About 10 days ago I noticed numbness in my left-hand pinky, and a bit in my ring finger. I thought I had pinched a nerve climbing, then last week I spent two days typing, tried to climb after the second day and my grip was just weak. Should this fully resolve itself? Could muscle wasting have occurred already?

KO / Carbondale, Colorado

First, go climbing, since avoiding it won’t actually help a lot, and find something to laugh about.

It sounds like a case of thoracic outlet syndrome. The ulna nerve, which supplies sensation to the little finger and half of the ring finger is usually the first to be compromised, as it is the lowest on the brachial plexus and has to pass up and over the first rib and under the collar bone. When the muscles around the neck and shoulders tighten from overload, the first rib becomes slightly elevated, tensioning the nerve. To make matters worse the space under the collarbone is reduced and tight muscles further compress the nerves after they exit the cervical spine.

Stretch like a yogi, especially your neck and shoulder girdle (Check out the video on my web page, www.drjuliansaunders.com) See a PT, osteo, chiro or whatever floats your therapeutic boat. When you feel the numbness coming on, take a few minutes to stretch your neck in all directions. The pattern of finger numbness you mention, without significant pain in your lower neck, makes a disc bulge not likely. That said, the referred ache down your arm does make me a little suspicious.

If the whole issue does not respond to some manual therapy, move up the medical ladder and get some imaging as recommended by your physician. Muscle wasting will be infinitesimally small and entirely transient in the short- to medium-term.

 

A month ago, I thought I tore the A4 pulley in my ring finger. The x-rays and ultrasounds showed no tendon tear, however, but an avulsion fracture. The finger is still swollen and a little tender, but I can climb easy stuff if I just open-hand. My concern is that because it wasn’t splinted, it may be healing in a weakened state, or that the bone shard may be floating. Can I still splint it? 

Marie Palmer / Squamish, Canada

That’s some proper climbing mojo you have, pulling so hard you are breaking bones!

I have seen quite a few fractured fingers over the years. Mostly, they occur in teenagers who train too hard. What starts as a stress fracture ends as what’s called a Salter-Harris fracture, where the fracture involves the growth plate of the bone. Others generate a stress fracture in the mid shaft. The latter is typically so painful that it prohibits bearing any weight and doesn’t progress to a full fracture.

The most common avulsion fracture in that region is when the tendon insertion of flexor digitorum profundis (FDP) rips a chunk of bone off the front of the distal phalanx. What gets me here is that you say it isn’t painful to pull on in an open-hand position, but rather you couldn’t crimp due to pain. That’s odd. Both should be painful since FDP is the prime mover of finger flexion strength in either grip position. (FYI, crimping would be less painful than open hand if you did an A4).

That makes me think the avulsion fracture could be off the rim of the bone, where the joint capsule attaches. Ultimately, however, it is beside the point since in either case you need to curl up in a cozy corner for at least a month. There is no way of “safely” loading this in relation to the healing process. End of story.

If it is an FDP avulsion fracture and the chip doesn’t relocate itself, surgical intervention is possible, but not easy if the chip is too small to accommodate a screw. Rest first, then get an MRI or ultrasound in a month or so to see if it is adhering, and then consider your options.

 

I have an intermittent pain under my right shoulder blade that started after a long day of strenuous climbing. It improves with rest, but comes back after a strenuous climb. The other night I jumped off a problem at the gym and had searing pain under the shoulder blade. Amazingly, after a little stretching the pain almost disappeared. WTF?

ABT / rockandice.com Forum

Simples … your thoracic musculature is tighter than a djembe drum. Thoracic tightness usually refers to a scapular region, and often presents as a burning pain, or a pins-and-needles-type sensation. Jumping down likely sent some compressive forces through an already tight thoracic spine, causing the sharp pain. Picture joint surfaces slapping together rather than tearing tissue.

You need to lie on your tummy and have a suitably qualified person beat the crap out of your back until it is soft again. Make the time to do yoga once a week.