People regularly get confused between a pulley strain and an irritation of the tendon, which Huffy has called 'crimp finger'. In this podcast highlight it explains the differences between the two to enable you to diagnose the correct injury so that you can seek the correct treatment.
This podcast highlight is a snippet of our podcast with GB climbing physio, which covers various topics related to climbing injuries and rehabilitation.
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huffy (00:00)
what we've sort of discovered, I guess, because it's a relatively new sport and you're gonna find these things, is that perhaps it's been overly demonised when actually the source of the problem's actually the tendon, the contractile problem itself, with the A4 pulley actually being absolutely fine, not even being involved with the pain generation. So it's a really easy oversight to make because when you press, the difference between being on a pulley and the tendon is probably
about two or three mil. And so yeah, you could easily be fooled into thinking it's an A4 problem.
And I think, you know, cause the pulleys are so well understood and talked about, the same thing happens to the A2. So if you've got something like a trigger finger problem, and you know, you've got like a little bump on that tendon that's catching between your A2 and your A1, a lot of climbers will feel pain when their fingers are flexed. But what's happening in that position is that tendons track down to your A1 and it's getting compressed there.
Then when you open your hand up, that little irritated bit of tendons actually gliding up to sit right underneath your A2. So when you open your hand, you obviously sesh your hand by straightening your fingers. You're actually pressing on a painful tendon. And the A2 is just a sort of symptom of that kind of collection of problems. So you'll say you've got an A2 problem, but for those people who this proves true, you'll find if they flex and you press around your A1,
play as you flex the finger. You might even feel a bump running underneath your finger, that's quite sore. So a lot of people assume it's an A2 partial tear or something, but it's not. It's actually the tendon itself and the same proves true for the crimp finger. I've called it crimp finger because it seems to happen at higher flexion angles. So yeah, it's the same sort of thing, a tendon problem, not a pulley.
josh (01:54)
Yeah, as well as you mentioned there, like the prevalence is often when you're crimping, hence the name and whatnot, but is there any kind of differences that you've noticed with how it onsets? So obviously pulleys very typically have that like bang effect when they go and you're quite aware. Does that differ with the crimp finger?
huffy (02:10)
Yeah.
It does, so it can come on really slowly or it can come on really suddenly and that can be with or without trauma to the A4. The more common thing I do see is actually the slow buildup as people get onto progressively smaller edges and that inevitably sees the DIP, the end of your finger, falling into a bit of hyperextension and then the flexion angle of your PIP getting greater, which just goes to see that tendon becoming more and more active.
There's risk factors for that. So if you're hypermobile, you're more likely to get that problem because obviously if an edge size is smaller than the distal phalanx, you're gonna put more and more stress on your volar plate, that stretchy ligament which goes backwards. And anyone listening to this can just test and see how bendy that joint is. And the bendier that is, the more you're gonna see overload through this guy, which sees your FDS slowly building up more load.
And that's usually why they become a sort of a gradual chronic problem. And that's where you see people saying, well, I think it's probably your A4, it's sore in that spot. And then they say, well, I didn't hear a pop. And that's where sometimes people will go down, oh, it might be a partial tear. And it behaves very much like that. But actually it's a low tolerance issue in the tendon itself. And it usually takes a specific approach to see that low tolerance build up.
josh (03:40)
interesting with the hyperextension of that distal joint on the finger because I definitely I have extended a lot. You just said like you get a bit of hyperextension I think I get a lot of hyperextension. I get quite a lot. Do you see this occurring more in people with these hypermobile distal joints in their fingers?
huffy (03:45)
Yeah.
Yeah.
Definitely, there's a much higher incidence of it in hypermobile people. Same for the TFCC problems. You see more TFCC problems in people who are hypermobile and that's usually when their hand goes from really engaged to there's loads of good muscle tension through their flexor tendons and forearm muscles. And the more open they get to, so it's the opposite crimp finger, the more they fall onto a straight wrist and that's where you tend to see traction problems and twisting problems in more vulnerable connective tissue
seatbelt of tension's gone in that crimp position. So unfortunately, whether you're high angle crimping or open-handed being hypermobile does sort of predispose you slightly more to more of these sort of issues.