[分享]一篇关于攀岩手指伤的文章

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暂居上海。近期手指隐隐作痛，不胜其烦。本想寻找一家专科医院做些治疗，竟没有一位运动损伤科的大夫可以专门看手。

于是上网搜索相关文章，现分享如下，希望为受同样伤病困扰的岩友供绵薄之力。

原文来源：http://www.climbinginjuries.com/page/fingers

Fingers and Pulleys

Climbing too much or on particularly bad holds can cause an overstraining of the annular (flexor) pulleys of the fingers (notably ring and middle fingers) This can be anything from a Grade I (strain) to a Grade III (complete rupture). Generally, if you have a Grade 3 injury you will have three phases of treatment. After graduating from Grade 3 treatment you will move to Grade II treatment, and finally Grade I treatment. The grade based treatment and are just guidelines. You be the judge. If it hurts to climb, then don't climb. Avoiding pain is key to getting back to 100% (mild discomfort ok). Other finger injuries are possible with climbing (such as collateral ligament strains, flexor tendon strains, tendonitis and ruptures), so if your injury is not described below or the below treatment isn't’t working, read these articles

• Orthopedic Problems in sport climbing: http://www.wemjournal.org/wmsonline/?request=get-document&issn=1080-6032&volume=012&issue=02&page=0100
• Hand Injuries in Rock Climbing: Reaching the Right Treatment: http://www.physsportsmed.com/issues/1997/05may/jebson.htm
• And/or consult with an orthopedic surgeon or physical therapist who is a certified hand therapist

Please Note:
“Any finger injury that is sustained by a young adolescent (12 - 16) should be seen by a physician and have x-rays performed. These skeletally immature athletes are very susceptible to developing debilitating joint arthritis later in adulthood.” Source: http://www.athleticadvisor.com/


DIAGNOSIS:

Pulleys

• Grade III - Complete rupture of the pulley causing bowstringing of the tendon. Symptoms can include: Pain locally at the pulley (usually sharp), may feel/hear a 'pop' or 'crack', swelling and possible bruising, pain when squeezing or climbing, pain when extending your finger, pain with resisted flexion of the finger.
• Grade II – Partial rupture of the pulley tendon. Pain locally at the pulley, pain when squeezing or climbing, possible pain while extending your finger.
• Grade I - Sprain of the finger ligaments (collateral ligaments), pain locally at the pulley, pain when squeezing or climbing.

Knuckles

• Stress fractures- If your middle knuckle hurts and is swollen much of the time, you may have a stress fracture. This is especially common, and troublesome, in young climbers. I urge you to seek medical attention to confirm the diagnosis although it is often hard to see a stress fracture on x-ray. If you do have a stress fracture, you will need to take at least a month off (but as long as 3 months), especially from crimping. You can probably climb on jugs without irritating the finger, but if it hurts at all, you are just setting yourself back on the healing spectrum. You can assess your healing by noticing decreased tenderness, swelling and no pain when climbing. If it still hurts, don’t do it.
• Collateral ligament injury- This pain will be on one or both sides of the middle knuckle.


TREATMENT:

General Notes on Treatment:

(1) Go buy some TheraPutty! All orthopedic doctors and physical therapists will recommend putty as a tool for successful recovery.
(2) The fingers generally receive poor blood flow so getting blood to the injured area is important. Contrast baths have had mixed results in the literature, but it wouldn't hurt to try. To do a contrast bath, get a bowl of warm water, and cold water. Put injured finger in cold water for a few minutes, then place it immediately in the warm water for a few minutes. Repeat 3-5 times. Finish with the cold water. This could be done after squeezing the putty ball to "flush out" the injured joint. Massaging the effected area can be effective as well. Start out lightly and gradually increase the pressure.

Pulleys

• Grade III: - Immediately- Stop climbing Apply ice or cold immediately, no more than 15 minutes at a time (1-2 days) Take ibuprofen for 1- 2 day Keep the hand elevated Week 1-2 Don't climb! Don't immobilize the finger. Unless there is a lot of pain, open and close your hand often VERY light massage at the site of the injury. Concentrate on other aspects of your life. Week 4-8 Warm the hands by use of a bath or an electric blanket, then squeeze the yellow (softest) putty. Don't push it, if there's pain…stop. Repeat a few times per day. Go to Grade II Treatment.

