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Schöffl V, von Schroeder H, Lisse J, El-Sheikh Y, Küpper T, Klinder A, Lutter C. Wrist Injuries in Climbers. Am J Sports Med 2023; 51:3416-3425. [PMID: 37800447 DOI: 10.1177/03635465231199671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Acute and chronic injuries to the wrist are among the most common sport-related complaints of climbing athletes but have not been extensively evaluated in this population. Therefore, it is important to categorize climbing injuries to the wrist, analyze risk factors, and assess treatment outcomes. PURPOSE To evaluate the distribution, outcomes, and influencing factors of wrist injuries in climbers. STUDY DESIGN Case series; Level of evidence, 4. METHODS Climbing athletes with wrist injuries who presented to our specialized sports medical center over the course of 4 years (2017-2020) were selected. All had prospectively completed questionnaires including their climbing-specific background (years of training, climbing level, training methods, etc). Injuries were analyzed (International Climbing and Mountaineering Federation [UIAA] grade and diagnosis), and treatment methods and outcomes were retrospectively assessed with a minimum follow-up of 2 years. Parameters included the climbing score, visual analog scale for pain score, Patient-Rated Wrist Evaluation (PRWE) score, and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score including the sport component (DASH-Sport) score before and after treatment as well as time to return to climbing. RESULTS A total of 69 patients (25 female, 44 male) with 78 wrist injuries were identified and analyzed. Of these, 7 injuries were bilateral, occurring at the same time, and 2 injuries were independent reinjuries to either the same or the contralateral side. In addition, 24 injuries (30.8%) were acute, while 54 (69.2%) were chronic. Overall, 2 injuries had a UIAA grade of 3; all others had a UIAA grade of 2. The most frequent injuries were synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains (joint capsular pain with stress, with no pathological finding on magnetic resonance imaging), and wrist ganglion cysts. Nonoperative treatment was performed for 61 of the injuries, while 17 were treated surgically. In 51 cases (65.4%), injuries healed without consequences; in 27 cases (34.6%), discomfort remained. The visual analog scale pain score decreased from 4.8 ± 1.9 before treatment to 0.7 ± 1.0 after treatment (P < .001), the PRWE score decreased from 53.6 ± 24.9 to 10.3 ± 13.1 (P < .001), the QuickDASH score improved from 53.0 ± 16.6 to 20.0 ± 20.2 (P < .001), and the DASH-Sport score improved from 82.0 ± 16.1 to 38.1 ± 23.5 (P < .001). The climbing score improved from 2.5 ± 1.1 to 4.3 ± 1.0 points (P < .001). The patient-reported number of days with pain was negatively correlated with changes in the PRWE score (r = -0.351; P < .001), QuickDASH score (r = -0.316; P = .007), and climbing score (r = -0.264; P = .025) as well as the number of days without climbing (r = -0.266; P = .025). The number of days without climbing was positively correlated with changes in the PRWE score (r = 0.369; P < .001). CONCLUSION Wrist injuries in climbers constituted a diverse set of diagnoses. Ulnar-sided injuries were most common, and many patients had >1 diagnosis. Outcomes for all treatment methods (surgery and nonoperative care) were favorable, but approximately one-third of climbers had persistent wrist discomfort after treatment, underscoring the need for accurate diagnoses and acute and expert care.
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Affiliation(s)
- Volker Schöffl
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- School of Health, Leeds Beckett University, Leeds, UK
| | - Herb von Schroeder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Hand Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Dovigi Orthopaedic Sports Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jens Lisse
- Department of Trauma Surgery, Klinikum Forchheim, Forchheim, Germany
| | - Yasser El-Sheikh
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Küpper
- Institute for Occupational, Social & Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Annett Klinder
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Sims LA. Upper Extremity Injuries in Rock Climbers: Diagnosis and Management. J Hand Surg Am 2022; 47:662-672. [PMID: 35256226 DOI: 10.1016/j.jhsa.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.
