Comprehensive Review of Rock Climbing Injuries

Less Talk More Chalk: A Retrospective Review of Rock Climbing-Related Trauma

Introduction Climbing is a strength and strategy-driven sport that has greatly increased in popularity over the last decade, partially due to its debut in the Tokyo 2020 Summer Olympics. With an increasing number of new climbers and the emergence of recreational indoor climbing facilities, fall injury risk remains a legitimate concern within the climbing community. This study evaluates the pattern of injury in trauma patients presenting to the Desert Regional Medical Center, a level 1 trauma center in Palm Springs, CA, following falls from height while rock climbing. Methods Our study retrospectively investigated a de-identified dataset on trauma patients at the Desert Regional Medical Center, a level 1 trauma center located in Palm Springs, CA, from 2016 to 2021. This analysis focused on 75 patients who presented following falls from height while rock climbing. We reviewed several parameters, including patient demographics, Injury Severity Score (ISS), hospital length of stay (LOS), injury type, and patient outcomes. Descriptive statistics including median values, standard deviations (SD), and P-values were assessed via Microsoft Excel. Several paired, one-tailed t-tests and a Pearson's correlation test were also conducted to further evaluate the association between variables within the dataset. Results In this retrospective analysis of patients presenting to the emergency department post-fall from heights while rock climbing, the patient profile was predominantly younger or middle-aged climbers under 60 years old (65, 86.7%). The mean patient age was 37 years old. The majority of patients were non-Hispanic (69, 92%), noting a male predominance (57, 76%). Most patients (60, 80%) required partial trauma code status. Hospitalization was required for most individuals (67, 89.3%), with several requiring intensive care unit (ICU) admission (29, 38.7%). The average hospital LOS was 6.7 amongst all admissions. Patients requiring LOS greater than 10 days had a higher average ISS (12.9) when compared to climbers with shorter lengths of admission (ISS of 10.4). There was no significant difference in ISS between younger patients (ISS of 9.3) and those 60 and older (ISS of 10.6). The most common critical injury was lower extremity fracture (36, 48%), noting no significant increase in injury incidence over the last five years. Conclusion Rock climbers who experience falls from cliffs are most at risk for a lower extremity fracture. Demographically, a majority of injured climbers in this study were young males, who may exhibit risk-taking behavior. To better prevent critical injuries within the climbing sector, we encourage an increase in safety measures (crash mats, harnessing) and the implementation of a new climber education program.

"Run-and-jump failure": new injury patterns in indoor bouldering

In recent years, professional and non-professional bouldering have seen a fundamental change in movement patterns towards complex movement sequences. This is associated with increased demands on the musculoskeletal system, especially the lower extremities, which can lead to new injury patterns. In the course of our clinical work, we have already seen an increasing number of lower extremity injuries after run-and-jump sequences, with a severe one being highlighted in this case report.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study

OBJECTIVES

To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.

METHODS

A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

RESULTS

A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).

CONCLUSION

The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Lower back pain in young climbers: a retrospective cross-sectional study

Objective

The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers.

Methods

The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS).

Results

A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes.

Conclusions

This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.

Risk factors and injury prevention strategies for overuse injuries in adult climbers: a systematic review

Introduction

Climbing is an increasingly popular activity and imposes specific physiological demands on the human body, which results in unique injury presentations. Of particular concern are overuse injuries (non-traumatic injuries). These injuries tend to present in the upper body and might be preventable with adequate knowledge of risk factors which could inform about injury prevention strategies. Research in this area has recently emerged but has yet to be synthesized comprehensively. Therefore, the aim of this study was to conduct a systematic review of the potential risk factors and injury prevention strategies for overuse injuries in adult climbers.

Methods

This systematic review was conducted in accordance with the PRISMA guidelines. Databases were searched systematically, and articles were deemed eligible based upon specific criteria. Research included was original and peer-reviewed, involving climbers, and published in English, German or Czech. Outcomes included overuse injury, and at least one or more variable indicating potential risk factors or injury prevention strategies. The methodological quality of the included studies was assessed with the Downs and Black Quality Index. Data were extracted from included studies and reported descriptively for population, climbing sport type, study design, injury definition and incidence/prevalence, risk factors, and injury prevention strategies.