• Grade II: (Week 1-2) No climbing Warm the hands by use of a bath or an electric blanket, then squeeze the red putty. Don't push it, if there's pain…stop. Repeat a few times per day. Lubricate and lightly massage at the site of the injury. (Week 3-6) Tape the injured finger, stretch your forearms (this relieves the stress on the finger tendons) and climb the biggest holds you can find. Start easy, this will be the quickest way to recovery. If you climb too hard, too fast, then return to the start of Grade 2 and do not collect $200. Always stretch your forearms after warming up and prior to climbing. Start squeezing the medium to firm putty. Lubricate and massage the finger at the site of the injury a couple of times/day. Start lightly and gradually increase the intensity using very short strokes on the injured site. Go to Grade I Treatment

• Grade I (Week 1) Tape the injured finger and continue to climb at a level well below your normal level. Gradually increase the stresses on the fingers. Stretch your forearms after warming up and prior to climbing. This relieves the stress on the finger tendons. Squeeze the medium to firm putty a few times per day. Lubricate and massage the finger at the site of the injury. Start light and gradually increase intensity. Very short strokes on the injured site. Expected outcome Take advice from a practitioner who specializes in climbing. However, if treated early and effectively, with an appropriately graded return to activity, recovery will usually take 3-8 weeks. However, if the injury is pushed beyond its stage of recovery, re-injury will occur and may result in a chronic injury that will require a much more protracted rehabilitation period.

• Post Treatment Reinjury Prevention - After Warm up thoroughly and stretch, paying particular attention to the elbow, wrist, and forearm. Do easier routes and larger holds early in your climbing session. Avoid over training (depending on how hard you are climbing, you may only want to climb every other day). Take adequate rest and recovery periods (particularly if feeling ' under the weather'). Regularly massage the forearms. Continue to tape the finger until there is no pain involved in climbing.

Collateral ligament injury

• Treatment involves rest (of course) and buddy taping the involved finger to the finger next to it (on the side of the injured ligament, if only on one side). Also icing (or contrast baths), and range-of-motion exercises are beneficial. Again, 4-6 weeks is the common timeframe for healing. If the finger seems to have a lot of movement from side-to-side or is just not healing, you may have had a full ligament rupture and should seek medical attention.


SUMMARY:

Finger injuries are probably the most common of the upper limb injuries that are sustained in climbing. The large stresses transmitted through the pulleys makes them more vulnerable. They can be traumatic or overuse in nature. Effective management is important for both climbing and everyday activities.

-End-


译文：

手指和韧带

攀岩过量或难度过大，都会导致手指屈肌韧带拉伤（多为无名指和中指）。程度从一级（一般性拉伤）到三级（完全断裂）。通常来讲，三级伤需要完成三个治疗周期，依次是三级护理、二级护理和一级护理。但分级护理只起到指导作用，一切还要依靠自己的判断。如果攀爬导致疼痛，那就别爬。百分之百康复的关键就是避免疼痛（轻微痛可以接受）。攀岩也会导致另外一些伤情（旁系韧带拉伤，屈肌腱拉伤，肌腱炎及肌腱断裂），如果你的伤情不属于下列描述范围或以下治疗对你不起作用，可以阅读这些文章：

• 竞技攀登中的骨科问题：http://www.wemjournal.org/wmsonline/...e=02&page=0100
• 攀岩的手部损伤：实现正确的治疗：http://www.physsportsmed.com/issues/...may/jebson.htm
• 和/或咨询获得手部治疗认证的外科医生或理疗医师

请注意：
持续发生在12~16岁的青少年身上的手指伤应由一名医师通过X光进行检查。手伤极易导致这些骨骼尚未成熟的年轻运动员在成年之后出现类风湿关节炎。（资料来源：http://www.athleticadvisor.com/）

诊断

韧带受伤

• 三级伤 – 韧带完全断裂，肌腱呈弓弦状。症状：韧带疼痛（通常是刺痛），可以感觉/听到咔吧声，肿胀，或伴有青紫，挤压或攀爬时疼痛，伸拉手指时疼痛，握拳时疼痛。
• 二级伤 – 屈肌腱部分断裂，韧带局部疼痛，挤压或攀爬时疼痛，可能在伸拉手指时疼痛。
• 一级伤 – 手指韧带拉伤（旁系韧带），局部疼痛，挤压或攀爬时疼痛。

指关节受伤

• 应力性骨折（*） – 如果你的第二指节疼痛且肿胀多时，有可能是应力性骨折。它常发生在年轻攀岩者当中，而且很麻烦。我敦促你尽快就医，尽管应力性骨折很难透过X光确诊。如果确实是应力性骨折，那么至少需要休息一个月（也可长达三个月），那些crimp就别想了。你可以攀爬不伤手指的大点，如果还是疼，就应该重新设置康复计划。康复以减少攀登带给伤指的触压、水肿和疼痛为准。如果疼，就别做。
• 旁系韧带拉伤 – 这种疼痛会出现在中间指节的单侧或两侧。