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Affiliation(s)
- Laura A Sims
- University of Saskatchewan, Saskatoon Orthopedic and Sports Medicine Centre, Saskatoon Saskatchewan, Canada.
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Schöffl V, Schöffl I, Flohé S, El-Sheikh Y, Lutter C. Evaluation of a Diagnostic-Therapeutic Algorithm for Finger Epiphyseal Growth Plate Stress Injuries in Adolescent Climbers. Am J Sports Med 2022; 50:229-237. [PMID: 34817275 DOI: 10.1177/03635465211056956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending. PURPOSE To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers. STUDY DESIGN Case series; Level of evidence, 4. METHODS On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d'Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score. RESULTS Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3. CONCLUSION The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future.
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Affiliation(s)
- Volker Schöffl
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Section of Wilderness Medicine, Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, Colorado, USA
- Department of Orthopedic and Trauma Surgery, University Erlangen-Nuremberg, Erlangen, Germany
| | - Isabelle Schöffl
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Sascha Flohé
- Department of Orthopedic and Trauma Surgery, Klinikum Solingen, Solingen, Germany
| | - Yasser El-Sheikh
- Department of Surgery, North York General Hospital, Toronto, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Christoph Lutter
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany
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MRI of Finger Pulleys at 7T-Direct Characterization of Pulley Ruptures in an Ex Vivo Model. Diagnostics (Basel) 2021; 11:diagnostics11071206. [PMID: 34359289 PMCID: PMC8303165 DOI: 10.3390/diagnostics11071206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations.
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Kadar A, Haddara MM, Fan S, Chinchalkar S, Ferreira LM, Suh N. Use of Thermoplastic Rings Following Venting of Flexor Tendon Pulleys: A Biomechanical Analysis. J Hand Surg Am 2021; 46:485-492. [PMID: 33357985 DOI: 10.1016/j.jhsa.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/08/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Normal digital flexion relies on flexor tendon pulleys to convert linear muscular force to angular digital motion. However, there is a growing trend to vent them partially during flexor tendon repair. The objective of this study was to examine the effects of a thermoplastic ring, acting as an external pulley, on flexor tendon biomechanics and finger range of motion (ROM) after pulley venting. METHODS We tested 15 cadaveric digits using an in vitro active finger motion simulator. We measured loads induced by flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) as well as joint ROM with sequential sectioning of the A2, A3, and A4 pulleys compared with an intact pulley condition. At each stage, external thermoplastic pulley rings were applied snugly over the proximal and middle phalanges to recreate A2 and A4 function, respectively. RESULTS After complete venting of the A2, A3, and A4 pulleys, proximal interphalangeal joint ROM significantly decreased by 13.4° ± 2.7° and distal interphalangeal joint ROM decreased by 15.8° ± 2.1°. Application of external rings over the proximal and middle phalanx resulted in a residual ROM decrease of 8.3° ± 1.9° at the proximal interphalangeal joint and 7.9° ± 2.1° at the distal interphalangeal joint, nearly restoring ROM. Similarly, complete pulley venting resulted in reduced FDS load by 37% and FDP load by 50% compared with intact pulleys. After application of external rings, loads were restored almost to normal, with a 9% reduction for FDS load and 9% reduction for FDP load compared with intact pulleys. CONCLUSIONS The application of thermoplastic rings acting as external pulleys is an effective, noninvasive, and reproducible approach to restore flexor tendon biomechanics and digit ROM after pulley venting. CLINICAL RELEVANCE Thermoplastic rings may be a useful therapeutic adjunct in restoring joint ROM and flexor tendon loads after surgical venting of the pulleys.
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Affiliation(s)
- Assaf Kadar
- Division of Orthopedic Surgery, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada; Department of Orthopedics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad M Haddara
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada
| | - Stacy Fan
- Department of Biomedical Engineering, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada
| | - Shrikant Chinchalkar
- Division of Orthopedic Surgery, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada
| | - Louis M Ferreira
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- Division of Orthopedic Surgery, University of Western Ontario, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada.
