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Injuries and Medical Advice

Ruptured Finger Pulley

"I felt something in my ring finger and heard a pop."

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I was bouldering and I suddenly weighted a two-finger hold with my left hand. I felt something in my ring finger and heard a pop, like a knuckle cracking, and had mild pain but no swelling thereafter. I tried a V0 with big holds to see how my finger felt and I had no trouble and no pain. It seems that I have a pulley injury. What should I do about this?

—Hambone, Rock and Ice Forum

A “mild strain” is incongruent with any sense of popping.

By all appearances it sounds like you ruptured a pulley, except that there is little to no swelling. That’s odd. Though a pulley that fully snaps can (ironically)
be less painful than a partially torn variety, it typically inflates faster than a porn star and stays that way for several weeks.

You haven’t mentioned exactly where the mild pain is, so it’s difficult to give you a definite diagnosis. If you were torqueing the finger you may have
torn a collateral ligament, an injury that usually exhibits minimal swelling and only mild pain.

You may have simply cavitated the joint (cavitation is the popping noise that you hear when you crack your fingers or spine, among other freely movable
joints). Still, I would have to qualify that 99.9 percent of the time, when a person thinks he has cracked a knuckle under load he has actually snapped
some form of connective tissue, most often a pulley. The pulleys hold the tendon close to the bone and are essentially a ligament that rejoins to the same bone rather than cross a joint to neighboring bone.

I would give it an acid test at the gym or outside, where you can control how much force you are using. Start on something easy and build the difficulty,
albeit cautiously. Stop at roughly 75 percent of your max (for example, if your best is V8, warm up and try a V6) and take a rest day to assess any
delayed soreness. Next time around, go to 90 percent, after which, if you still have no pain, release the hounds.

Experimenting on your project is a no-no, unless you have had zero trouble on every grade leading up to it. You may well have made an unsanctioned pass
under the Sword of Damocles, lucky you, but I would be cautious wielding your power again until you are sure there is more than a hair between you
and bisection.


This article was published in Rock and Ice issue 215 (January 2014).


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