Results

Out of 1,183 records, a total of 34 studies were included in the final analysis. Higher climbing intensity, bouldering, reduced grip/finger strength, use of a "crimp" grip, and previous injury were associated with an increased risk of overuse injury. Additionally, a strength training intervention prevented shoulder and elbow injuries. BMI/body weight, warm up/cool downs, stretching, taping and hydration were not associated with risk of overuse injury. The evidence for the risk factors of training volume, age/years of climbing experience, and sex was conflicting.

Discussion

This review presents several risk factors which appear to increase the risk of overuse injury in climbers. Strength and conditioning, load management, and climbing technique could be targeted in injury prevention programs, to enhance the health and wellbeing of climbing athletes. Further research is required to investigate the conflicting findings reported across included studies, and to investigate the effectiveness of injury prevention programs.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42023404031).

Palmar Shift of the Proximal Interphalangeal Joint in Different Grip Positions as a Potential Risk Factor for Periphyseal Injuries in Adolescent Climbers

INTRODUCTION

The aim of this study was to evaluate different grip positions as a contributing factor for primary periphyseal stress injuries of the finger phalanges in climbing.

METHODS

Ultrasound imaging of the proximal interphalangeal joint was performed on 37 asymptomatic adolescent climbers. Longitudinal images were obtained of middle and ring fingers of both hands in different grip positions (open, half-open, and crimp), unloaded and loaded. The translation between the dorsal head of the proximal phalanx and the shaft of the middle phalanx was measured in an unloaded and loaded situation for all grip positions. The resulting difference was determined as the palmar shift.

RESULTS

The mean age of the study population was 13 y. Results showed a palmar shift of 0.57 mm in a loaded crimp grip position compared to 0.13 mm in an open position and 0.20 mm in a half-open grip position. With a P value of <0.001, this shift was significantly higher in a crimp grip position compared to open or half-open grip positions.

CONCLUSIONS

This leads to an increase in joint incongruity and much higher peak forces on the dorsal aspect of the epiphyseal-physeal-metaphyseal complex, which is particularly vulnerable during the adolescent growth spurt. Thus, climbing and training behavior should be adapted accordingly during this phase by avoiding the crimp grip position until epiphyseal fusion.

Neuromechanics of finger hangs with arm lock-offs: analyzing joint moments and muscle activations to improve practice guidelines for climbing

Introduction

Climbing imposes substantial demands on the upper limbs and understanding the mechanical loads experienced by the joints during climbing movements is crucial for injury prevention and optimizing training protocols. This study aimed to quantify and compare upper limb joint loads and muscle activations during isometric finger hanging exercises with different arm lock-off positions.

Methods

Seventeen recreational climbers performed six finger dead hangs with arm lock-offs at 90° and 135° of elbow flexion, as well as arms fully extended. Upper limb joint moments were calculated using personalized models in OpenSim, based on three-dimensional motion capture data and forces measured on an instrumented hang board. Muscle activations of upper limb muscles were recorded with surface electromyography electrodes.

Results

Results revealed that the shoulder exhibited higher flexion moments during arm lock-offs at 90° compared to full extension (p = 0.006). The adduction moment was higher at 135° and 90° compared to full extension (p < 0.001), as well as the rotation moments (p < 0.001). The elbows exhibited increasing flexion moments with the increase in the arm lock-off angle (p < 0.001). Muscle activations varied across conditions for biceps brachii (p < 0.001), trapezius (p < 0.001), and latissimus dorsi, except for the finger flexors (p = 0.15).

Discussion

Our findings indicate that isometric finger dead hangs with arms fully extended are effective for training forearm force capacities while minimizing stress on the elbow and shoulder joints. These findings have important implications for injury prevention and optimizing training strategies in climbing.

Evaluation of finger cartilage composition in recreational climbers with 7 Tesla T2 mapping magnetic resonance imaging

Purpose

Sport climbing may lead to tissue adaptation including finger cartilage before apparent surface damage is detectable. The main aim was to assess finger cartilage composition with T2 mapping in young, active climbers and to compare the results to a non-climbers' collective. A secondary aim was to compare whether differences in cartilage T2 times are observed between older vs. younger volunteers.

