5 Common Finger Injuries in Climbers

Helen Neal - Take Hold Physiotherapy

Unsurprisingly, the fingers are one of the most commonly injured body parts in climbers due to the high levels of stress that we place on them. Some of the most common finger injuries that I see in clinic include: the pulleys, lumbrical muscles, growth plates in children, flexor tendon strain, and synovitis.

1.Pulley injuries

The one we all have heard of, the dreaded pulley injury...

Each finger has 5 annular pulleys that act to hold the flexor tendon close to the bone when gripping. The ‘A2’ and ‘A4’ pulleys are connected to the bones of the finger. They withstand the strongest forces and are the most susceptible to injury.

Injury to the pulley can occur following ‘chronic overuse’ or a sudden dynamic overload of the pulley. It usually occurs in closed crimp positions due to the increased downwards force that the flexor tendons are putting onto the pulleys. You will usually experience sudden pain and sometimes hear a ‘pop’.

2.Lumbrical muscle

The lumbricals are a group of muscles within the hand that originate on one of the flexor tendons (the flexor digitorum profundus, FDP), and insert of the back of the finger. They help to flex the fingers at the ‘MCP joint’ (- or the knuckle!), whilst also helping to straighten the rest of the finger. The lumbrical between the middle and ring, and ring and little fingers are attached to the FDP of two different fingers.  

The lumbricals are usually injured when suddenly loaded whilst climbing in a pocket because when one finger is straight and the other is bent, the muscle is getting pulled in two different directions. Pain will be felt in the palm, and sometimes down to the wrist. 

Low grade injuries are usually managed by a short period of rest, followed by taping the affected finger to the adjacent finger through climbing and a gradual return to pockets.

3.Epiphyseal injury

In children and adolescents, the ‘epiphyseal plate’, or growth plate, is the area located at the end of the bones where the majority of growth takes place.

Epiphyseal cartilage is more prone to fracture than other parts of the bone. In young climbers, fracture of the growth plate is caused by large amounts of stress on the immature skeleton, and is more common than other types of finger injury, although often misdiagnosed.  

Young climbers should avoid over training and large amounts of dynamic movement on small holds. 

If suspected, early diagnosis is important to avoid premature closing of the growth plate and asymmetrical deformity of the finger, or other long-term complications. If you suspect a growth plate injury you should see a healthcare provider with a good knowledge of climbing injuries straight away. 

Image source: bonepit.com

4.Flexor tendon strain

Flexor tendon strains usually occur at the point where the muscle and tendon join. They most commonly occur to the flexor digitorum profundus (FDP), on hold types where most of the force is going through the last joint of the finger (DIP joint).

Pain will usually be felt around the level of the wrist or forearm. Rehab will likely involve a period of relative rest followed by gradual exposure back to open handed crimps.

5.Synovitis

The synovial membrane is tissue that surrounds the joint and is filled with fluid. The synovial fluid provides nutrients for the cartilage within the joint. Injury to the synovial membrane is caused by overuse and usually affects the middle joint of the finger (PIP joint). It usually presents as pain, swelling, and loss of full range of movement. Treatment needs to consist of some offloading of the finger. This might mean less time climbing/ finger-boarding, or avoiding so much use of an aggravating hold type such as a full crimp.

The above information is only a brief outline. It is always a good idea to see a healthcare professional to rule out serious injury and to safely manage recovery if you are unsure.

About the author:

Take Hold Physiotherapy is a climbing specific injury rehab clinic operating at The Climbing Hub in Bradford. Take Hold was founded in 2021 by Helen Neal. Helen is a climber herself and has a wealth of experience as a physiotherapist, working as both a private practitioner and as a hand specialist for the NHS.