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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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Abstract
Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.
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Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock Climbing Injuries. Wilderness Environ Med 2017; 28:185-196. [PMID: 28755819 DOI: 10.1016/j.wem.2017.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries. METHODS Design: retrospective cross-sectional study. SETTING web-based survey. PARTICIPANTS rock climbers who sustained a climbing-related injury during the prior 24 months. Criteria for inclusion: aged ≥18 years; participation in rock climbing at least 4 times per year in the United States. INTERVENTIONS none. MAIN OUTCOME MEASURES percentage of injured climbers seeking medical care, providers seen, subspecialty referral, development of chronic problems, factors affecting return to climbing, injuries by climbing type, body region, and injury type. RESULTS Data were collected over a 60-day period using the Research Electronic Data Capture (REDCap) survey system. Seven hundred and eight surveys were collected from 553 male and 155 female climbers. Thirteen hundred ninety seven injuries were reported, and 975 injuries were suitable for analysis. The most common provider initially seen was a primary care provider. Subspecialty referral was commonly obtained. Injury patterns differed by climbing type. The percentage of respondents that returned to climbing before their injury was fully healed was 51.1%, and 44.9% of respondents developed chronic problems related to their climbing injury. Twenty-eight percent of respondents were unable to return to their previous level of climbing performance. Several factors were associated with delayed recovery from climbing injury. CONCLUSIONS A significant number of climbers sought healthcare after injury. A majority of climbers who sought treatment were referred to subspecialist providers. About one-half of climbers were symptomatic when they returned to climbing and developed chronic problems after injury. Factors associated with slower return to climbing included increasing age, smoking, fractures, and surgery.
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Abstract
BACKGROUND Climbing is a physical activity and sport involving many subdisciplines. Minimization of prolonged pauses, use of a relatively simple path through a route and smooth transitions between movements broadly define skilled coordination in climbing. OBJECTIVES To provide an overview of the constraints on skilled coordination in climbing and to explore future directions in this emerging field. METHODS A systematic literature review was conducted in 2014 and retrieved studies reporting perceptual and movement data during climbing tasks. To be eligible for the qualitative synthesis, studies were required to report perceptual or movement data during climbing tasks graded for difficulty. RESULTS Qualitative synthesis of 42 studies was carried out, showing that skilled coordination in climbing is underpinned by superior perception of climbing opportunities; optimization of spatial-temporal features pertaining to body-to-wall coordination, the climb trajectory and hand-to-hold surface contact; and minimization of exploratory behaviour. Improvements in skilled coordination due to practice are related to task novelty and the difficulty of the climbing route relative to the individual's ability level. CONCLUSION Perceptual and motor adaptations that improve skilled coordination are highly significant for improving the climbing ability level. Elite climbers exhibit advantages in detection and use of climbing opportunities when visually inspecting a route from the ground and when physically moving though a route. However, the need to provide clear guidelines on how to improve climbing skill arises from uncertainties regarding the impacts of different practice interventions on learning and transfer.
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Desaldeleer AS, Le Nen D. Bilateral fracture of the base of the middle phalanx in a climber: Literature review and a case report. Orthop Traumatol Surg Res 2016; 102:409-11. [PMID: 26993857 DOI: 10.1016/j.otsr.2016.01.016] [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: 11/11/2015] [Revised: 12/15/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
During climbing, tears of the annular pulley are the most common injuries, while fractures of the dorsal base of the middle phalanx are rare and atypical. Only a few cases have been reported in international literature. The authors present a case of a Salter-Harris type III fracture of the base of the middle phalanx of the middle finger in a young climber and a review of the literature. The patient was a 17-year-old boy who regularly and intensively practiced climbing. He consulted for a non-traumatic history of proximal pain of the interphalangeal joints of the middle fingers. On clinical examination, there was pain on the dorsal surface of the proximal interphalangeal joints, with no decrease in range of motion of the fingers. X-rays showed a Salter-Harris type III, displaced epiphyseal fracture of the dorsal base of the middle phalanx of the middle fingers. Conservative treatment resulted in fracture union and the patient had recovered normal activity of his hand at the 6-month follow-up. Stress fractures are common in athletes like climbers in response to repetitive and prolonged sports. Epiphyseal fractures are the most common injuries in young climbers.