Methods and materials

7 Tesla MRI of the fingers Dig.2-4 was performed using a multi-echo spin echo sequence. Manual segmentation of 3 ROIs at the metacarpal heads, 1 ROI at the base phalanx and 1 ROI at the proximal interphalangeal joint was performed. Included were 13 volunteers without history of trauma who are regularly performing climbing activities as a recreational sport (>20 h/month). These were age-matched with 10 control subjects not performing climbing activities.

Results

Mean age was 32.4 years for the climbing group and 25.8 years for the controls. Mean T2 values for the 5 different ROIs were 42.2 ± 7.8 msec for climbers and 41.4 ± 6.8 msec for non-climbers. No significant differences were observed for T2 values between both groups. However, higher age had a significant impact on T2 values for all assessed ROIs (higher age 44.2 ± 9.5, younger age 32.9 ± 5.7, p = 0.001).

Discussion

This study evaluated the cartilage composition of young, engaged climbers with a T2 mapping MRI technique with the purpose to depict early onset joint changes. No negative impact on cartilage composition due to the sport activity was found, whereas age-related effects on the cartilage seemed to be more prominent.

Flexor Tendon Pulley Injuries: A Systematic Review of the Literature and Current Treatment Options

Closed injuries of the finger flexor pulley system are rare among the general population, and most of them occur during rock climbing. During the last few decades, scientific interest on this topic has increased. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The research was limited from January 2000 to March 2022. PubMed and Scopus databases were investigated for full-text articles published in English, French, and Italian using the following MeSH terms: ([pulley rupture] OR [finger pulley lesion]) AND ([injur*] OR [ruptur*] OR [damage] OR [trauma*]). Initial screening results identified 461 studies, among which 172 were included after including additional records identified through other sources and excluding repeated studies. Finally, four clinical studies were included in the analysis. The methodological quality of the articles was evaluated through the methodological index for nonrandomized studies (MINORS) score. Our search identified four studies that enrolled a total of 189 patients, of whom 164 were male and 25 were female. We finally examined 154 patients with a total of 208 pulleys damaged. Except for the thumb, all fingers were involved. Depending on the type of flexor pulley injury, graded with Schöffl classification, 69 patients underwent a surgical procedure, whereas 85 patients were treated conservatively. Closed finger pulleys injury occurred in rock climbers and non - rock climbers. All patients had excellent results on the Buck-Gramcko score regardless of the return to sports activity. Considering the overall outcomes of the reviewed articles, functional results were satisfactory in both conservative and surgical treatment. Moreover, in grade 3 and 4, surgical results were positive regardless of the specific technique used for finger pulley reconstruction. Only minor complications were reported. Closed flexor tendon pulley injuries require a careful clinical and imaging examination to confirm the diagnosis. In most cases, positive clinical results can be achieved with either conservative or surgical therapy.

Closed flexor pulley injuries: A literature review and current practice

Background

Closed flexor pulley injuries are a clinical entity of great interest in hand surgery, and these lesions could be observed mainly in rock-climbing athletes.

Objective

An extensive literature search of PubMed, SCOPUS, Cochrane Library, and Web of Sciences databases on closed finger pulley rupture, related treatments, and outcomes were performed. All relevant information was used in this literature review.

Conclusions

Many athletes are potentially exposed to these uncommon injuries. Therefore, these lesions require careful examination and a high index of suspicion to confirm the diagnosis and identify the degree of soft tissue injury, particularly in patients not involved in sporting activities. The data summarized in this literature review demonstrated that according to Schöffl's classification, conservative treatment should be indicated for low-grade injuries (grade 1 or 2), whereas surgical treatment should be performed in patients with more severe acute injuries (grade 4). Grade 3 flexor pulley injuries lie in a grey area where conservative and surgical treatment may give good clinical and return-to-sport patient results.

