regression...

Its 7 weeks today. Just got back from a week trip to Chatt that was unfortunately sendless. The first few days my hand felt okay, but progressively got more and more sore from days on days.. Not happy about it. The 5th day of the trip I was in too much pain and had to stop climbing. Granted, the easiest thing I got on was a v7, i'm not exactly being patient. All the ligaments that are still connected are under alot of extra strain.. They better just deal with it and catch up because I don't have time for this shit! However, after only a few days rest I can feel the strength returning, and I know it will be better soon. Thats the worst part about these kind of injuries; they get worse before they get better. Its hard to see the light at the end of the tunnel when you can't tell if you're getting closer or further away. I'm taking another trip down south this weekend, should be more fruitful.

Starting to feel better

It is 5 weeks from the surgery. For the last week or so I was still in quite alot of pain when I would try any pulling with the ring or pinky finger. It feels like all the ligaments that are still attached to the hamate bone are being put under extra strain from having less support. Numbness is still there, but has been gradually getting better. Also I think the hamate bone is still bruised... BUT! Just over the last two days pain has gone down alot, I was able to climb a few things up to v6 yesterday with the least amount of paint i've had yet. I even used the hand as a mantle for an easy topout, but I can tell it will be at least another month before I can start doing push-ups again. On the hangboard, I'm able to hang 2 hands on the small crimps (its a metolious simulator) and I can almost hang 1 arm on the bad hand. I guess things are looking pretty good! Still, I would recommend the reattachment of the hook instead of excision 100%. I can feel now what is still attached in there, and it will eventually get better.. But eventually is an annoying word.

I'm gearing up for a trip to Chattanooga Tennessee in a few days, and trying to think of hard climbs that I can eek out with my unbalanced power situation... maybe King James?  not sure if I can do the pinch on Golden Harvest.. I know I can do Kneed It. Anything that isn't too overhanging should be alright. Mostly i'm going to get drunk and make my friends get on hard climbs. Should be fun!

October 2012 - Rehab

Not sure if I'm the type of person that can stay disciplined to a gradual rehab program. Stitches came out on day 13, a new V5 was sent on day 14. Also another dozen climbs v2 and under were done. The index and middle fingers were still very strong. A little drop in power in the thumb. Power was still there in the ring finger, but too much pain to pull on it. Pinky finger was at about 30% , with numbness still lingering from surgery that went from the incision all the way up the palm to the tip of the pinky. They said this will go away with time. Also a good bit of pain is coming from the ligaments of the hamate bone that are still attached. It was the steepness of the climb, not the size of the holds, that would cause the most pain.

Now for the actual rehab, since I know most of you aren't as foolish (I mean bad ass) as me. The doctors said I wouldn't need any.. They are wrong. Maybe those pussy ass baseball players didn't need any, that's probably because their grip strength isn't anywhere near ours.

This is the best way to rehab any hand related injury, because you can go as light or as hard as needed. I first warm up the hand with a heating pad for about 15 minutes before any rehab activity. Then I'll stretch it out, trying to get back to 100% range of motion. I do the majority of the rice work out, going pretty lightly with my right hand. The hard part is making the fist and rotating the wrists in the rice - I can tell that there is instability in the wrist.

I also have a full set of Theraputty, its a progressive resistance putty that is cheap and works great. I'm still on the extra soft, but its feeling good. I mash it up in my hand, paying extra attention to the pinky and ring fingers. Pushing it against the incision at first is painful, but then feels good.

Another tool i just got is a "Theraband PowerWeb Junior" (pictured below). It will help specifically to rebuild my pinky strength and range of motion. My goal is to break the record for grip strength at the doctors office when I see him again in 3 weeks.. Shouldn't be too hard ;)

There is no real set routine that I follow when I do any physical therapy. I think the best way to go at it is, "if it doesn't hurt, its not hurting it." Just go as much as pain allows. Be aware of what your body is telling you. The worst thing you can do is a set routine that might be too much for you to take, or even worse too little to build back the strength you want. My theory is, the sooner you can tell those new cells what they are there for, the stronger and faster you can come back to your sport with full force.

Today is day 21. I have full range of motion. The feeling in my palm and pinky is slowly starting to come back, and is actually accompanied by some false pain in the joints of my pinky that is pretty annoying. Two days ago I climbed two v5s and a few other warm ups, feeling fairly good. Still alot of pain on steep terrain from the remaining ligaments. I'll continue to update this blog from week to week for a while until i'm back to full POWER!!! Muahhaha

October 2nd, 2012 - Surgery

The big day. I was lucky enough to find a surgeon who I absolutely loved. He has performed the surgery on several professional baseball players, and does about six of them every year. So the deal is they cut open the palm, move the ulnar nerve, cut away everything attached to the hook, take it out, grind down any sharp edges on the hamate bone itself, sew together a few ligaments, and then the palm.

This is an actual pic of me, 9 days after surgery. They told me to keep the brace on for 10-14 days, but hey I'm a rebel. Its a nice scar actually, it will blend right in with the creases of my palm once its healed.. not that I really care what it looks like. I was able to get I would say about 90 % range of motion right away, but it was definitely soar. From some light testing of the ring and pinky finger, things were looking pretty grim. Alot of pain, way more then before the surgery, but this is to be expected.