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Affiliation(s)
- A-S Desaldeleer
- Hôpital de la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - D Le Nen
- Hôpital de la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
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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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Wegner L, Pagel JE, Smit AW, Straszacker A, Swart SL, Taft SJ. Common neuromusculoskeletal injuries amongst rock climbers in the Western Cape. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:227. [PMID: 30135869 PMCID: PMC6093122 DOI: 10.4102/sajp.v71i1.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/20/2015] [Indexed: 11/01/2022] Open
Abstract
Background Rock climbing is an extreme sport that is fast gaining interest in the Western Cape. Due to the physical nature of the sport, climbers often suffer neuromusculoskeletal (NMS) injuries. Physiotherapists are first-line practitioners who diagnose and treat NMS injuries, but no previous study has been conducted regarding common NMS injuries amongst rock climbers in the Western Cape. Objective To determine the common NMS injuries amongst rock climbers, and the relationships between independent variables and injury. Method A Quantitative, cross-sectional, retrospective descriptive study design utilised a self-developed survey based on the literature. This was completed by rock climbers from an indoor climbing gym in Cape Town and two outdoor crags in the Western Cape. Out of the total population of 650 climbers, 247 were conveniently sampled to complete the self-administered survey, making the results generalisable to the climbing population. Results Finger flexor tendon pulley injuries were the most commonly diagnosed NMS injury. Injury to the fingers, hand and elbow regions were the most common self-reported injury by area. The risk of suffering climbing-related injuries was significantly correlated to gender, setting, grade and type of climbing, but not to frequency of climbing. Conclusion The results of this study could assist physiotherapists to assess and manage the common NMS injuries that occur in this group of extreme athletes, as well as to raise awareness amongst rock climbers in the Western Cape about potential risk of injury.
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Affiliation(s)
- Liezel Wegner
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Jarryd E Pagel
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Ashley W Smit
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Aimee Straszacker
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Sarah L Swart
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - St John Taft
- Department of Physiotherapy, University of the Western Cape, South Africa
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Abstract
Medial epicondylar tendinopathy, also known as golfer's elbow, is less common than lateral elbow tendinopathy. Overhead throwing athletes and those participating in sports that require repeated forearm pronation and wrist flexion are most commonly affected by this disorder. This problem predominates in amateur as opposed to professional athletes and is also seen more commonly in patients over 40 years of age. This review will begin by outlining the incidence, history, and physical examination of medial epicondylar tendinopathy, including a new clinical test. Imaging modalities, nonoperative, and operative treatments will then be outlined. Finally, future directions will be explored including emerging biological therapies.
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Schöffl V, Küpper T. Feet injuries in rock climbers. World J Orthop 2013; 4:218-28. [PMID: 24147257 PMCID: PMC3801241 DOI: 10.5312/wjo.v4.i4.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023] Open
Abstract
While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.
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Crowley TP. The flexor tendon pulley system and rock climbing. J Hand Microsurg 2012; 4:25-9. [PMID: 23730085 DOI: 10.1007/s12593-012-0061-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/03/2012] [Indexed: 01/24/2023] Open
Abstract
Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed.
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Affiliation(s)
- Timothy P Crowley
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP UK
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Merritt AL, Huang JI. Hand injuries in rock climbing. J Hand Surg Am 2011; 36:1859-61. [PMID: 22036284 DOI: 10.1016/j.jhsa.2011.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/02/2011] [Accepted: 08/20/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew L Merritt
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
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12
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El-Sheikh Y, Wong I, Farrokhyar F, Thoma A. Diagnosis of finger flexor pulley injury in rock climbers: A systematic review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 14:227-31. [PMID: 19554140 DOI: 10.1177/229255030601400405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Closed injury to the finger flexor pulley system is found frequently in rock climbers. There are no evidence-based published guidelines on the diagnosis and treatment of these injuries. OBJECTIVES THE PRESENT SYSTEMATIC REVIEW WAS UNDERTAKEN TO ANSWER THE FOLLOWING QUESTIONS: what are the most commonly recommended diagnostic criteria for finger flexor pulley injury in rock climbers; and, based on the available evidence, what is the best diagnostic test for these injuries? METHODS Four electronic databases were searched using specific key terms, with limits set for language and date. Two reviewers independently identified potentially relevant titles based on inclusion criteria. Inter-reviewer variability was assessed using the Kappa statistic. The scientific quality of articles was assessed using validated scales. RESULTS Of the 93 articles identified, 29 were included in the present analysis. The inter-rater agreement for selection of potentially relevant titles was 88% (kappa=0.74). The most commonly cited diagnostic criterion for closed finger pulley injury was clinical bow-stringing of the flexor tendons over the volar aspect of the proximal interphalangeal joint. However, the best study of diagnostic accuracy for these injuries supports the use of dynamic ultrasound. CONCLUSIONS Dynamic ultrasound is recommended for the diagnosis of closed finger pulley injuries in rock climbers. The prevailing notion that these injuries can be diagnosed by testing for clinical bowstringing is not supported by evidence.