Rock climbing confers distinct injury risk in pediatric versus adult populations: an analysis of twenty-year national trends

OBJECTIVES

The sport of rock climbing has recently gained in popularity due in part to its adoption by noncompetitive athletes as a physical activity with a level of intensity that can be self-regulated. However, the epidemiology of rock climbing injuries is poorly described at the national level.

METHODS

We report demographic and injury characteristics from 85,235 national weighted estimates of rock climbing injuries presenting to United States (US) emergency departments (EDs) between 2000 and 2019 in the National Electronic Injury Surveillance System, stratifying by whether patients were ≤18 years of age (A) or ≥19 years of age (B).

RESULTS

The national weighted estimate of patients presenting to US EDs with injuries associated with rock climbing rose significantly (p < 0.001) from 2000 (2,667, CI 1,777-3,557) to 2019 (7,087, CI 4,544-9,630). Patients ≤18 years of age were significantly less likely to be male (A: 56.3%, CI 52.0-60.6%; B: 64.7%; CI 60.4-69.0%; p = 0.003), sustain injuries on weekends (A: 29.8%, 24.5-35.1%; B: 64.7%, CI 60.4-69.0%; p = 0.002), or sustain injuries during summer seasons (A: 26.6%, CI 22.1-31.1%; B: 33.2%, CI 28.1-38.3%; p = 0.049). Multivariate logistic regression demonstrated that patients ≤18 years of age were significantly more likely to present to EDs with head and neck (OR: 1.52, CI 1.04-2.21; p = 0.032) or upper extremity (OR: 1.55; CI 1.24-1.93; p < 0.001) injuries associated with rock climbing.

CONCLUSION

We identified a significant increase in the annual estimated number of patients presenting to US EDs with rock climbing injuries compared to what has previously been reported. As the number of climbers continues to grow, standardized safety policies may be implemented that specifically target injury mechanisms and patterns unique to both adult and pediatric populations.

Upper Extremity Injuries in Rock Climbers: Diagnosis and Management

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.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers

INTRODUCTION

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers.

METHODS

Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y^-1, prior to age 12 y (late specialization if after age 12 y).

RESULTS

Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups.

CONCLUSIONS

Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

Nonoperative Treatment of Finger Flexor Tenosynovitis in Sport Climbers—A Retrospective Descriptive Study Based on a Clinical 10-Year Database

Simple Summary

Finger flexor tenosynovitis is among the most frequent overuse injuries in sport climbers. Targeted therapy is currently based mostly on reports of the anecdotal practical experience of single centers rather than scientific investigations, as there is very little research available on this pathology. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis treatments in sport climbers by retrospectively asking patients about injury triggers, therapy contents and outcomes. All patients were initially treated conservatively, and only one of the patients needed further therapy in the form of a single injection with hyaluronic acid; none of them underwent further operative treatment. The average symptom duration was 30.5 weeks, and all patients were able to resume climbing, with approximately 75% of them regaining or exceeding their initial climbing level. These good to excellent outcomes and no correlation between particular therapy contents and therapy outcome suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations from this study.

Abstract

The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.

Injuries in outdoor climbing: a retrospective single-centre cohort study at a level 1 emergency department in Switzerland

Objectives

Outdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland.

Methods

A retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012-December 2018.

Results

78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1-38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF.

Conclusions

Accidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.

Evaluation of a Diagnostic-Therapeutic Algorithm for Finger Epiphyseal Growth Plate Stress Injuries in Adolescent Climbers

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.

Patterns of traumatic outdoor rock-climbing injuries in Sweden between 2008 and 2019

Purpose

Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden.

Methods

Patients that experienced a climbing related traumatic injury during outdoor climbing between 2008 and 2019 and who submitted a self-reported questionnaire to the Swedish Climbing Association were included in the study. Medical records were retrieved, and the International Climbing and Mountaineering Federation injury classification system was used for injury presentation.

Results

Thirty-eight patients were included in the study. Seven (18%) injuries occurred during traditional climbing, 13 (34%) during sport climbing and 9 (24%) during bouldering. Varying with climbing discipline, 84–100% injuries were caused by falls. Injuries of the foot and ankle accounted for 72–100% of the injuries. Fractures were the most common injury (60%) followed by sprains (17%) and contusions (10%).

