Climbing Injuries Research Articles

Assessing Finger Flexor Pulley Injuries in Climbers: A Comprehensive Review of Clinical and Functional Testing Methods

Objectives: This systematic review addressed the following questions: what are the most recommended diagnostic criteria for pulley injuries in finger flexors among climbers? What is the best functional or classification clinical test for these injuries based on the available evidence? Materials and Methods: Following the PRISMA Statement checklist, a systematic literature review was conducted between August and September 2023, using a search on the PubMed database with a string of keywords and MeSH terms. The PEDro scale was used to analyze bias in the individual studies examined. Conclusions: Based on the exclusion criteria and research question, 14 articles with heterogeneous study designs were selected. Studies involving diagnosis through clinical examination or instrumental tests were analyzed. The data obtained provide an overview of different diagnostic and classification criteria for the injury under consideration. Ultrasounds remain the gold standard in diagnosing finger pulley injuries. The distance between the tendon and bone is the most used diagnostic criterion, with a distance greater than 2 mm corresponding to an A2 or A4 pulley injury. The clinical sign of bowstringing coincides with a multiple pulley injury involving A2, A3, and A4. Clinical signs, ultrasounds, and grip strength should be evaluated for a comprehensive diagnosis. A grip deficit of 41.4% corresponds to a pulley injury.

More Than Just Another Elbow Tendinopathy: A Case Series of Misdiagnosed Ulnar Nerve Compression and Review of Common Upper Extremity Misdiagnoses in Climbing

Abstract Climbing is an increasingly popular sport. Yet, we have encountered numerous misdiagnosed climbing injuries, highlighting a gap in climbing-related literature and a need for heightened awareness within the sports medicine community. We present a case series that highlights the clinical manifestation of ulnar nerve entrapment and compression in three patients with initially misdiagnosed and mismanaged elbow tendinopathy. After a correct diagnosis of ulnar nerve pathology was made, each patient underwent a prescribed rehabilitation protocol that focused on nerve motility exercises (tensioning and flossing), resulting in a significant reduction in pain and a successful return to their pre-injury climbing performance. We thus aim to raise awareness of this often-mistreated presentation. Furthermore, we highlight other common upper extremity climbing misdiagnoses and provide relevant clinical recommendations to accurately identify and manage such injuries in climbers.

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

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

Wrist Injuries in Climbers

Background: Acute and chronic injuries to the wrist are among the most common sport-related complaints of climbing athletes but have not been extensively evaluated in this population. Therefore, it is important to categorize climbing injuries to the wrist, analyze risk factors, and assess treatment outcomes. Purpose: To evaluate the distribution, outcomes, and influencing factors of wrist injuries in climbers. Study Design: Case series; Level of evidence, 4. Methods: Climbing athletes with wrist injuries who presented to our specialized sports medical center over the course of 4 years (2017-2020) were selected. All had prospectively completed questionnaires including their climbing-specific background (years of training, climbing level, training methods, etc). Injuries were analyzed (International Climbing and Mountaineering Federation [UIAA] grade and diagnosis), and treatment methods and outcomes were retrospectively assessed with a minimum follow-up of 2 years. Parameters included the climbing score, visual analog scale for pain score, Patient-Rated Wrist Evaluation (PRWE) score, and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score including the sport component (DASH–Sport) score before and after treatment as well as time to return to climbing. Results: A total of 69 patients (25 female, 44 male) with 78 wrist injuries were identified and analyzed. Of these, 7 injuries were bilateral, occurring at the same time, and 2 injuries were independent reinjuries to either the same or the contralateral side. In addition, 24 injuries (30.8%) were acute, while 54 (69.2%) were chronic. Overall, 2 injuries had a UIAA grade of 3; all others had a UIAA grade of 2. The most frequent injuries were synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains (joint capsular pain with stress, with no pathological finding on magnetic resonance imaging), and wrist ganglion cysts. Nonoperative treatment was performed for 61 of the injuries, while 17 were treated surgically. In 51 cases (65.4%), injuries healed without consequences; in 27 cases (34.6%), discomfort remained. The visual analog scale pain score decreased from 4.8 ± 1.9 before treatment to 0.7 ± 1.0 after treatment (P < .001), the PRWE score decreased from 53.6 ± 24.9 to 10.3 ± 13.1 (P < .001), the QuickDASH score improved from 53.0 ± 16.6 to 20.0 ± 20.2 (P < .001), and the DASH–Sport score improved from 82.0 ± 16.1 to 38.1 ± 23.5 (P < .001). The climbing score improved from 2.5 ± 1.1 to 4.3 ± 1.0 points (P < .001). The patient-reported number of days with pain was negatively correlated with changes in the PRWE score (r = −0.351; P < .001), QuickDASH score (r = −0.316; P = .007), and climbing score (r = −0.264; P = .025) as well as the number of days without climbing (r = −0.266; P = .025). The number of days without climbing was positively correlated with changes in the PRWE score (r = 0.369; P < .001). Conclusion: Wrist injuries in climbers constituted a diverse set of diagnoses. Ulnar-sided injuries were most common, and many patients had >1 diagnosis. Outcomes for all treatment methods (surgery and nonoperative care) were favorable, but approximately one-third of climbers had persistent wrist discomfort after treatment, underscoring the need for accurate diagnoses and acute and expert care.

Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers.

Traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, with rising numbers over the last years. The objective of this study was to analyze the outcome following traumatic first-time shoulder dislocation and subsequent surgical treatment in this population. In a retrospective study, climbers who experienced a traumatic shoulder dislocation were treated with an arthroscopic repair of the labrum-ligament complex (LLC). The functional outcome was assessed with a standardized questionnaire and clinical examination, including the Constant Murley and Single Assessment Numeric Evaluation scores. The sport-specific outcome was analyzed using the Union Internationale des Associations d'Alpinisme (UIAA) scale of difficulty and a sport-specific outcome score. The functional and sport-specific outcome for 27 climbers (20 men; 7 women; 3 with bilateral injuries; age, 34±11 [17-61] y; data presented as mean±SD [range]) was assessed 53±29 (12-103) mo after surgery. The postoperative Constant Murley score was 95±8 (67-100) points. At follow-up, 93% (n=25) of patients had started climbing again. Twenty-one climbers (78%) reached a climbing level within the range of ±0.33 UIAA grades of their initial capability or even exceeded their preinjury grade. Only 7% (n=2) of the patients had a recurrent shoulder dislocation, leading to a secondary surgery, and, therefore, required ongoing postoperative treatment at the time of follow-up. Arthroscopic repair of the LLC following first-time traumatic shoulder dislocation in climbers shows a good outcome and a low recurrence rate. After surgery, most patients are able to regain a high level of rock-climbing ability.

A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury

Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.

Escalada e Lesões no Membro Superior

Climbing sports are having an exponential growth nowadays, placing unique demands on the upper body, so that injuries to this region are common. This paper discusses the various types of injuries that can occur, including strains, sprains, dislocations, and fractures, and explores the factors that contribute to their development. It is necessary to understand the preventive measures such as proper warm-up, strengthening exercises, and proper technique, as well as treatment options for climbers who experience upper body injuries. Ultimately, proper training, conditioning, and safety measures are of utmost importance in preventing and managing upper body injuries in climbers.

Causes, Diagnosis and Treatment of Finger Flexor Pulley Injuries in Climbers – a Literature Review

Introduction: Climbing, which has recently become very popular, causes significant loads on the upper limbs, especially the fingers, which often leads to a closed traumatic rupture of the finger flexor pulleys.

Use of closed chain exercises, eccentric exercises, and proprioceptive muscle facilitation to prevent elbow injuries in climbers: a randomized control trial

IntroductionTo determine the influence of exercises in a closed kinematic chain, exercises in eccentric mode in combination with proprioceptive muscle facilitation on the level of injuries and technical skill of amateur climbers.MethodsThe participants in this study were 84 male amateur rock climbers, aged 18–19; 40 athletes were in the Intervention Group and 44 athletes were in the Control Group. In the Intervention Group, a developed injury prevention program was used. The program included the use of neuromuscular training. Exercises for proprioceptive muscle facilitation were also used. We determined the Incidence rate ratio and confidence intervals and the reliability of the influence of the level of mastery of the technique on the number of injuries by the Cochran’s and Mantel-Haenszel methods.ResultsThe use of our program reduces the Incidence rate ratio in climbers for mild, moderate and severe elbow injuries; a significant decrease was found for moderate and severe injuries. There was also a significant improvement in the results of biomechanical analysis of climbing technique in athletes in the Intervention Group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). There was a high reliability of the influence of the level of mastery of the technique on the number of injuries (&lt;i&gt;p&lt;/i&gt; &lt; 0,001).ConclusionsThe use of exercises in a closed kinematic chain, exercises in eccentric mode in combination with proprioceptive muscle facilitation reduces the Incidence rate ratio of the shoulders and increases technical skill among amateur climbers.

Epidemiology of Ice Climbing Injuries Among Recreational Ice Climbers at the 2019 Ouray Ice Climbing Festival.

As a close relative to the sports of mountaineering and rock climbing, water ice climbing has been traditionally considered "high risk." There is little data to support or refute this assertion. Prior estimates of the injury rate range from 4.8 to 248 injuries per 1000 participation hours. In this study, we characterized the types of injuries and determined an injury incidence among water ice climbing participants at the 2019 Ouray Ice Festival climbing manmade ice walls. A survey was distributed during the 2019 Ouray Ice Festival in Ouray, Colorado. Respondents were asked to include festival-related injuries and estimate their participation time at the 4-d festival. Individuals who reported an injury were asked to provide additional details with regard to injury type, location, and timing. The injury incidence rate was calculated as the total number of injuries reported divided by the total number of participation hours and is reported as injuries per 1000 participation hours. A total of 75 surveys were analyzed. A total of 16 injuries, all which were minor, and 912 participation hours were reported, resulting in an injury incidence of 17.6 injuries per 1000 participation hours. This study reports an injury incidence based on an unselected sample of water ice climbers at an ice climbing festival. Water ice climbing at festivals appears to result in injuries of minor severity with no major accidents or fatalities. This study could be repeated to confirm its validity with a larger sample size.

