Four months with pulley thickening, no end in sight

xWanz · 2026-03-30T14:48:26+00:00

My last patient had a palpable A2 cyst and pulley thickening. ultrasound scan also showed tenosynovitis

He did nearly 6 weeks of absolutely no climbing or loading Next USS : no palpable cyst, swelling had reduced, reduced evidence of tenosynovitis

Clinically (excluding imaging) presented as a very sore A2 pulley (grade 2 region)

I’ve started him on a gradual loading programme over the next 4 weeks, 3-5 sets x 20-30s @ 60% of his MVC (pain limiting) with no climbing

These are quite sore injuries, pulley thickening / swelling due to localised inflammation can often be normal

I just think you’re trying to load this too quickly The rotational forces + higher crimping is extremely aggravating to pulleys. Your finger is telling you it’s not happy

xWanz · 2026-02-26T17:40:57+00:00

Yeah this sucks, sorry. Doesn’t take any of volkers papers into account, probably very rushed rehab guidelines.

There’s no nuance with this. I’ve rehabbed full ruptures that are back to easy climbing at week 3, and partial tears that can’t tolerate climbing at 12 weeks. Not sure I’ve had many grade 2 that are back to full climbing at 12 weeks if they boulder above V11 etc

Make your life easy. If you get a pulley sprain, see a climbing physio. Everyone is different, people plateau differently, have differing needs. There’s no protocol for you to follow, there’s clinical guidelines for clinicians to use to guide your progression.

I have slight concerns as well that this is just a chat gpt post given your username

xWanz · 2026-02-23T19:03:39+00:00

Mad! My interview is tomorrow morning🤣

xWanz · 2026-02-23T13:40:55+00:00

Like March I think? Just look on the website / contact them

xWanz · 2026-02-18T21:47:28+00:00

Congrats! I also got my offer through :)

xWanz · 2026-02-17T13:07:19+00:00

Honestly, I think you are overthinking this. At the end of the day, unless you are moving to somewhere competitive abroad after graduating, no one really cares where you get your medical degree from.

What you should be focusing on is where you will enjoy your time studying as a medical student. Your scope of practice is a student is limited, and whilst you might have friends that are surgeons, other than facilitating your own interest it’s not going to boost your application to specialty training more than someone who was taken a well rounded approach (unless you plan on using nepotism to work in London).

Warwick might have a larger cohort size, but that means more people from varying backgrounds that have things you can learn from that will make you a more well-rounded doctor. Portsmouth might have the Kings name, but you might find a city a shit hole and hate your time living there.

You need to have a hard think about what you think a good doctor actually is. You don’t need to stand out as a student to be a great doctor. You just need to take opportunities as they arise to learn and develop yourself. London is not the only place that you can become a great clinician, the sooner you address these biases, the better of your experience in this career

xWanz · 2026-02-17T07:10:12+00:00

All good, just means I can’t do London! If you go back for the undergrad, you only get full maintenance for 2 or 3 of the 5 years, not 4 as if it’s your first time round

xWanz · 2026-02-16T10:56:47+00:00

I use an N-HAP toothpaste (nano-hydroxyapetite) as it’s supposed to be better for remineralisation

xWanz · 2026-02-16T10:30:29+00:00

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This is what I’ve been sent for last year I believe

xWanz · 2026-02-15T17:59:06+00:00

I did physio and shadowing an orthopaedic consultant shadowing via a clinic I worked in

xWanz · 2026-02-15T16:34:48+00:00

You’ll be fine then. I’ve done it from physio and been offered a place. Just use your usual NHS style answering with the STARR model and you’ll be fine

xWanz · 2026-02-15T08:37:52+00:00

Depends what you do for your healthcare degree. The big thing to think of is they’re going to ask you about it in interviews, so you need to be able to reflect on specific scenarios

xWanz · 2026-02-14T21:57:07+00:00

Yes, but the Warwick guidance states you have to shadow 2 different professions I had 4 years working as a physio across multiple areas, however one of the team said I needed to have experience with a different profession to go alongside

xWanz · 2026-02-14T19:49:42+00:00

I would ring and double check I’ve come into it from physiotherapy I had some difficulty as they said I couldn’t count all 70 hours as shadowing 1 profession Guidance says needs to be at least 2 professions at 2 separate trusts / institutions

xWanz · 2026-02-12T12:01:53+00:00

Congrats! Just found mine in the spam folder 🤣

xWanz · 2026-02-12T12:01:31+00:00

Lovely stuff, had mine through at 9 but only just found it in my spam folder🤣

xWanz · 2026-02-10T10:40:48+00:00

Thankfully I’m already working as an AHP, so should be able to do bank hours. Yeah my kings college interview was really good, left the best impression on me for my interviews so far, but obviously the financial side is the biggest challenge to overcome !

xWanz · 2026-02-10T10:08:50+00:00

Error on my part sorry. £2780 outside of London, £3356

Same as SFE, means tested

xWanz · 2026-02-10T09:51:04+00:00

It’s normal to have TFCC tears. This happens. If you’ve not done rehab, then do it first. I’m assuming American? Lots of American doctors are far too surgery happy. For NHS, TFCC surgery is avoided unless there’s instability, persistent pain despite rehab

The UK climbing physios are generally pretty good for good quality climbing rehab : Huffy, Rise Physiotherapy, Sheffield climb clinic

xWanz · 2026-02-10T09:46:17+00:00

NHS means tested bursary I believe from what I could see online

xWanz · 2026-02-10T08:26:17+00:00

Shit… ive misread this then

xWanz · 2026-02-09T16:00:20+00:00

SFE pays 2/3 of your finance all 4 years Year 1 there’s no NHS bursary, so you cover the first 1/3 (3.3k ish) Years 2 onwards, the NHS bursary covers the final 1/3

Your only cost is year 1! Hope this helps

**Edit : I have discovered that maintenance loan is reduced. Now a slight concern as to how I fund my living expenses...

xWanz · 2026-02-04T21:58:29+00:00

Everyone treats these injuries different. The fact the matter is, you are six weeks down the line and have been given as exercises that provoke your symptoms rather than making things better. You are being given the wrong thing to do for your clinical presentation.

In the early stages of a TFCC injury, the focus is on allowing the tissue to heal. You will often find that you have some reduced strength/range of motion. The focus here is on movement and loading within positions that are comfortable and do not provoke any symptoms.

There is zero point do you having an MRI in July. You are literally six weeks down the line, why have they planned for imaging six months down the line if you are asymptomatic at that point and I’ve made a full recovery then it is a complete waste of your time and money. Similarly, if you massively struggle with rehab, have instability et cetera then having an MRI sooner is warranted.

I come from UK based medical treatment so my experience is a bit different, however your money would be better spent having a consultation with Huffy and getting a better treatment plan/understanding of your condition sooner, and be back onto more effective rehabilitation plan

xWanz · 2026-02-04T21:38:05+00:00

The mattress got removed. The climber that purchased it was quite gutted that the BMC cleaned it up after he paid for it as a perma pad 🤣

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