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Miro PH, vanSonnenberg E, Sabb DM, Schöffl V. Finger Flexor Pulley Injuries in Rock Climbers. Wilderness Environ Med 2021; 32:247-258. [PMID: 33966972 DOI: 10.1016/j.wem.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Finger flexor pulley system injuries are the most common overuse injury in rock climbers. These injuries occur rarely outside of rock climbing, owing to the sport's unique biomechanical demands on the finger. As rock climbing continues to grow and earn recognition as a mainstream sport, an understanding of how to diagnose and treat these injuries also has become important. Our purpose is to describe current concepts in anatomy, biomechanics, clinical evaluation, imaging, prevention, and treatment strategies relating to finger flexor pulley system injuries. Our literature search was performed on PubMed with MeSH terms and keywords as subject headings to meet the objectives of this review. The "crimp grip" used in rock climbing is the mechanism for these injuries. The A2, A3, and A4 pulleys are at the highest risk of injury, especially when loaded eccentrically. Physical examination may reveal clinical "bowstringing," defined as the volar displacement of the flexor tendons from the phalanges; however, imaging is required for characterization of the underlying injury. Ultrasound is highly sensitive and specific for diagnosis and is recommended as the initial imaging technique of choice. Magnetic resonance imaging is recommended as an additional imaging study if ultrasound is inconclusive. Properly warming up increases the amount of physiologic bowstringing and is thought to prevent injury from occurring. Pulley injuries may be classified as grade I through IV. Conservative treatment, including immobilization, the H-tape method, and the use of a protective pulley splint, is recommended for grade I to III injuries. Surgical repair is reserved for grade IV injuries that are not amenable to conservative treatment.
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Affiliation(s)
- Paulo H Miro
- University of Arizona College of Medicine, Phoenix, AZ.
| | | | - Dylan M Sabb
- University of Arizona College of Medicine, Phoenix, AZ; University of California, Davis, Department of Family & Community Medicine, Sacramento, CA
| | - Volker Schöffl
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany; Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, FRG, Germany; Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO; School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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Lutter C, Tischer T, Schöffl VR. Olympic competition climbing: the beginning of a new era-a narrative review. Br J Sports Med 2020; 55:857-864. [PMID: 33036996 DOI: 10.1136/bjsports-2020-102035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.
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Affiliation(s)
- Christoph Lutter
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Volker Rainer Schöffl
- Section of Sports Medicine, Department of Trauma and Orthopedic Surgery, Klinikum Bamberg, Bamberg, Germany.,Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen-Nuremberg, Germany.,Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.,School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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Lutter C, Tischer T, Cooper C, Frank L, Hotfiel T, Lenz R, Schöffl V. Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes. Am J Sports Med 2020; 48:730-738. [PMID: 32004071 DOI: 10.1177/0363546519899931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes. PURPOSE To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores. RESULTS Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5). CONCLUSION Increased attention should be placed on the climber's knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.
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Affiliation(s)
- Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | | | - Luisa Frank
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Thilo Hotfiel
- Department of Orthopedics, Trauma and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany.,Department of Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Lenz
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Volker Schöffl
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Section Sports Orthopedics & Sports Medicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany.,Wilderness Medicine Section, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.,School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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10
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Efficacy of corticosteroid injection in rock climber's tenosynovitis. HAND SURGERY & REHABILITATION 2019; 38:317-322. [DOI: 10.1016/j.hansur.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 01/03/2023]
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Jones G, Schöffl V, Johnson MI. Incidence, Diagnosis, and Management of Injury in Sport Climbing and Bouldering. Curr Sports Med Rep 2018; 17:396-401. [DOI: 10.1249/jsr.0000000000000534] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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12
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Schöffl I, Meisel J, Lutter C, Schöffl V. Feasibility of a New Pulley Repair: A Cadaver Study. J Hand Surg Am 2018; 43:380.e1-380.e7. [PMID: 28985979 DOI: 10.1016/j.jhsa.2017.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/03/2017] [Accepted: 08/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE In this study, the feasibility of a new pulley reconstruction in which the tendon graft is pulled through a tunnel in the proximal phalanx, was evaluated using a cadaver model, with particular attention paid to the weakening of the bone structure by the drill hole. METHODS Nine fingers from 6 cadaver hands with intact pulley systems were compared with 9 fingers from 6 cadaver hands with missing A2 to A4 pulleys but that included a repair using the new surgical technique. Each finger was fixed to an isokinetic loading device. The forces in the flexor tendons were recorded in each finger using a force transducer. RESULTS The forces recorded in the flexor tendons of the control group were significantly higher than in the reconstructed fingers. The most common event in the reconstructed fingers was graft failure. A fracture of the bone due to the drill hole was not observed. CONCLUSIONS The new pulley reconstruction could represent an alternative to existing reconstructive techniques. The cause for the higher forces recorded in the control group could be attributed to sutures used in the operated fingers. CLINICAL RELEVANCE The new pulley reconstruction method may enable reduced extensor tendon irritation because it avoids contact with the extensor hood and could possibly prohibit cortical bone loss, a serious side effect in the "one and one-half loop" technique.
