Finger Pain That Isn't a Pulley: Tenosynovitis, Capsulitis, Bone Spurs, Lumbricals and Collateral Ligaments

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The previous post, Finger Pulley Injuries, covered what to do after a pop. Plenty of finger pain comes without a pop: a knuckle that is puffy every morning, one finger that stings on every small crimp, or a deep ache in the palm since that one-finger pocket.

These are not necessarily pulleys. Volker and Isabelle Schöffl's 2007 review says climbers' finger pain has more than 20 possible diagnoses, and after history, examination and X-ray, ultrasound is the most helpful tool.

This post covers the five most common, plus ganglion cysts. The aim is to know what is possible and when to see a doctor, not to diagnose yourself. The "typical presentations" below come from studies or physiotherapists, and one finger can have two problems at once.

Start with where it hurts

Climbing.com's finger injury guide notes that stiffness, swelling and tenderness of the knuckle joints themselves are usually not a pulley injury. They can come from a capsular strain, arthritis, a collateral ligament, an extensor hood problem or something else.

The table puts the usual locations of this post's five problems side by side, to help you describe your symptoms to a doctor:

Something you can do tonight: If a finger hurts now, write three lines using the table's columns: which finger, which segment, and which movement hurts most. Show them to your doctor.

1. Flexor tenosynovitis: same place as the pulleys

Physiotherapist Jason Hooper, in Hooper's Beta's tenosynovitis article, explains that tenosynovitis is inflammation of the sheath around the tendon, caused by friction between the sheath and the pulleys under heavy load. Half and full crimps create much more friction than open-hand grips, so frequent crimping and hard campusing on small rungs are typical causes.

It sits almost exactly where pulley injuries sit. Hooper's distinguishing signs are that tenosynovitis often hurts when the finger is passively straightened, and also when pulling open-handed. Pulley injuries usually do not (evidence level: expert opinion; ultrasound settles it).

Research on treatment points two ways:

• In Zurich, Mohn and colleagues 2022 reviewed 65 climbers treated almost entirely conservatively, most often by reducing climbing load. All returned to climbing, but symptoms lasted a mean of 30.5 weeks. The authors suggest a favourable natural course and say randomised trials are needed to confirm it.
• In Bamberg, Schöffl and colleagues 2019 gave 42 climbers with tenosynovitis lasting over 6 weeks two corticosteroid injections within 7–10 days; 74% were pain-free after the second, with no complications.

Hooper sits in between: reduce whatever triggers it first, without necessarily stopping climbing completely, and consider injections only if conservative care fails for more than six weeks. He also says it is unclear whether H-taping helps tenosynovitis. Whether to inject is between you and your doctor.

Persistent swelling after a minor pulley rupture can also be long-term tenosynovitis from a folded pulley stump; see "flap tear" in the previous post.

Something you can do tonight: Split last week's sessions into two columns, "mostly open hand" and "mostly crimps". If the crimp column is clearly longer and a finger is starting to hurt, rebalance first.

2. Capsulitis: swollen in the morning, better after climbing

Schöffl and colleagues' 2025 study followed 50 climbers with 69 joints affected by capsulitis. The most common site was the proximal interphalangeal joint of the middle finger (the PIP, the first knuckle of the finger); overall, more than 80% were PIP joints. Most patients described morning stiffness and swelling, reduced range of motion and pain, which often improves after activity.

That "it stops hurting once I'm climbing" pattern makes it easy to ignore. The study's definition was swelling, pain and tenderness with effusion for more than 6 weeks, after excluding pulley and collateral ligament injuries, so diagnosis still needs an exam and ultrasound.

The outcome was good: with their staged treatment, everyone returned to climbing within 12 months, and most kept their grade. But this was one clinic, with no control group, and treatment included injections and other invasive steps. It cannot be read as "it will go away on its own".

For prevention, the authors suggest letting fingers adapt to load gradually, for example not hanging from the smallest campus rungs too early (evidence level: expert opinion).

Something you can do tonight: Tomorrow morning, make a fist and open it, and compare the same finger on both hands. If one knuckle is clearly puffier and tighter, and has been for weeks, get it checked.