September 15th-ish, 2012 - Diagnosis

Here I am again out climbing because that is all I ever do... No wonder I can't heal, I haven't had any significant rest since day 1, five years ago! This time its a V7 with the crux being powerful mantle off a right jack-hand. I really shit the bed on this one... It hurt. alot. But because i'm a finisher, I tried a few too many times and got it done. In retrospect, this was a bad idea. However, this was when it hurt enough to finally get it checked out. I stopped climbing (for real this time) for a few weeks and it didn't get better, so I got an MRI.

This is not my actual MRI, because I am too lazy to photoshop in any fancy arrows like this one has.. but you get the idea. From this angle you can really see how much that hook helps protect the carpal tunnel. I was worried at this point. 

Oh, also I am a testicular cancer survivor as of about 2 years ago... This hamate hook fracture, in my mind, was WAY more serious. Rock climbing is my life. You don't see Daniel Woods or Chris Sharma out there missing any hamate hooks... How will this effect my climbing and progression? Losing a nut is actually not big deal. I was climbing full strength 6 days after that surgery. Losing a link in the chain of the rock climbing machine? That scares me.

So now what do I do? 

Heres the 3 options:

1. Do nothing. - as climber you can not just do nothing. The hamate hook is floating around in there, and its rough edges are rubbing directly on your ring and pinky finger tendons. It will continue to do so until they rupture, which has happened to people who don't do anything athletic.

2. Screw it back on. - Duh! That is the obvious solution for just about every other small bone fracture in the history of orthopedics! Sorry climbers, not this time. If you want it screwed on, you'll have to goto Switzerland and be someone's guenea pig. Over there all they have to do is drill in from the back side of your hamate bone into the hook, cinch it down, and three weeks later you'll be full strength ready to go! In the US they won't do it because it is too dangerous to risk missing the hook and damaging the ulnar nerve that sits too close. That means your pinky and ring fingers would be paralyzed. I have read about some places in the US going in through the palm instead, and screwing it on with headless screws. This way they can move the ulnar nerve, and also have nothing protruding from the hook. Good luck finding a surgeon close by who will do this one, but in my opinion it would be the best solution. Problem with this - after being fractured for so long, the hamate hook will loose blood supply, it is not always possible to reattach. Most likely, in my case, It would not have reattached.

3. Take it out. - Sounds pretty barbaric, yeah? If something is broken, rip it out. Since this is basically the only option, I had to accept it. 

Summer 2012

In the summer its difficult to climb very hard anyway, so rest was on my mind. Now, that doesn't mean that I actually got any!, but I tried my best to go pretty easy. The pain in the hamate region of my right hand would get better and then worse from week to week, which lead my to believe again that it was just some ligament damage. I've had plenty of other minor ligament problems that I was able to climb through, and this felt similar. I was able to climb a V9 that I am super proud of in early summer. I've done other v9s, but I beleive this was my hardest climb to date. My hand did bother me quite a bit on this climb, as it was crimpy and powerful, but it started to get better again right away.

Finally it got to a point where I was comfortable to start training hard for the fall season. I was on a good schedule for almost a month. Yea I had some pain still, but I really felt that it was ready to build back some strength. The pain felt like good pain for a while.

Spring 2012

I'm feeling pretty strong, the insignificant tweaky fall from February isn't even on my radar. Im on the starting holds of a dead horizontal v7. The right hand is fully twisted in a gaston and pushing away from my body. I hear a pop and some sharp pain in the hamate region. I went on to finish the climb, but this time the pain did not go away so quickly. My first thought was that I must have sprained some minor ligaments. I figured it would go away with some rest and light climbing.

My advice from here - If you feel ANY pain that lasts more then a day in the Hamate region, go get an x-ray. Again, the sooner the better with this thing.

February 28th, 2012

When on a short weekend climbing trip to a new boulder field, I had a tweaky fall. On a right leaning, 20 degree overhanging v4 arete, I reach the "apex" with my right hand. It was a "ham hock" grip, think grabbing the top of a large triangle with your fingers facing away from you and all of your weight on, you guessed it, the Hamate region. The arete came to a sharp point, but was also very slopey, so I had a left heel on to keep me nice and tight on that right hand. My heel slipped. I tried to hold the swing with just my right hand, but as my body swung right and my right hand stayed in that ham hock position - ouch.. I let go. I quickly did the climb second try. At the time I didn't notice much lingering pain. It was the beginning of my day and I went on to send half a dozen harder things.

It actually took me a while to pinpoint this as the start of my injury, it is to the best of my knowledge when the initial fracture occurred.

My advice from here: If you think you may have broken something in your Hamate region, just go get an x-ray. If you discover the fracture within the first week you have a really good chance of the Hamate Hook reattaching by itself by spending only a few weeks in a cast. You DO NOT want to wait, the longer you wait, the worse your odds get for a proper heal.

What is the Hook of Hamate?

The Hook of the Hamate is a small extension of the hamate bone that helps protect the Carpal Tunnel. It also has quite a few (but mostly insignificant) ligaments attached to it.

They say professional baseball players get this all the time, and that they can return to full grip strength in about 6 weeks..

But what about rock climbers? Well it just so happens I am both a rock climber and a recent victim of a hamate hook fracture! For all intensive purposes I can remain anonymous. I am going to record my experience to let my fellow climbers out there know what to expect if this ever happens to you. Brief personal climbing history - almost 5 years, sport @ 5.13a, boulder @ V9, but suck in the gym. Thats right, we're not asking, "oh how will my hamate hook fracture affect me when I am hiking 3 miles up a snow covered hill???", we're talking about hard technical actual rock climbing. So lets go back to the beginning.