Consultation with a hand therapist or surgeon is appropriate for such a patient. As the climber ascends rapidly past a pocket in the rock in which his or her fingers are placed, a finger can become trapped and bent, stretching the ligament awkwardly. Examination of patients who have ligament injuries reveals mild to moderate PIP joint swelling, tenderness, and pain with motion. To assess the integrity of the collateral ligaments, palpate them gently and then stress the ligaments with the joint first flexed and then extended. The joint may need to be anaesthetized.
Complete rupture is suggested when the joint can be widely deviated during stress testing.
Persistent pain and swelling are common and may take months to resolve, but patients are still able to climb. Patients who have partial collateral ligament tears should be treated with the same protocol. The management of complete tears of the PIP collateral ligament is controversial, and there are proponents for both surgical and nonsurgical treatment methods. Management of complete tears of the thumb MCP collateral ligaments is controversial and confusing, with many different recommendations. If such an injury is suspected or detected, the patient should be referred appropriately.