Case Study: The Athlete That Climbed Through Fracture.

A little prequel.

Ashley, a medical provider herself, came in two months after fracture. When asked about how she was injured, she said she had been climbing, did a reachy side pull, and during a crucial weight transfer, she lost her core strength and her foot popped off its hold. In doing so, she had wrenched the hand that was doing the side pull and felt (and heard) a pop followed by immediate pain and swelling. A similar story to the usual pulley tendon injury; she was in horrific pain. But of course not enough to keep from climbing on it.

A later X-Ray by her family physician showed a fracture (though it was not discussed what type or where its location was in respect to the joint line) and it was guessed that she had a moderate to severe pulley injury. Ashley was then told to take 6 weeks off though she said that the pain was bearable, and she climbed on it gingerly anyway. She then began climbing aggressively on it again at the two month mark only to find that it still was bothering her to weight the affected joint; thus bringing her into my office. This athlete made a variety of self-care mistakes from which we can learn together as a group.

First off, Ashley’s X-ray did not show a pulley tendon injury, it couldn’t. Only visible on MRI or Diagnostic Ultrasound, the x-ray was merely to rule out fracture (which they saw). X-Rays show the dense bone as white and the swelling as gradients of gray. It is very hard to see how much swelling has occurred and what that means on an X-Ray. Only in extreme cases and new injuries can injuries be visualized. We do not want to see anything on an x-ray. If we do, that’s a mandatory two months off if not more. A bone must be broken 45% of the way through to be visualized on an X-Ray, this means that we can very easily have smaller fractures that we cannot see on the lm, which can of course break more with climbing. A warning to the wise.

A fracture always requires a period of time to heal. There is a life cycle of fractures, periosteal reactions, and healthy bone that is a wavy line. It can take a fracture two weeks to become a periostealreaction, which is where the bone is healed but there is still in ammation and damage at the surface of the bone along the surface of the bone itself. If a periosteal reaction is allowed to heal, this can become a normal healthy bone. Often fractures, left alone, heal quite well. But if we weight them and break up the bits of healing that occur via osteophytes to lay down new bone, none will form. In the case of this patient, all the work her body was doing to heal was being undone by her with each use. Her best bet would have been to immobilize the nger until the bone itself healed.

When we looked at her finger with diagnostic ultrasound, we did not see a fracture through the bone itself, but of the little extensor tendons on the top of her finger. Flexing under no weight, it wasextremely evident that the anchor point of the tendon had pulled off a little bit of the bone, and thatbony bit was now oating around. Left to heal, it is hard to tell if it will re-adhere all by itself, it is likely it would, but with her history of not following medical advice, it was unlikely that she would give it the time it needs to heal.

I left her with an understanding of what she had done to her nger and her structures and aboveall, upon my recommendations I also mentioned the fact that she could also choose the option to keepclimbing and hope that the rest of her extensor tendons were solid enough to handle years of climbingwithout one important anchor point. At this point, I had not known that the extensor tendons attached on each side of the bone of the knuckle, so her accident was an excellent way for all of us to learn.

Dr Lisa

Enjoy reading this? It's an excerpt from Climbing Injuries Solved! Click here to get more.

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