治疗

常规处理注意事项

• 买一些康复用品（TheraPutty：http://www.rehaboutlet.com/therapy_p...��助康复。

• 手指通常都会血流不畅，所以让受伤的部位获得足够的血液变得很重要。文献中对冷热浴疗法褒贬不一，但试试无妨。要完成一整套冷热浴疗法，需要准备一碗温水和一碗冷水。将受伤的手指先浸入冷水数分钟，拿出后直接放入温水碗几分钟。交替3~5次，最后在冷水中结束。此前可以用TheraPutty彩泥让受伤指节稍作“热身”。对受伤部位进行按摩也可达到同样效果。最初轻柔一些，而后逐渐加大按揉力度。

韧带伤

• 三级训练：立即从岩壁下撤，马上用冰或凉物降温，一次不要超过15分钟（1~2天），吃1~2天的止痛药，第1~2周，不要攀岩！不必固定手指；反复练习展开、握拳，并且非常轻柔的按摩受伤部位，除非疼痛难忍。分散注意力去关注其他的事情。第4~8周，用热水或电热毯加热双手，然后揉捏黄色的（最软的）Putty彩泥。如果疼就不要用力，立刻停止。每天重复练习，而后进入二级训练。

• 二级训练：第1~2周，不要攀岩。用电热毯/热水加热双手，并使用红色Putty彩泥。如果出现疼痛，不要继续……立即停止。每天重复数次。使用润滑剂轻柔的按摩受伤部位。第3~6周，胶带固定受伤的手指，伸展前臂（这个动作可以减轻手指肌腱上的压力）用你能看到的最大的点进行攀爬。从简单开始，这才是彻底恢复的最快途径。如果你攀爬的难度太大、太快，就回到二级训练的起点。要始终先热身，然后伸直手臂进行攀爬。使用从中到硬的Putty彩泥进行训练。每天两次，涂抹润滑油按摩手指受伤的部分。短而轻的敲击手指受伤部位，并逐步增加力度。进入一级训练。

• 一级训练：第1周，将伤指用胶带进行保护后，攀爬的强度应稍低于你正常的攀爬水平。逐步增加使用手指的力度。热身后伸展前臂准备攀爬，这个动作可以减轻手指肌腱上的压力。每天使用中等硬度的Putty彩泥练习数次。涂抹润滑油并对伤处进行按摩。短促敲击受伤部位并逐步增加强度。期待获得好的结果，多听取攀岩前辈们的建议。不管怎样，尽早、尽可能有效的进行恰当的恢复性训练，通常3~8周即可康复。但如果康复训练强度超越伤情，就会反复受伤并导致需要花费更长治疗周期的慢性损伤。

• 预防反复受伤的后期治疗：热身和彻底伸展，特别是手肘、腕和小臂。攀岩时先从简单线路和大点开始。避免过量训练（取决于你当前的攀登强度，你可能只想隔天攀一次岩）。要充分休息，耐心度过康复期。经常的按摩小臂。坚持用绷带环绕固定手指，直至攀登时不再有痛感。

旁系韧带拉伤

• 治疗包括休息（这是当然），用绷带将受伤手指与一侧的另一只手指固定在一起（哪一侧肌腱拉伤就固定哪边手指）。同时冰敷或进行冷热浴疗法，指关节运动锻炼是非常有益。同样的，第4~6周是通常认为的愈合期，如果手指伤情从一侧转移到另一侧或完全没有愈合，你的肌腱可能就是完全撕裂了，应该寻求专业的医疗帮助。


总结

手指伤恐怕是最常见的攀登引起的上肢伤害。韧带承载巨大的力量使它们极易受到伤害。有效的保护无论对攀岩还是日常活动都很重要。

-结束-

* 何谓应力性骨折？
应力性骨折又叫疲劳性骨折，是一种过度使用造成的骨骼损伤，当肌肉过度使用疲劳后，不能及时吸收反复碰撞所产生的震动，将应力传导至骨骼，可引起小的骨裂或骨折。应力性骨折的症状会在病症开始的二到三周内逐渐地显现出来。与其它因过度使用所造成的慢性伤害症状不同，应力性骨折的症状多停留在同一部位且疼痛较明显。患者长时间或剧烈运动后通常出现前足疼痛，休息数秒钟后可消失，在随后的训练中，疼痛的发生越来越早，越来越重，以致不能进行运动，触及肿胀部位可引起疼痛，甚至躺在床上都会有疼痛感。

本人E文水平有限。不尽之处，请翻译高手不吝赐教，批评指正。

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