Conclusions

Traumatic injuries sustained during outdoor climbing in Sweden were predominantly caused by falls and affected the lower extremities in all major outdoor climbing disciplines. Rope management errors as a cause of injury were common in sport climbing and in activity surrounding the climbing, indicating there is room for injury-preventing measures.

Unusual rupture of the middle finger flexor digitorum superficialis tendon in a climber: Biomechanical analysis

Sport climbing is increasingly popular and consultations by climbers in hand surgery departments are on the increase. The pathologies related to this sport concern essentially the pulley system, tendons being rarely affected. We report the case of a male climber who presented an atypical rupture of the flexor superficialis tendon in his left middle finger sustained when using an atypical climbing grip technique: the "hook grip". This consists in extension of the metacarpophalangeal joints and maximal flexion of the proximal interphalangeal joints with force exerted only on middle phalanx of the middle finger. A biomechanical analysis using finger musculoskeletal modeling was performed to compare the hook grip to other grips, and the patient's recovery performance was assessed. Adapted functional treatment with physiotherapy seems to have been a good option for the treatment of this atypical lesion since the patient recovered normal use of his finger in daily life. He recovered maximal force in climbing holds. The biomechanical analysis confirmed that the atypical "hook grip" was likely at the origin of the rupture, since flexor digitorum superficialis tendon force for this grip is greater than in other climbing grip techniques. The "hook grip" seems to be dangerous and should be used cautiously by climbers to prevent similar pathology. Additionally, the patient should henceforth be careful when climbing, since the biomechanical model showed that the remaining flexor digitorum profundus tendon was overused.

Acute Septic Carpal Tunnel Syndrome in a Rock Climber

Introduction:

Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Our purpose is to describe an acute septic carpal tunnel syndrome following rock climbing at an indoor climbing gym in a patient who required urgent irrigation and debridement.

Case Report:

A 33-year-old Caucasian male presented with an acute septic carpal tunnel syndrome 4 days after rock climbing at an indoor gym. On physical examination, he exhibited numbness over the fingers, significant tenderness to palpation, and pain with passive range of motion. His inflammatory markers were markedly elevated and deep space hand infection was confirmed with computed tomography scans. The patient was taken for urgent exploration, irrigation and debridement, and carpal tunnel release.

Conclusion:

We theorize that the patient had an abrasion on the finger or palm that created an entryway for a pathogen. We are unaware of another report of a deep space hand infection associated with rock climbing activities. This case report will hopefully spread awareness of this clinical entity to improve evaluation and prevention of hand infections in rock climbers, as well as providing guidelines for appropriate and timely treatment of the condition.

Rock Climbing Emergencies in the Austrian Alps: Injury Patterns, Risk Analysis and Preventive Measures

To elucidate patterns of and risk factors for acute traumatic injuries in climbers in need of professional rescue, a retrospective evaluation was performed of the Austrian National Registry of Mountain Accidents regarding rock climbing incidents over a 13-year timeframe from 2005 to 2018. From 2992 recorded incidents, 1469 were uninjured but in need of recovery, mainly when alpine climbing. Acute traumatic injuries (n = 1217) were often classified as severe (UIAA ≥ 3; n = 709), and commonly involved fractures (n = 566). Main injury causes were falls (n = 894) frequently preceded by rockfall (n = 229), a stumble (n = 146), a grip or foothold break-out (n = 143), or a belaying error (n = 138). In fatal cases (n = 140), multiple trauma (n = 105) or head injuries (n = 56) were most common, whereas lower extremity injuries (n = 357) were most common in severely injured patients. The risk for severe or fatal injuries increased with age and fall height when ascending or bouldering, during the morning hours, and when climbing without a helmet or rope. The case fatality rate was 4.7%, and the estimated total mortality rate was 0.003–0.007 per 1000 h of rock climbing. Acute traumatic injuries requiring professional rescue when rock climbing are often severe or fatal. Consequent use of a helmet when sport climbing, consistent use of a rope (particularly when ascending), proper spotting when bouldering, and proper training, as well as high vigilance when belaying are likely to help prevent such injuries.