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Schöffl V, Morrison A, Schwarz U, Schöffl I, Küpper T. Evaluation of injury and fatality risk in rock and ice climbing. Sports Med 2010; 40:657-79. [PMID: 20632737 DOI: 10.2165/11533690-000000000-00000] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.
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Affiliation(s)
- Volker Schöffl
- Department of Sportorthopedics, Orthopedics and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany.
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Affiliation(s)
- Stephanie Simonson
- Musculoskeletal Radiology Hospital, University of Pennsylvania, Philadelphia, PA 19104, USA
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Schöffl I, Oppelt K, Jüngert J, Schweizer A, Bayer T, Neuhuber W, Schöffl V. The influence of concentric and eccentric loading on the finger pulley system. J Biomech 2009; 42:2183-7. [PMID: 19646704 DOI: 10.1016/j.jbiomech.2009.04.049] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/03/2009] [Accepted: 04/04/2009] [Indexed: 02/07/2023]
Abstract
In this study we investigated the influence of the loading condition (concentric vs. eccentric loading) on the pulley system of the finger. For this purpose 39 cadaver finger (14 hands, 10 donors) were fixed into an isokinetic loading device. The forces in the flexor tendons and at the fingertip were recorded. In the concentric loading condition A2 and A4 ruptures as well as alternative events such as fracture of a phalanx or avulsion of the flexor tendons were almost equally distributed, whereas the A2 pulley rupture was the most common event (59%) in the eccentric loading condition and alternative events were rare (23.5%). The forces in the deep flexor tendon, the fingertip and in the pulleys were significantly lower in the eccentric loading condition. As the ruptures occurred at lower loads in the eccentric than in the concentric loading condition it can be concluded that friction may be an advantage for climbers, supporting the holding force of their flexor muscles but may also increase the susceptibility to injury.
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Affiliation(s)
- I Schöffl
- Institute of Anatomy 1, Friedrich-Alexander University Erlangen-Nuremberg, FRG.
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Schöffl I, Oppelt K, Jüngert J, Schweizer A, Bayer T, Neuhuber W, Schöffl V. The influence of concentric and eccentric loading on the finger pulley system. J Biomech 2009; 42:2124-8. [PMID: 19646704 DOI: 10.1016/j.jbiomech.2009.05.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/22/2009] [Accepted: 05/23/2009] [Indexed: 11/29/2022]
Abstract
In this study we investigated the influence of the loading condition (concentric vs. eccentric loading) on the pulley system of the finger. For this purpose 39 cadaver finger (14 hands, 10 donors) were fixed into an isokinetic loading device. The forces in the flexor tendons and at the fingertip were recorded. In the concentric loading condition A2 and A4 ruptures as well as alternative events such as fracture of a phalanx or avulsion of the flexor tendons were almost equally distributed, whereas the A2 pulley rupture was the most common event (59%) in the eccentric loading condition and alternative events were rare (23.5%). The forces in the deep flexor tendon, the fingertip and in the pulleys were significantly lower in the eccentric loading condition. As the ruptures occurred at lower loads in the eccentric than in the concentric loading condition it can be concluded that friction may be an advantage for climbers, supporting the holding force of their flexor muscles but may also increase the susceptibility to injury.
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Affiliation(s)
- I Schöffl
- Institute of Anatomy 1, Friedrich-Alexander University Erlangen-Nuremberg, FRG.
