Rock Climbing Finger Tenosynovitis

The following is a blog post from 2020 that I wrote and shared while involved in a rock climbing rehab group with Dr. Jared Vagy. I continue to have people reach out to me about their own cases, so I thought it would be worthwhile to share on our own site.

-Aaron Simon, PT, DPT


In preparation for your anticipated climbing trip to Red Rocks, you double the volume and increase the intensity of your training regimen. During your second week of your new regimen, you notice that your fingers are unusually sore. Thinking of this as a good sign of getting stronger, you go to bed motivated to continue your training. The next day, your fingers are still sore, but you decide to train through it. The soreness worsens as the week progresses, and you worry you may have injured your fingers by overtraining. Your trip is just a few weeks away and all the plans are already set in motion. What should you do?

Image courtesy of "Climb Injury Free"

Signs and Symptoms

Pain typically comes on within minutes or hours after a climbing session, or acutely while climbing. While flexor tendon tenosynovitis can have a rapid onset from a single hard day or training session, it is most common with an increase in training volume, or from consistent overuse.

Tenosynovitis, or inflammation of the finger flexor tendon sheath (synovium), is a common overuse syndrome that climbers may experience. There are 2 musculotendinous units that could be involved, the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP). They extend well beyond the fingers that they move, originating around the medial aspect of your elbow and forearm, and inserting into the middle and distal phalanges of the fingers. While these muscles work together to flex your fingers at their individual joints, the stresses required of them vary, especially with different holds and grip techniques.(8) In general, the FDS is going to be most stressed in a full crimp position, and the FDP more involved when the fingers are bent at the last joint (think open hand crimps on small edges or large positive holds you can wrap your fingers around. As climbing technique affects how your load is distributed to these muscles, you may be able to differentiate how they are involved based on the types of holds that bring on your symptoms.

Below are some common signs and symptoms: