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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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Schöffl VR, Hoffmann PM, Imhoff A, Küpper T, Schöffl I, Hochholzer T, Hinterwimmer S. Long-Term Radiographic Adaptations to Stress of High-Level and Recreational Rock Climbing in Former Adolescent Athletes: An 11-Year Prospective Longitudinal Study. Orthop J Sports Med 2018; 6:2325967118792847. [PMID: 30202767 PMCID: PMC6125860 DOI: 10.1177/2325967118792847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport. PURPOSE While radiographic changes in long-term climbers are known, there are little data available on adolescent climbers. The question arises as to whether climbing at high levels at a young age leads to radiographic changes and possibly an early onset of osteoarthritis of the finger joints. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 19 members of the German Junior National Team (GJNT group) and 18 recreational climbers (RC group) were examined clinically and radiographically in 1999. In 2011, these climbers were re-examined (mean follow-up, 11.3 ± 1.2 years). Radiographs were evaluated using a standard protocol, searching for physiological adaptations such as cortical thickness of the middle phalanx and an increased adopted Barnett-Nordin index, as well as for early-onset osteoarthritic changes of the hand. In contrast to the Kellgren-Lawrence scale, subchondral sclerosis was added to the group of physiological, adaptive stress reactions and was not defined as osteoarthritis. Osteoarthritis was defined by a Kellgren-Lawrence grade ≥2. RESULTS Overall, 15 of 19 (follow-up rate, 78.9%) climbers in the GJNT group and 13 of 18 in the RC group (follow-up rate, 72.2%), with a mean age of 26.8 years, were examined at the 11-year follow-up. Five climbers (33%) in the GJNT group presented with a decreased range of motion for the finger joints, in contrast to only 1 climber (8%) in the RC group. Radiographic stress reactions of the hand were found in 80% of the GJNT group and 46% of the RC group, including cortical hypertrophy (GJNT: 73%; RC: 23%), subchondral sclerosis (GJNT: 80%; RC: 31%), a broadened proximal interphalangeal joint base (GJNT: 67%; RC: 38%), and a broadened distal interphalangeal joint base (GJNT: 53%; RC: 31%). Training intensity in 1999 and body weight in 1999 were significant for the development of radiographic stress reactions in 2011 (P < .05 for both). Signs of early-stage osteoarthritis were seen in 6 climbers: 4 (27%) in the GJNT group and 2 (15%) in the RC group. Significant statistical influences for the development of early-onset osteoarthritis were found for overall total training years (P = .024), use of campus board training in 1999 (P = .033), and climbing level (P = .030). CONCLUSION One-quarter of climbers who performed at a high level in their youth showed a "mild" form of osteoarthritis (Kellgren-Lawrence grade 2). In analyzing the training regimens of our climbers for longer than 10 years, we conclude that intensive finger training (eg, campus board training) can lead to early-onset osteoarthritis of the hand. We also demonstrate that a high Union Internationale des Associations d'Alpinisme (UIAA) climbing level correlates with the risk for early-onset osteoarthritis of the hand and therefore must be seen as a risk factor for developing early-onset osteoarthritis of the finger joints.
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Affiliation(s)
- Volker Rainer Schöffl
- Section of Sports Medicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Phillip Max Hoffmann
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
- Department of Orthopedic Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Andreas Imhoff
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Thomas Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | - Stefan Hinterwimmer
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
- OrthoPlus, Munich, Germany
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Abstract
OBJECTIVE Sport climbers strain passive and active anatomical structures of their hands and fingers to the maximum during training or competition. This study was designed to investigate bone marrow edema (BME) in rock climbing athletes. DESIGN Systematic detection, treatment, and follow-up investigation of rock climbing athletes with BME of the hand. SETTING Primary-level orthopedic surgery and sports medicine division of a large academic medical center. PATIENTS Thirty-one high-level climbers with diffuse pain in the hand and wrist joint caused by rock climbing were included in this study. INTERVENTIONS The therapy consisted of consequent stress reduction and a break from sports. MAIN OUTCOME MEASURES Reduction of BME shown through magnetic resonance imaging (MRI) and regaining of preinjury climbing levels (Union Internationale des Associations d' Alpinisme metric scale). RESULTS In 28 patients, MRI revealed osseous edema because of overload at the respective area of interest, mainly in the distal radius, the distal ulna, or the carpal bones, which could not be otherwise diagnosed as inflammations, tumors, or injuries. We classified these edemas and fractures of the hamate because of overload. The edema was a stress reaction to highly intensive training and climbing with presumably high traction to the wrist area. The control MRIs demonstrated that even with a consequent stress reduction, the edemas required 3 to 4 months to disappear completely. CONCLUSIONS Climbers with nonspecific, diffuse pain in the wrist and/or the fingers should be examined with MRI to detect or exclude the diagnosis of a BME.
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Schöffl V, Lutter C, Woollings K, Schöffl I. Pediatric and adolescent injury in rock climbing. Res Sports Med 2018; 26:91-113. [DOI: 10.1080/15438627.2018.1438278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Volker Schöffl
- Section Sportorthopedics, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Germany
- Section Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Christoph Lutter
- Section Sportorthopedics, Klinikum Bamberg, Bamberg, Germany
- CvPath Institute, Gaithersburg, MD, USA
| | - Kaikanani Woollings
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Lutter C, Schweizer A, Hochholzer T, Bayer T, Schöffl V. Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering. Wilderness Environ Med 2016; 27:492-499. [PMID: 27793442 DOI: 10.1016/j.wem.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/02/2016] [Accepted: 09/03/2016] [Indexed: 01/03/2023]
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Lutter C, El-Sheikh Y, Schöffl I, Schöffl V. Sport climbing: medical considerations for this new Olympic discipline. Br J Sports Med 2016; 51:2-3. [PMID: 27821387 DOI: 10.1136/bjsports-2016-096871] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/03/2023]
Affiliation(s)
- C Lutter
- CVPath Institute, Gaithersburg, Maryland, USA.,Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamberg, Germany.,Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamberg, Germany
| | - Y El-Sheikh
- Division of Plastic Surgery, Department of Surgery, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - I Schöffl
- Department of Pediatrics, Klinikum Bamberg, Bamberg, Germany
| | - V Schöffl
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamberg, Germany.,Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamberg, Germany.,Department of Trauma and Orthopedic Surgery, Friedrich Alexander University, Erlangen-Nuremberg, Germany
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