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Valbuena SE, Gasiunas V, Roulot E. Re: scapholunate interosseous ligament rupture in an elite rock climber. J Hand Surg Eur Vol 2008; 33:393-4. [PMID: 18562386 DOI: 10.1177/1753193408090119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Vytautas Gasiunas
- Institut de la main, Clinique Jouvenet, 6 Square Jouvenet,
75016, Paris, France
| | - Eric Roulot
- Institut de la main, Clinique Jouvenet, 6 Square Jouvenet,
75016, Paris, France
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Josephsen G, Shinneman S, Tamayo-Sarver J, Josephsen K, Boulware D, Hunt M, Pham H. Injuries in bouldering: a prospective study. Wilderness Environ Med 2008; 18:271-80. [PMID: 18076293 DOI: 10.1580/06-weme-or-071r1.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Bouldering is a type of rock climbing in which the climber ascends small boulders with pads and spotters in lieu of ropes, with an emphasis on ascending the most difficult surface possible. We sought to investigate the prevalence and incidence of injuries, and we hypothesized boulderers who enlisted preventative measures and those who bouldered indoors would have fewer injuries. METHODS This cross-sectional cohort study assessed incidence and pattern of injury among indoor and outdoor boulderers over 1 year. RESULTS Spotting other boulderers resulted in few injuries, but both climbing and falling were associated with diffuse injuries. Finger and ankle injuries were common. Traditional preventative measures were ineffective, and there were few differences between indoor and outdoor boulderers. CONCLUSIONS Bouldering outdoors has an increased risk of injury to the fingers. Preventative measures appear largely ineffective in reducing the number of injuries in both cohorts.
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Affiliation(s)
- Gary Josephsen
- Department of Emergency Medicine Harbor--UCLA Medical Center, Torrance, CA, USA.
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Sylvester AD, Christensen AM, Kramer PA. Factors influencing osteological changes in the hands and fingers of rock climbers. J Anat 2007; 209:597-609. [PMID: 17062018 PMCID: PMC2100343 DOI: 10.1111/j.1469-7580.2006.00640.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study examines the osteological changes in the hands and fingers of rock climbers that result from intense, long-term mechanical stress placed on these bones. Specifically, it examines whether rock climbing leads to metacarpal and phalange modelling in the form of increased cortical thickness as well as joint changes associated with osteoarthritis. This study also attempts to identify specific climbing-related factors that may influence these changes, including climbing intensity and frequency of different styles of climbing. Radiographs of both hands were taken for each participant and were scored for radiographic signs of osteoarthritis using an atlas method. Total width and medullary width were measured directly on radiographs using digital calipers and used to calculate cross-sectional area and second moment of area based on a ring model. We compared 27 recreational rock climbers and 35 non-climbers for four measures of bone strength and dimensions (cross-sectional area, second moment of area, total width and medullary width) and osteoarthritis. A chi-squared test for independence was used to compare climber and non-climber osteoarthritis scores. For each measure of bone strength climbers and non-climbers were compared using a manova test. Significant manova tests were followed by principal components analysis (PCA) and individual anova tests performed on principal components with eigenvalues greater than one. A second PCA was performed on the climber subsample and the first principal component was then used as the dependent variable in linear regression variable selection procedures to determine which climbing-related variables affect bone thickness. The results suggest that climbers are not at an increased risk of developing osteoarthritis compared with non-climbers. Climbers, however, do have greater cross-sectional area as well as second moment of area. Greater total width, but not meduallary width, indicates that additional bone is deposited subperiosteally. The strength of the finger and hand bones are correlated with styles of climbing that emphasize athletic difficulty. Significant predictors include the highest levels achieved in bouldering and sport climbing.
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Affiliation(s)
- Adam D Sylvester
- Department of Anthropology, The University of Tennessee, Knoxville, Tennessee, USA.
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Affiliation(s)
- Bruce S Rudy
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Schoffl I, Einwag F, Strecker W, Hennig F, Schoffl V. Impact of Taping after Finger Flexor Tendon Pulley Ruptures in Rock Climbers. J Appl Biomech 2007; 23:52-62. [PMID: 17585178 DOI: 10.1123/jab.23.1.52] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexor tendon pulley ruptures are the most common injury in rock climbers. Therapeutic standards usually include a prolonged use of taping applied as a replacement for the lost pulley in a circular fashion at the base of the proximal phalanx. Our biomechanical considerations, however, suggest a new taping method, the H-tape. The purpose of the study is to evaluate whether this new taping method can effectively change the course of the flexor tendon and therefore reduce the tendon–bone distance. In order to compare the effects of different taping methods described in the literature with the newly developed taping method, we performed standardized ultrasound examinations of 8 subjects with singular A2 pulley rupture and multiple pulley ruptures of A2 and A3 pulleys and determined the respective tendon–bone distance for the different taping methods, versus without tape at a preset position on the proximal phalanx. In a second approach, we evaluated the effect of the new taping method on the strength of the injured finger using a force platform on 12 subjects with different pulley ruptures with injuries older than 1 year. The new taping method decreased the tendon–bone distance in the injured finger significantly by 16%, whereas the other taping methods did not. The strength development was significantly better with the new tape for the crimp grip position (+13%), but there was no significant improvement for the hanging position. We recommend taping with the newly presented taping technique after pulley rupture.
