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Thread: Impact injury to hand

  1. #1
    Join Date
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    Default Impact injury to hand

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    M, 50 years old, training for 6.5 years.
    5'8", 240 lbs
    SQ 442
    Pr 231
    BP 340
    DL 431
    TRT through Wittmer for about 4 months so far

    I'm stupid. My garage gym does not have the ceiling or equipment for a chin bar, and I had sunk eyebolts into the joists to do pulldowns with exercise bands. This was going rather well, until one popped clean through without warning or previous sign of wear. I had foolishly made handles for the bands with a large carabiner, which whipped around and caught me on the back of my left hand rather spectacularly:

    W, 21 Jan 2022 - impact injury occurred
    Focal swelling appeared immediately, between 3rd and 4th knuckle of left hand.
    Iced right away, took 800 mg ibuprofen. Checked motion and function - was able to clench the hand, though it was somewhat painful.
    Within an hour or so, was able to both press and curl the bar.
    Over the next two days, focal swelling subsided, general swelling persisted, but began to resolve slowly. Continued taking ibuprofen.

    F, 23 Jan 2022 - trained as scheduled:
    Pressed 205 x 3 x 3, 205 x 4, 205 x 2 (x3 and x4 were PRs)

    M, 26 Jan 2022
    Benched 320 x 4, 320 x 3 x 2 (also PRs)

    R, 29 Jan 2022
    Squatted 285 x 5 x 3 (vol), pulled 405 x 5 (PR)

    Etc.

    None of these workouts aggravated the hand, which continued to appear to recover steadily. During the three weeks following the injury, I shoveled large amounts of heavy, wet snow multiple times, trained normally 3x/wk, (setting weekly PRs on press and bench, squatting 360 x 5 x 3), loaded and unloaded a two-stage snow blower from a neighbor's pickup, wrestled and played with my sons, etc. No issues.

    Until…

    F, 13 Jan 2023
    Mid/late day, seemingly out of nowhere, the hand started swelling, and it became harder to flex the fingers, particularly the ring finger and, to a lesser extent the middle one. Alternating 800 mg ibuprofen and 1000 mg acetaminophen every 8 hours each at 4 hour offset for pain. Pain was somewhat disruptive to sleep.

    By Saturday, swelling was quite pronounced, and finger flexion very compromised. Went to ER - X-rays came back with no evidence of fracture or bone displacement, good joint spacing, evidence of soft tissue swelling. Blood work showed no elevation of WBC count. However, their best guess from the nature of the swelling was an infection, so they administered IV broad-spectrum antibiotic, gave me a stylish compression glove, and issued a prescription for a seven-day course of antibiotics, with instructions to contact my PCP and come back if evidence of infection worsens.

    By next morning, things seem about the same. This recent development has my hand flexion compromised worse than at any point. I could hang from and grasp a barbell before. Now I cannot close especially the ring finger enough to make a fist. I continue to check capillary return in the fingers of the hand, (I remember the M*A*S*H episode about compartment syndrome) - no issues so far there.

    I'm alarmed that things were fine for over three weeks, and now... whatever this is has arisen. I don't know enough to know whether an infection that isn't raising WBC count will benefit from antibiotics - is it in an area not well supplied by blood? Does that even make sense?

    What could be going on structurally? Over three weeks of uninterrupted, productive training would seem to rule out something significant from the initial impact, right?

    Any thoughts from the board? I need to be able to train, and I need to bed able to type...

    Thank you!

  2. #2
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    They have you on the wrong antibiotic. Ask somebody else about this. And do not take any Cipro. Ever.

  3. #3
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    Quote Originally Posted by Mark Rippetoe View Post
    They have you on the wrong antibiotic. Ask somebody else about this. And do not take any Cipro. Ever.
    Makes sense - thank you. Likewise for the reminder about Cipro. To be safe, is the tendon concern the same for all antibiotics in the quinolone family?

    By way of update, I have now become aware that zinc supplements taken within 3 hours of Cephalexin can significantly reduce availability, which would have been good to know. While arranging a follow-up, I've adjusted accordingly.

    Any thoughts on range of motion while seeking further care? If I slowly and carefully power through on finger flexion, I can increase ROM over several reps, with some relief of overall stiffness, though it comes back after a while. Am I risking anything here?

  4. #4
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    Quote Originally Posted by Jason Donaldson View Post
    Makes sense - thank you. Likewise for the reminder about Cipro. To be safe, is the tendon concern the same for all antibiotics in the quinolone family?
    Yes, all of them do.

    Any thoughts on range of motion while seeking further care? If I slowly and carefully power through on finger flexion, I can increase ROM over several reps, with some relief of overall stiffness, though it comes back after a while. Am I risking anything here?
    When they get you on the right antibiotic, the relief will be very quick. Just wait on this.

  5. #5
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    Quote Originally Posted by Mark Rippetoe View Post
    Yes, all of them do.


    When they get you on the right antibiotic, the relief will be very quick. Just wait on this.
    Very good - thank you, sir.

  6. #6
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    I saw my PCP, today. His diagnosis is tenosynovitis, which is admittedly a descriptive term (like cellulitis), not a etiology. The cause could be infection, but he's not convinced from examining it - he's thinking it may be related to something from the original injury, exacerbated by overuse. Since infection needs to be ruled out, and should be a fast fix (like you said, Rip), we've added doxycycline on top of completing the course of cefalexin. If there's no relief by Friday morning, he'll order an MRI. Follow-up appointment with him is for next week. In the meantime it's, rest, elevation, and NSAIDs.

    I absolutely do NOT want to end up sedentary for any length of time if this drags on. If the hand remains unusable in the gym for any length of time, when is an appropriate time to look at commercial gym "leg day" machines and perhaps unilateral dumbbell presses or such while getting back to being able to train properly? I ask for reasons of health both physical and mental.

  7. #7
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    What is the proposed mechanism here for how you got an infection in your hand?
    Did the impact cause a puncture wound?

  8. #8
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    Quote Originally Posted by Yngvi View Post
    What is the proposed mechanism here for how you got an infection in your hand?
    Did the impact cause a puncture wound?
    Sometimes you just don't know.

  9. #9
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    Quote Originally Posted by Yngvi View Post
    What is the proposed mechanism here for how you got an infection in your hand?
    Did the impact cause a puncture wound?
    Good question, Yngvi. Negative - no breach to the skin at time of impact or since.

    An acquaintance told me this week about a friend who sustained a non-penetrative injury to the knee, then developed an infection there 3 days later - days for that vs weeks for this, but... It doesn't seem like a stretch to imagine a situation where microbes under control in one part of the body could be introduced via damage into another area and there gain a foothold (pseudopodhold?)..but that's merely speculative. See Rip's point, I guess.

  10. #10
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    Today's update: day 6 of one antibiotic, day 4 of the other, no relief. I've contacted my doc for the MRI order.

    Naproxen and elevation continue to help with pain, but the swelling is still there, especially approaching time to re-dose, and ROM is still jacked up. I've been wrapping the hand and ring finger with a boxing wrap most of the time for protection and rest, and to remind myself not to use it so much. (Snow still needs to be shoveled, but this week's was pretty light. Typing sucks, though I'm adapting to not using all ten fingers.)

    This is one week since it flared up - any reason to wait further before working out an option for something, e.g. on leg machines? Or just focus on walking for activity? Both?

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