I grabbed a small pocket on a boulder and felt a pang in my forearm but kept climbing. I read your article “Fingers: Blown Tendons” [see], and it seems on the money in terms of mechanism of injury and symptoms. The “Dr. J Test” of pulling on my ring finger alone (causes pain in the middle of my forearm) versus pulling ring and middle finger together (no pain) seems to confirm I have the exact injury described in your article. The article said I am able to keep climbing with it. How long does it typically take to heal? And any advice to speed recovery?
Scott Sklar /

A tear in the tissue between the tendons as they fuse into the end of one of the finger flexors does seem like the source of your pain. The Dr. J Test is also positive if pain arises in the palm, but given that you have none, it is unlikely that you have damaged the lumbricals muscle between these two fingers. For a small fee I can do some Reiki through your Internet connection so you can bathe in the pure light emanating from my core, or you can avoid climbing pockets that split those two fingers for a month, after which you can progressively split under load. Try using an edge board, where you can really control force output and the degree of splitting.


Eight months ago I hyperextended my big toe while bouldering. Although only moderately painful, the injury did not heal. My doctor immobilized the foot for four weeks. I started climbing again but any weight on the big toe now produces excruciating pain. An MRI showed a 50 percent tear in the flexor hallucis brevis. PRP injections, more periods of immobilization, multiple PT’s for rehab, a second MRI, amnion fix injection, and more immobilization, and I am no better. I saw a surgeon, who was reluctant to do surgery but suggested that fusing the joint is an option. That or stop climbing and live with the pain. Surely there is another option?
Jessica Garwood /

Wow, you’ve been through the medical wringer! I have full respect for any surgeon who is reluctant to do surgery where the benefit is debatable or they are not au fait with a particular procedure, but in the instance of surgery, particularly without any attempt to repair the tendon, I don’t really get how fusing the joint is going to help in any long-term practical manner, let alone as a front-line option. I think there are likely other surgical options before you need to consider that or, God forbid, early retirement!

I have no revolutionary rehab moment for you. You have tried it all and now need to invest in other surgical opinions. I tend to think this surgeon is being a little conservative, all things considered, especially given your predilection for climbing!


I felt and heard a pop in my fourth finger five weeks ago while crimping. There was not a lot of pain, but I quickly saw a doctor, who sent me to a PT, who referred me to an orthopedic surgeon. With minimal evaluation I was told the injury was likely an A3 or A4 pulley injury. Since that appointment the pain has worsened, and I can’t fully extend my finger, passively or actively. There is no noticeable bowstringing. Can a pulley rupture stay swollen and not show improvement for this long, or should I get a second opinion? Is there anything else I can do to self diagnose?
Bailey Miller /

The specialist is probably right. Not because she has done a comprehensive examination, but rather by virtue of the fact that pulley injuries account for more than 90 percent of finger injuries; the trick is figuring out what the other 10 percent are. You haven’t mentioned what advice you were given, assuming it is a pulley issue, but from your line of questioning I take it that you didn’t get anything constructive.

Diagnosis is not as simple as feeling for bowstringing, which, as an assessment criterion, is fraught with epic levels of failure. Although you can certainly feel bowstringing of the flexor tendons in some people with ruptured pulleys, it is a high-end palpation skill and even then prone to false negative results.

For chronic pulley injuries, I recommend really getting into it with a thumb and massaging it until your eyes water. However, I am going to gamble here that this is not a pulley injury—or at least there is more to it than that. The decreasing extension to both active and passive efforts is a worry. That would be unusual behavior for a pulley injury. I am concerned about bone and joint integrity given the worsening ROM. In some instances, a pulley rupture can mar joint mechanics, and subsequently cause reduced ROM, but there are other more likely catalysts.

Although the surgeon provided a somewhat austere summation of potential diagnoses, he or she shows no less than you would expect with regard to finger injuries in climbers. That is not meant as a pejorative statement. Fifteen years ago most any doctor would have looked at you quizzically and said, “Just stop climbing.” At least now they have a solid inkling of what may be wrong before they tell you to stop climbing.

If you want to have a climbing future I would push like a dozer to get an MRI, ideally from a hand specialist.