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Affiliation(s)
- Isabelle Schoffl
- Institute of Medical Physics, University of Erlangen, Nuremberg, Germany
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23
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Abstract
BACKGROUND Rock climbing is gaining popularity. The injury patterns and safety practices of climbers have not been well described. This study seeks to identify the general injury patterns and safety practices associated with rock climbing. METHODS An anonymous multiple choice, Likert scale, and short-answer Internet survey was posted on several rock climbing Websites. Data were collected autonomously for a 2-month period in 2004. Demographic data were obtained and subjects self-identified their three most significant injuries. Participants were also surveyed regarding safety practices and training. SPSS 12.0 was used for statistical analysis and p < 0.05 was considered significant. RESULTS In all, 1,887 subjects reported a total of 2,472 injuries. The mean number of injuries reported was 2.3 (SE 0.14) and 17.9% reported no injuries. Sprains and overuse were the most commonly described injuries, whereas fingers, ankles, elbows, and shoulders were the most commonly injured body parts. Some participants (28%) reported climbing under the influence of drugs or alcohol and these climbers documented more injuries (p < 0.008). Most of the injuries (77%) occurred while climbing at or below the subject's normal climbing level. Climbers who participated in traditional climbing (p < 0.001) or solo climbing (p < 0.001) documented more injuries. Males had less helmet use (p = 0.019) and more illicit substance use (p < 0.001). CONCLUSIONS Sprains and overuse were common climbing injuries, with the upper extremity being the most frequently injured body part. Rock climbers who participated in traditional or solo climbing, or who have climbed while under the influence or drugs or alcohol, reported more injuries.
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Affiliation(s)
- Erik M Gerdes
- Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, OSF St. Francis Medical Center, Peoria, IL 61637, USA
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24
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Schöffl VR, Hochholzer T, Imhoff AB, Schöffl I. Radiographic adaptations to the stress of high-level rock climbing in junior athletes: a 5-year longitudinal study of the German Junior National Team and a group of recreational climbers. Am J Sports Med 2007; 35:86-92. [PMID: 16973900 DOI: 10.1177/0363546506293256] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiographic adaptations and changes in adult climbers are a well-known fact, but few data are available for young climbers. HYPOTHESIS Radiographic adaptations have been shown for highly active young climbers. The question arises whether these adaptations may lead to an early onset of osteoarthrosis in the fingers. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Ten members of the German Junior National Team (GJNT; 21.0 +/- 1.6 years) and 10 recreational climbers (RC; 19.9 +/- 1.9 years) were examined using a standard questionnaire and radiographs of the hand. For comparison, radiographs of 12 young nonclimbers (control group [CG]) were evaluated. RESULTS The climbing level of GJNT increased significantly during the 5-year evaluation period (P < .01) and was significantly higher than that of the RC (1999: P < .01, 2004: P < .01). There was no increase in finger contractures or finger joint capsular width during the 5 years. Stress reactions were found in 8 of 10 of GJNT (1999 and 2004) and increased in RC from 2 of 10 (1999) to 3 of 10 (2004). No osteoarthrotic changes were found in 2004. There was no significant difference for the Barnett-Nordin Index between GJNT, RC, and CG. Years of climbing (P < .01), participation in climbing competitions (P < .01), hours of training per week (P < .01), number of training units per week (P < .05), and climbing level (2004) (P < .01) were significant factors for development of radiographic stress reaction in all athletes (GJNT and RC). CONCLUSION Intensive training and climbing leads to adaptive reactions such as cortical hypertrophy and broadened joint bases in the fingers. Nevertheless, osteoarthrotic changes are rare in young climbers. A longer follow-up is necessary to evaluate whether these adaptive stress reactions may lead to an early onset of osteoarthritis.