3. Bone spurs and joint changes after years of climbing: common, not always painful

"Climb long enough and your fingers will degenerate." The research answer: bone spurs are very common, osteoarthritis depends on the population, and pain does not necessarily follow.

• High-level climbers almost all have spurs. Allenspach and colleagues 2011 compared 31 high-level Swiss male climbers with 67 non-climbers. They concluded that "development of osteophytes seems to be ordinary in every climber", and more climbers had clear signs of osteoarthritis.
• Recreational climbers, not necessarily. Sylvester and colleagues 2006 compared 27 recreational climbers with non-climbers and found no higher osteoarthritis risk; climbers' finger bones were actually thicker.
• Hard training when young may matter. Schöffl and colleagues 2018 followed the German junior national team for 11 years; about a quarter showed mild osteoarthritis, linked to total training years, campus board training at the time, and climbing grade. The authors conclude intensive finger training can lead to early-onset osteoarthritis.
• Spurs are not the same as pain. Pastor and colleagues 2022 followed 31 elite climbers for 10 years: spurs increased, but radiological signs of osteoarthritis were not associated with pain in the previous six months. Schmid and colleagues 2026, in the same group, found no correlation between spur growth and joint space narrowing.

Spurs can still cause symptoms. Schöffl 2010 described 13 high-level climbers whose dorsal spurs irritated the extensor tendon, causing effusion and pain. All got back to their previous grade after treatment, but the authors expect the condition to progress.

Something you can do tonight: If you coach young climbers, check whether their plan includes campus boarding. If it does, read Young Climbers and Finger Growth Plates first.

4. Lumbrical tears: deep palm pain after a one-finger pocket

Schweizer 2003 described the mechanism: when you hold a one-finger pocket with the ring or little finger, the neighbouring fingers flex hard to help. That pulls apart the origins of the lumbrical between the deep flexor tendons. One-finger pockets are a kind of pocket; how to hold them is in Hold Types and Grips.

Lutter and colleagues 2018 reviewed 60 patients, 57 of them climbers. Their stress test: the patient makes a fist while the examiner passively straightens the ring finger; pain in the palm is a positive test. If the middle finger is straightened at the same time, the pain disappears. They graded tears I to III and treated all conservatively, explicitly not recommending immobilisation for grade I.

Outcome: all patients were pain-free after 12 weeks of conservative care and all returned to climbing. Regaining the pre-injury grade took about 7 weeks on average; grade III took significantly longer, about 10 weeks. The authors warn that an untreated lumbrical tear may become a chronic problem, so timely diagnosis matters.

Hooper's view, in his lumbrical article, is that mild to moderate strains can usually keep climbing lightly, avoiding pockets and strenuous slopers. He also suggests buddy-taping the neighbouring fingers together (evidence level: expert opinion).

Something you can do tonight: Count how many problems last month had a one-finger pocket as the crux. If there were several and you are not systematically training pockets, pick other problems.

5. Collateral ligaments: sidepulls, gastons and wide moves

You may have read that "collateral ligament injuries are 40.5% of climbing injuries, the most common one". The figure comes from Rohrbough and colleagues in 2000: of 42 elite competitors at the US national championships, 17 had injured a PIP collateral ligament. It describes a small group of elite climbers, not climbers in general. Vagy and colleagues' 2026 scoping review of 45 studies found pulley injuries frequent in both sport climbing and bouldering.

Clinical research on climbers' collateral ligaments is thin. What follows is mostly Hooper's collateral ligament article, which he labels as mostly expert opinion:

• Mechanisms: sidepulls, especially when you are below the hold or move dynamically to a distant hold while still on it; gastons far overhead or out to the side; and wide moves that bend the wrist sideways.
• Presentation: tenderness on one side of the joint, possibly swelling; pain when the joint is pushed sideways.
• Versus capsulitis: capsulitis does not wobble when pushed sideways, swells more and more chronically, and often swells on both sides.
• Referral: if the joint is unstable when pushed sideways, see a skilled professional; a dislocation should be assessed by a specialist.

Something you can do tonight: Think back to what you were doing before the last time a finger hurt on one side. If it was a sidepull or gaston, next time adjust your body so the finger pulls in line with the hold.