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Affiliation(s)
| | - Julia Meisel
- Institute of Anatomy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christoph Lutter
- Department of Orthopaedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Volker Schöffl
- Department of Orthopaedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Abstract
PURPOSE OF REVIEW While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries. RECENT FINDINGS With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers. Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.
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Affiliation(s)
- Louis Christopher Grandizio
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA.
| | - Joel Christian Klena
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA
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Janetzki H. Delayed Annular Pulley Rupture Following Distal Radius Repair. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316664308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Annular pulley injuries are commonly found in the 3rd and 4th fingers under extreme strain in rock climbers. Here is presented a case of pulley rupture in the 5th finger following surgery to the wrist with no specific injury to the finger itself. The mechanism of injury here is likely to be a combination of repetitive strain during rehabilitation, partial injury during initial fall, and possibly irritation to the tendon caused by surgical hardware. Diagnosis was inconclusive or not possible by other modalities (clinical and imaging) and ultrasound has proved useful here given the correct technique and a good knowledge of anatomy and pathology.
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Carruthers KH, Skie M, Jain M. Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health 2016; 8:469-78. [PMID: 27421747 PMCID: PMC5010131 DOI: 10.1177/1941738116658643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Context: Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play. Evidence Acquisition: Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes. Study Design: Clinical review. Level of Evidence: Level 5. Results: Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient. Conclusion: Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care.
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Affiliation(s)
| | - Martin Skie
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio
| | - Margaret Jain
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio
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16
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The “Heel Hook”—A Climbing-Specific Technique to Injure the Leg. Wilderness Environ Med 2016; 27:294-301. [DOI: 10.1016/j.wem.2015.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/11/2015] [Accepted: 12/03/2015] [Indexed: 01/03/2023]
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Bouyer M, Forli A, Semere A, Chedal Bornu BJ, Corcella D, Moutet F. Recovery of rock climbing performance after surgical reconstruction of finger pulleys. J Hand Surg Eur Vol 2016; 41:406-12. [PMID: 26763272 DOI: 10.1177/1753193415623914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 11/27/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1-42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Bouyer
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - A Forli
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - A Semere
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - B J Chedal Bornu
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - D Corcella
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - F Moutet
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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18
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Lutter C, Schoeffl V. Intermittent unspecific osteitis and cortex atrophy of the proximal phalanx after surgical pulley repair. BMJ Case Rep 2015; 2015:bcr-2015-213109. [PMID: 26628314 DOI: 10.1136/bcr-2015-213109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Climbing athletes frequently suffer from pulley ruptures, as the shear stress on the finger flexor tendon pulley system is extremely high, especially in the 'crimping position'. Studies showed that surgery only has to be performed in a multiple pulley rupture situation (grade IV injuries). This case describes a complication that appeared after performing a 'bone-encircling' technique recommended for climbers (modified 'one-and-a-half-loop' technique). Simultaneously with resumption of full-strength training after surgery and rehabilitation, the dorsolateral cortex of the proximal phalanx, to which the tendon transplant (palmaris longus tendon surrounding bone and flexor tendon of the finger) is entangled, developed an osteitis and atrophy. We investigated two athletes with the same complaints and symptoms.
