Before discussion of frozen cadaver hands, physics of pulleys and taping methods, I had to refresh my basic hand and finger anatomy. A few translations:
- Fingers = Phalanges or Phalanx
- Distal phalanges = furthest part of the finger, tip
- Proximal = closer to the hand
- Metacarpals and Carpals are found in the hand, not fingers
- Tendons run along the sides, top and bottom of the fingers
- Flexor tendons help close the hand into a fist
- Extensor tendons open the hand, like waving hello
- MCP = Metacarpal Phalangeal joint (base of finger and hand)
- PIP = Proximal Interphalangeal joint (second finger joint)
- DIP = Distal Interphalangeal join (last finger joint, closest to tip)
The fingers are a very complex system of levers and pulleys, much like a crane. The separate bones of the fingers are able to move because of a system of pulleys that direct the pull of the tendons. These pulleys are often what fails (breaks) during the stresses a climber puts on their fingers. The pulleys are numbered A1-A5:
A-1 Pulley: arising from the proximal plate and proximal MCP joint, the first pulley in the finger, closest to the hand; released during a trigger finger injury
A-2 Pulley: located at the proximal and lateral area of the proximal phalanx, or where you’d typically wear a ring; a critical pulley
A-3 Pulley: located at the PIP joint
A-4 Pulley: found at the middle phalanx is considered to be the most important pulley
Back To Climbing:
So now that we’ve prodded through the anatomy of the finger including bones, joints and pulleys, lets get back to climbing! A very nice article on finger injuries can be found here at the American Academy of Family Physicians website. There is lots of mention of many finger injuries, but none really specific to climbing. Climbing injuries typically involve the tendons of the fingers and damage to the pulleys that the tendons use as leverage points. Symptoms include the typical “locked up” feeling, when moving a finger and usually involves a lot of pain in the finger joints.
There is very little literature on the subject of climbing related finger injuries and one of the best works can be found in the American Journal of Sports Medicine. The study looked at circumferential taping of the A2 pulley and then placed cadaver hands in the climber’s “crimp” position, to simulate a hold. The flexor digitorum profundus and superficialis were then pulled until either the tendons or the pulleys broke. Yikes! Findings from the study showed that the A-2 pulley of the little finger was the weakest, overall males had more strength versus females and there was no change in failures of taped and non-taped fingers.
The British Journal of Hand Surgery also featured a nice study, by A. Schweizer, concluding that circular taping is minimally effective in relieving A2 pulley force and is probably ineffective in preventing pulley ruptures.
So, two decent studies have found that finger taping does not prevent injury.
If I already have an injury, can I just tape it and keep climbing?
A piece of tape is made of cloth and some glue, not nearly as good as the wonderful collagen your own body makes. Taping an injury should serve only two purposes. First, to stabilize an already injured A2 pulley, allowing you to keep punishing it and keeping it from healing or maybe even making it worse. Second, to remind you that you have an injury on that finger and to proceed with caution.
Maybe I am taking a conservative approach but I would rather sit out a few weeks to heal properly, rather than risk a severe injury that could keep me out for months!
OK, I am injured. How bad is it and what to do?
An article in the WMS journal, Pulley Injuries and Rock Climbers, looked at a grading system of severity of injury and treatment based on level of injury. The authors graded based on severity, from one (least) to four (worst). 94% of the injuries in their article were grade three or below. The grade 4 injuries represented 6% and required surgery. Diagnostic methods included ultrasound and MRI, so get it looked at! Thus, 94% of finger injuries in climbing can be treated the following way:
- Immobilization for 10 days
- Waiting 4 weeks before getting back into basic/easy climbing training
- Taping for 3-6 months following the injury, while climbing
- Full return to climbing activities after 6 weeks to 3 months
- Pain control with NSAIDs such as ibuprofen
Finger injuries are an unfortunate product of climbing. Hopefully, this has helped show that preventative taping of fingers does very little to stop injuries, in healthy fingers. In fact, there is some argument that always taping your fingers prevents the pulleys from strengthening, thus making yourself prone to injury when you do not use tape! There is also decent literature for the use of taping to recover from an injury, through supporting the already damaged pulley. Perhaps this acts a a “safety blanket” for those who have been injured in the past, but efficacy of taping 6 months after injury is doubtful.
Of course, if you get injured, get yourself looked at by a healthcare provider. There is no subsititute for common sense and you are ultimately responsible for your own health.
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand
Volume 25, Issue 1, February 2000, Pages 102-107
Emedicine: “Flexor Tendon Anatomy” http://emedicine.medscape.com/article/1245236-overview
“Pulley Injuries in Rock Climbers” Wilderness and Environmental Medicine: Vol. 14, No. 2, pp. 94–100
Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/
American Family Physician; Acute Finger Injuries: Part 1, Tendons and Ligaments: http://www.aafp.org/afp/20060301/810.html