

Best,
Eric

[Matt McCormick]

Hey Eric,

Out of curiosity, do you have a sense of what grip you might have injured it on. The first time I had this injury I'm pretty sure I did it hanging IM. I think that this grip can put a lot of torsion on the PIP unless you're very careful. Interesting what Lisa Erickson said. I had X-Rays and MRI but not under stress. My doctor didn't want to do ultra-sound but everything I've read since recommends ultra-sound in diagnosing finger injuries; and it's a lot less expensive than an MRI. Let me know what they find!

Matt

[ericg]

I'm pretty sure I hurt it on the full crimp grip. I had my visit to the hand surgeon today. He thought the joint was stable and didn't need any additional tests. If I'm still having problems after 8 weeks he thinks a cortisone shot should help it. I have had it in a splint for the past week which weirdly caused it to swell. So he told me to ditch the splint, wait for swelling to go down and then slowly ramp intensity.

[Matt McCormick]

Hey Eric,

I was wondering how your recovery is going? I've slowly been getting back into form and have been sport climbing for the past month. I still get a lot of soreness and stiffness in the side of my middle PIP going facing my ringer finger. Did you ever get another opinion on your finger?

Matt

[ericg]

Hi Matt,

Thanks for checking up. I ended up going with Lisa Erickson's advice, after emailing her about my visit to the hand surgeon, which was to keep splinting it. So up until today, I had been wearing a splint. This week I'm wearing the splint 50% of the time. I haven't got a second opinion but I do want to get another x-ray, to see if the bone fragment has reattached.

Eric

[Matt McCormick]

Hey Eric,

Just was curious how your finger was doing? Do you still get any soreness after a finger intensive session? Mine is doing pretty well but still aches sometimes if I really push it.

Thanks!

Matt

[ericg]

Hi Matt,

Sorry to hear your still experiencing soreness. I think my finger is pretty close to 100% now. I haven't had any symptoms in over a month. It is an aggravating injury to recover from, takes so long! It took 4 months until I was really able to rehab it. I tried to start rehab at 2 and 3 months but the finger was just not ready. After about 6 months I was feeling close to 100%. For rehab I ended up just doing a basic hangboard routine 3 grips, 5 sets each, 8 sec hold (1-2x a week), picking weights I was confident I could do each time and slowly increasing the weight. I found repeaters to be to intense for my finger even at very low weights. Surprisingly I found the pinch grip to be the most sensitive, I had to drop the weight down to the point where I was only holding 15lbs with that hand at first. But progress on this grip seemed to translate well to reduce pain and swelling.

[Matt McCormick]

Thanks Eric,

My finger had been feeling amazing for several months now even with really intense crimping and dynamic movement then recently it started to show symptoms again. Really frustrating. Did you ever see another surgeon or doctor for another opinion? It's crazy to have this recurring soreness and twinges.

Matt

[ericg]

Hi Matt,

Sorry, I didn't end up going to another surgeon or doctor. How frequently are you experiencing the soreness and twinges? Near the end of my recovery I got some soreness when I increased the volume but that doesn't sound like what you are experiencing.

Eric