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Affiliation(s)
- Volker Rainer Schöffl
- Department of Trauma and Orthopaedic Surgery, Klinikum Bamberg, Bugerstr. 80, Germany 96049.
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25
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Schöffl VR, Einwag F, Strecker W, Schöffl I. Strength measurement and clinical outcome after pulley ruptures in climbers. Med Sci Sports Exerc 2006; 38:637-43. [PMID: 16679977 DOI: 10.1249/01.mss.0000210199.87328.6a] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Ruptures of the finger flexor pulleys are the most frequent injuries in rock climbers. Whereas multiple pulley injuries demand a surgical reconstruction, single ruptures are mainly treated conservatively. Nevertheless, the question of the clinical outcome or a persisting finger strength deficit after conservative therapy arises. METHODS Twenty-one rock climbers (age 34 +/- 9 yr) with a grade 2-4 pulley injury were reevaluated 3.46 (range: 0.25-18) yr after injury. The clinical evaluation followed a standard questionnaire in combination with an ultrasound examination in extension and forced flexion. In order to determine the finger strengths, the subjects hung with the respective finger in various postures on a ledge attached above a door frame, while standing on a force platform, which measured the relative release. RESULTS The 21 subjects had old (3.46 yr, range: 0.25-18) pulley injuries in 27 fingers (10 A2, 1 A3, 11 A4, 3 A2/3, 2 A3/4). The clinical outcome was excellent (Buck-Gramcko score of 3) in all cases; the subjects regained their climbing level within a year. There was no difference between the initial ultrasound examination and the follow-up during the study. For 17 finger pairs, data for the relative strength of the injured and the respective healthy finger could be gathered. The finger strength was not significantly different for the injured and the healthy finger in either the hanging or the crimping finger position. CONCLUSIONS Nonsurgical treatment of single pulley ruptures is recommended. The clinical outcome was good to excellent, and no long-term strength deficit for the injured finger could be observed.
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26
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Schöffl VR, Schöffl I. Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg Am 2006; 31:647-54. [PMID: 16632061 DOI: 10.1016/j.jhsa.2006.02.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 01/06/2004] [Indexed: 02/02/2023]
Abstract
Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. This article analyzes this type of injury and the current diagnostic and therapeutic criteria. Ultrasound and magnetic resonance imaging are used to differentiate between a pulley strain, partial rupture, complete rupture, or multiple ruptures. Grade I to III injuries (strains, partial rupture, single ruptures) are treated conservatively with initial immobilization and early functional therapy under pulley protection. Grade IV injuries (multiple ruptures) require surgical repair.
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27
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Klauser A, Gabl M, Smekal V, Nedden DZ. [High frequency sonography in the detection of finger injuries in sport climbing]. ACTA ACUST UNITED AC 2005; 56:13-9. [PMID: 16218523 DOI: 10.1016/j.rontge.2005.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sport climbing shows an increasing popularity, including even school sport activity on high climbing levels. Climbing related injuries are predominantly located in fingers/ hands ("climber's finger"), and can present as annular pulley rupture or more common as overuse injury. Beside clinical examination imaging modalities such as MRI and high frequency sonography have shown to allow for detection of climbing related injuries. High frequency sonography enables for exact differential diagnosis of climbing related finger/hand injuries and therefore plays a central role in adequate therapeutic management.
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Affiliation(s)
- Andrea Klauser
- Universitätsklinik für Radiodiagnostik, Radiologie II, Anichstrasse 35, A-6020 Innsbruck.
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28
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Logan AJ, Makwana N, Mason G, Dias J. Acute hand and wrist injuries in experienced rock climbers. Br J Sports Med 2005; 38:545-8. [PMID: 15388536 PMCID: PMC1724952 DOI: 10.1136/bjsm.2002.003558] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The sport of rock climbing has its own spectrum of injuries, almost half of which involve the wrist and hand. OBJECTIVE To examine the incidence of acute wrist and hand injuries in 545 members of The Climbers' Club of Great Britain. METHOD A total of 1100 questionnaires were sent to current members of The Climbers' Club of Great Britain for them to detail any hand and wrist injuries sustained to date. In decade years, the climbing grades and time spent climbing at each grade were determined. From these results a total and historic climbing intensity score for each climber could be calculated. RESULTS Half of the questionnaires were returned complete. The respondents were almost entirely male. There were 235 wrist and hand injuries in 155 climbers (28%). The climbing intensity scores were significantly higher in the injury group than in those who had not suffered a wrist or hand injury (p<0.05). Finger tendon injuries were the most common injury, followed by abrasions/lacerations and fractures. DISCUSSION The most common injuries found in rock climbing involve the wrist and hand. The predominant injury to the hand involves the finger tendons or pulleys. The greater the climbing intensity calculated over a climber's career, the greater the likelihood of sustaining these injuries.