6. Ganglion cysts: just know they exist

Small cysts in climbers' fingers or wrists are barely studied. Schöffl's 2007 review calls flexor tendon ganglions "rather unknown"; Klauser and colleagues 1999 scanned 34 extreme climbers and found clinically unsuspected synovial cysts only in the climbers.

No study tells us how common they are in climbers or how to manage them. If you feel a lump that hurts or affects your grip, see a hand surgeon.

Something you can do tonight: If you have no symptoms, there is nothing to look for. If you do, note the size and whether it hurts, and mention it to your doctor.

When to see a doctor

The referral points from above, in one list:

• Under 18, any finger pain: treat it as a growth-plate injury first; see Young Climbers and Finger Growth Plates.
• A joint that wobbles when pushed sideways, or any dislocation.
• Swelling and pain that has not improved for several weeks, or morning stiffness lasting weeks.
• Deep palm pain after a one-finger pocket, with pain when you make a fist and one finger is straightened.
• Obvious deformity or a major loss of movement.

In Taiwan you can book orthopaedics or hand surgery; choosing a department is covered in the series overview.

Something you can do tonight: Screenshot this list and keep it in the same album as the "three steps after the pop" from the previous post.

Practice: four scenarios

Answers are under each question. Think first, then check.

1. The first knuckle of your middle finger has been swollen for a month. It's worst when you wake up and better after climbing, so you keep climbing.

2. Last week you tried a problem with a ring-finger one-finger pocket a dozen times. Now your palm aches deep inside when you make a fist.

3. A friend says: "My finger has hurt for six months. I looked it up: tenosynovitis means injections."

4. You've climbed for 15 years, an X-ray shows spurs on your knuckles, and you're worried you'll have to stop.

Next

Above the fingers are the wrist and elbow. What medial and lateral elbow pain and ulnar-side wrist pain are, and how to adjust training, is in Elbow and Wrist Pain in Climbers.

References

• Schöffl VR, Schöffl I. Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness 2007
• Mohn S et al. Nonoperative treatment of finger flexor tenosynovitis in sport climbers. Biology (Basel) 2022
• Schöffl V et al. Efficacy of corticosteroid injection in rock climber's tenosynovitis. Hand Surg Rehabil 2019
• Schöffl VR et al. Efficacy of a new treatment algorithm for capsulitis of the fingers in rock climbers. Front Sports Act Living 2025
• Vagy J. Clinical management of finger joint capsulitis/synovitis in a rock climber. Front Sports Act Living 2023
• Allenspach P et al. Radiological changes and signs of osteoarthritis in the fingers of male performance sport climbers. J Sports Med Phys Fitness 2011
• Sylvester AD et al. Factors influencing osteological changes in the hands and fingers of rock climbers. J Anat 2006
• Schöffl VR et al. Long-term radiographic adaptations to stress of high-level and recreational rock climbing in former adolescent athletes. Orthop J Sports Med 2018
• Pastor T et al. Long-term evolution of cartilage abnormalities and osteophytes in the fingers of elite sport climbers. Eur J Sport Sci 2022
• Schmid P et al. Osteophyte growth over 10 years in the fingers of high-level climbers. Eur J Sport Sci 2026
• Schöffl V et al. Extensor hood syndrome: osteophytic irritation of digital extensor tendons in rock climbers. Wilderness Environ Med 2010
• Schweizer A. Lumbrical tears in rock climbers. J Hand Surg Br 2003
• Lutter C et al. Lumbrical muscle tear: clinical presentation, imaging findings and outcome. J Hand Surg Eur 2018 (FAU open-access copy)
• Rohrbough JT et al. Overuse injuries in the elite rock climber. Med Sci Sports Exerc 2000
• Vagy J et al. Musculoskeletal injuries in rock climbing: a scoping review. BMJ Open Sport Exerc Med 2026
• Klauser A et al. Finger injuries in extreme rock climbers: assessment of high-resolution ultrasonography. Am J Sports Med 1999
• This Common Finger Pain is NOT a Pulley Injury (Jason Hooper, Hooper's Beta)
• How to Heal From a Lumbrical Injury: 5 Simple Stages (Hooper's Beta)
• Collateral Ligament Injury from Rock Climbing (Causes & Fix) (Hooper's Beta)
• Your Complete Guide To Finger Injuries (And How To Recover!) (Climbing.com, 2025)