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Affiliation(s)
- Christoph Lutter
- CvPath Institute, Gaithersburg, Maryland, USA Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Department for Orthopedics and Traumatology, Klinikum Bamberg, Bamberg, Germany
| | - Volker Schoeffl
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Department for Orthopedics and Traumatology, Klinikum Bamberg, Bamberg, Germany
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19
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Bayer T, Adler W, Schweizer A, Schöffl I, Uder M, Janka R. Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol 2015; 44:1279-85. [PMID: 25930946 DOI: 10.1007/s00256-015-2160-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture. MATERIALS AND METHODS MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured. RESULTS Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm. CONCLUSION Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture.
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Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
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20
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Chang CY, Torriani M, Huang AJ. Rock Climbing Injuries: Acute and Chronic Repetitive Trauma. Curr Probl Diagn Radiol 2015; 45:205-14. [PMID: 26360057 DOI: 10.1067/j.cpradiol.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 01/03/2023]
Abstract
Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA.
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
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21
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Bayer T, Fries S, Schweizer A, Schöffl I, Janka R, Bongartz G. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study. Skeletal Radiol 2015; 44:77-84. [PMID: 25253170 DOI: 10.1007/s00256-014-2002-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/07/2014] [Accepted: 08/31/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objectives of this study were the evaluation of flexor tendon pulley rupture of the fingers in the crimp grip position using magnetic resonance imaging (MRI) and the comparison of the results with MRI in the neutral position in a cadaver study. MATERIALS AND METHODS MRI in the crimp grip position and in the neutral position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (combined pulley rupture, n = 14; single pulley rupture, n = 7). Measurement of the distance between the tendon and bone was performed. Images were evaluated by two readers, first independently and in cases of discrepancy in consensus. Sensitivity and specificity for detecting combined pulley ruptures were calculated. RESULTS Tendon bone distances were significantly higher in the crimp grip position than in the neutral position. Sensitivity and specificity for detecting combined pulley rupture were 92.86 % and 100 % respectively in the crimp grip position and 78.57 % and 85.71 % respectively in the neutral position. Kappa values for interobserver reliability were 0.87 in the crimp grip position and 0.59 in the neutral position. CONCLUSION MRI examination in the crimp grip position results in higher tendon bone distances by subjecting the pulleys to a higher strain, which facilitates image evaluation with higher interobserver reliability, higher sensitivity, and higher specificity for combined pulley rupture compared with examination in the neutral position.
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Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
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22
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Two-stage tendon sheath reconstruction using sublimis tendon and silicone Penrose drain after severe purulent flexor tenosynovitis: a case report. Hand (N Y) 2013; 8:343-7. [PMID: 24426946 PMCID: PMC3745240 DOI: 10.1007/s11552-013-9507-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Two-stage tendon sheath reconstruction, a method of pulley reconstruction using the sublimis tendon and a pseudosheath formed with a silicone Penrose drain wrapped around the profundus tendon, is a new technique for improving a poor functional prognosis after purulent flexor tenosynovitis.
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23
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Wiater BP, Hentzen ER, Meunier MJ, Abrams RA. A2 pulley insufficiency. J Hand Surg Am 2013; 38:158-63. [PMID: 22995700 DOI: 10.1016/j.jhsa.2012.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 07/21/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Brett P Wiater
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, University of California San Diego, San Diego, CA, USA.
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24
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Schöffl V, Heid A, Küpper T. Tendon injuries of the hand. World J Orthop 2012; 3:62-9. [PMID: 22720265 PMCID: PMC3377907 DOI: 10.5312/wjo.v3.i6.62] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 05/11/2012] [Accepted: 06/05/2012] [Indexed: 02/06/2023] Open
Abstract
Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing.
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