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Affiliation(s)
- A J Logan
- Orthopaedics, Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham LL13 7TD, Wales, UK.
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29
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30
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Abstract
BACKGROUND In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport. HYPOTHESIS Although the radiographic changes in long-term climbers are known, there are little data available on young 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 osteoarthrosis in the finger joints. STUDY DESIGN Cross-sectional study. METHODS Nineteen members of the German Junior National Team and 18 recreational climbers were examined clinically and through radiographs. For comparison, radiographs of 12 young nonclimbers (control group) were collected. Radiographs were evaluated using a standard protocol. For evaluation of the physiologic adaptation, the cortical thickness of the middle phalanx and the Barnett Nordin index were analyzed. The results were compared between the 3 groups and against radiographs of 140 long-term, experienced climbers. RESULTS Six climbers (32%) of the German Junior National Team presented a decreased range of motion for the small finger joints; none of the recreational climbers showed this decrease. In 47% of the German Junior National Team and 28% of the recreational climbers, stress reactions could be found: cortical hypertrophy (26% German Junior National Team, 11% recreational climbers), subchondral sclerosis (47% German Junior National Team, 6% recreational climbers), broadened base of the proximal interphalangeal joint (42% German Junior National Team, 28% recreational climbers), and broadened base of the distal interphalangeal joint (16% German Junior National Team, 0 recreational climbers). Signs of an early stage of osteoarthrosis were seen in 1 climber in each group. The control group showed no radiologic abnormalities. The Barnett Nordin index was 0.49 +/- 0.05 in German Junior National Team, 0.49 +/- 0.07 in recreational climbers, and 0.48 +/- 0.08 in the control group. There was no statistically significant difference on the Barnett Nordin index between the groups (German Junior National Team/recreational climbers: P = .89; German Junior National Team/control group: P = .58; recreational climbers/control group: P = .55). CONCLUSIONS Intensive training and climbing lead to adaptive reactions; nevertheless, osteoarthrotic changes are rare.
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31
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Abstract
Performance rock climbing places high demands on the hand and may lead to specific injuries. In a "one-finger-pocket" hold, the interphalangeal joints remain in 20-40 degrees flexion. To increase the maximum force of the holding finger by the quadriga effect, the interphalangeal joints of the adjacent fingers become almost maximally flexed. Holding a "one-finger-pocket" with the ring or small finger leads to a shift of the deep flexor tendons which increases the distance between the two adjacent origins of either the third or the fourth lumbrical. This may cause disruption and tear of that muscle. An organized haematoma in the third lumbrical was visible by ultrasonography in one of the three cases described.
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Affiliation(s)
- A Schweizer
- Orthopaedic Department, University Children's Hospital Basel, UKBB, Basel, Switzerland.
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33
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34
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Rose V, Moloney D, Fleming ANM. The bra-strap injury: should men have lessons? BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:179-80. [PMID: 11987977 DOI: 10.1054/bjps.2001.3751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Abstract
Sport climbing is associated with unique upper- and lower-limb injuries involving predominantly the hand, elbow, and shoulder, and to a lesser extent the foot. Many pathologic conditions are limited to sport climbing. Physicians treating sport climbers should be aware of these unique injuries and overuse syndromes. This article presents an overview of orthopedic problems (injuries, overuse syndromes, and fractures) resulting from sport climbing. Sport climbing is defined in the context of existing mountain sports, and its characteristics and technical terms are presented. The etiology, diagnosis, and specific treatment for orthopedic problems associated with sport climbing are described.
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Affiliation(s)
- P Peters
- Institute for Sports Medicine, University Paderborn, Germany.
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36
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Abstract
The purpose of this study was to determine whether circumferential taping of the base of the finger increases the A2 pulley's load to failure in a model simulating a rock climber's grip. Nine pairs of fresh-frozen cadaveric hands, 20 to 47 years of age, were rigidly mounted in a specialized jig that maintained the finger in the climber's "crimp" position. Two of the four fingers of each hand were reinforced over the A2 pulley with three wraps of cloth adhesive tape. The flexor digitorum profundus and superficialis tendons were distracted until pulley or tendon failure. Overall, A2 pulley strength was greater in male specimens than in female specimens, and the A2 pulley of the small finger was the weakest tested. The A2 pulley failed simultaneously with the A3 and A4 pulleys in 55% of the tests. In the remaining trials, a single pulley failed initially followed by the remainder of the sheath. Of the 72 fingers studied, complete data were available for comparison of 22 pairs of fingers. No statistically significant difference in load to A2 pulley failure was noted between the taped and untaped finger pairs. Based on our findings we do not support taping the base of the fingers as a prophylactic measure against flexor tendon sheath injury in the climbing athlete.
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Affiliation(s)
- W J Warme
- William Beaumont Army Medical Center, Department of Orthopaedics, El Paso, Texas 79920-5001, USA
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37
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Chell J, Stevens K, Preston B, Davis TR. Bilateral fractures of the middle phalanx of the middle finger in an adolescent climber. Am J Sports Med 1999; 27:817-9. [PMID: 10569373 DOI: 10.1177/03635465990270062301] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Chell
- Department of Trauma and Orthopaedic Surgery, University Hospital, Queens Medical Centre, Nottingham, United Kingdom
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38
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Klauser A, Bodner G, Frauscher F, Gabl M, Zur Nedden D. Finger injuries in extreme rock climbers. Assessment of high-resolution ultrasonography. Am J Sports Med 1999; 27:733-7. [PMID: 10569358 DOI: 10.1177/03635465990270060801] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Dynamic high-resolution ultrasonography findings obtained in 34 extreme rock climbers with finger injuries were compared with those in 20 healthy volunteers. Thicknesses of the flexor tendon and A-2 flexor tendon pulley system were measured at the base of the proximal phalanx. The distance between the tendon and phalanx was evaluated with the finger in extension and in forced flexion as a measure of bowstringing. Gliding ability of the flexor tendons was assessed during active and passive motion. Compared with healthy volunteers, climbers showed a significantly increased thickness of the flexor tendons and the flexor tendon pulley system but no impairment of the gliding mechanism. Only in climbers did the distance between tendon and phalanx increase from 0.14 cm (+/-0.07) during extension to 0.30 cm (+/-0.09) during forced flexion. In three climbers with complete A-2 pulley ruptures this distance was up to 0.51 cm (+/-0.15) during forced flexion. Clinically unsuspected synovial cysts, thickened joint capsules, fibrous tissue, or fluid collection were found only in climbers. We concluded that dynamic ultrasonography is a valuable tool for accurate assessment of early changes in "climber's finger." It provides useful information, especially in cases where clinical evaluation is difficult, and should be performed to select appropriate therapeutic management.
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Affiliation(s)
- A Klauser
- Department of Radiology, University of Innsbruck, Austria
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39
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Masmejean EH, Chavane H, Chantegret A, Issermann JJ, Alnot JY. The wrist of the formula 1 driver. Br J Sports Med 1999; 33:270-3. [PMID: 10450483 PMCID: PMC1756177 DOI: 10.1136/bjsm.33.4.270] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions. METHODS The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically. RESULTS Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs. CONCLUSIONS This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers.
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Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S. Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med 1998; 26:651-5. [PMID: 9784811 DOI: 10.1177/03635465980260050901] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bow-stringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6 degrees (range, 0 degree to 10 degrees) in group A and 4 degrees (range, 0 degree to 10 degrees) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.
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Affiliation(s)
- M Gabl
- University Hospital of Traumatology, Innsbruck, Austria
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41
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Abstract
Athletic injuries of the wrist are common. Wrist anatomy, biomechanics, and injury mechanisms are outlined for the athletic population. Common injuries are discussed in a biomechanical context for impact sports; racquet, stick, and club sports; and apparatus and external contact sports.
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Affiliation(s)
- S L Werner
- Steadman-Hawkins Sports Medicine Foundation, Vail, Colorado, USA
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