Rock Climbing Injuries in the Youth Population

Rock Climbing Injuries in the Youth Population

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.

Comprehensive Review of Rock Climbing Injuries.

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.

Current Trends in Sport Climbing Injuries after the Inclusion into the Olympic Program. Analysis of 633 Injuries within the years 2017/18

Current Trends in Sport Climbing Injuries after the Inclusion into the Olympic Program. Analysis of 633 Injuries within the years 2017/18

Are Adolescent Climbers Aware of the Most Common Youth Climbing Injury and Safe Training Practices?

Finger growth plate injuries are the most common youth climbing injuries. The purpose of our study was to understand youth awareness of the most common youth climbing injury and safe training practices. We surveyed climbers, ages eight to 18 years old, at the 2017 USA Climbing Sport and Speed Youth National Championships. A total of 267 climbers completed the survey (mean age = 14 ± 2.7 years; 52% male). The A2 pulley injury was reported as the most common youth climbing injury by the largest portion of participants, 36%. The second most commonly identified injury was at the growth plate of the finger, 15% of participants, which was reported as significantly less than the A2 pulley injury, p < 0.001. Six percent of climbers reported the correct safe age to start double dyno campus board training. Roughly 18% of athletes identified growth plate injuries exclusively as a stress fracture, whereas 29.2% of those climbers self-reported as informed about finger growth plate injuries, but only 7.4% of climbers who self-reported as uninformed answered this question correctly. Misperceptions about skeletally-immature climbing injuries are prevalent amongst youth climbers. Education on the prevalence of finger growth plate injuries and the scarcity of A2 pulley injuries in youth climbers can increase diagnostic accuracy, improve care, and reduce long-term complications.

Musculoskeletal Injuries in Climbers

This article aims to review the epidemiology of musculoskeletal injuries in climbers, risk factors leading to those injuries, and treatment and prevention strategies specific to climbers. Most chronic climbing injuries occur in the upper extremities, especially the hands, and are due to overuse. Outdoor climbing is associated with a higher rate of injury than indoor climbing, and among indoor climbing sub-disciplines, bouldering has the highest injury rate. Further research is needed to identify specific techniques or training regimens that may lead to injury, and furthermore, if changing technique during training or competition could reduce these injuries. The types and incidences of most climbing injuries are fairly well documented. Evidence-based treatment and prevention strategies for chronic climbing injuries are limited, but many injuries can be managed conservatively with rest, activity modification, and rehabilitation. More work is needed to identify modifiable risk factors for climbing injuries.

Rock Climbing Injuries Treated in US Emergency Departments, 2008–2016

Previous research identified a trend for increasing numbers of injuries sustained while rock climbing. This study investigates whether that trend continued and describes characteristics of climbing injuries. The National Electronic Injury Surveillance System registry was searched for rock climbing injuries in US emergency departments in 2008 through 2016 among patients aged ≥7 y. Variables included each patient's age, diagnosis, injured body part, mechanism of injury, and disposition. Injuries were graded using International Mountaineering and Climbing Federation injury grades. National estimates were generated using sample weighting. An estimated 34,785 rock climbing injuries were seen in emergency departments nationally, a mean of 3816 per year (SD 854). The median age of injured climbers was 24 y (range 7-77), with those aged 20 to 39 y accounting for 60% and males for 66%, respectively. Fractures (27%) and sprains and strains (26%) were the most common types of injuries. The most frequently injured body parts were lower extremities (47%), followed by upper extremities (25%). The most commonly fractured body part (27%) was the ankle. The knee and lower leg accounted for 42% of all lacerations and were 5.8 times as likely as lacerations to other body parts. Falls were the most common mechanism, accounting for 60% of all injuries. This study reports continued increase in annual numbers of climbing injuries. Whether this is based on a higher injury rate or on a higher number of climbers overall cannot be stated with certainty because no denominator is presented to estimate the injury rate among climbers.

Incidence, Diagnosis, and Management of Injury in Sport Climbing and Bouldering: A Critical Review.

Competition climbing will debut as an Olympic sport at the 2020 summer games in Tokyo. The aim of this article is to critically review research on the incidence of injury in sport climbing and bouldering. The pathophysiology and clinical presentation of finger and shoulder injuries is discussed. A semisystematic approach in reviewing literature on incidence was applied. Articles were identified after searches of the following electronic databases: Discover, Academic Search Complete (EBSCO), PubMed, Embase, SPORTDiscus, and ScienceDirect. Despite methodological shortcomings of the included studies, we estimated the mean ± SD of the incidence rate of injury in sport climbing and bouldering from the eight studies to be 2.71 ± 4.49/1000 h. Differential diagnosis and the clinical management of finger and shoulder injuries in climbers are challenging. An updated diagnostic and therapeutic algorithm for the clinical management of finger injuries in climbers is presented.

Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock Climbing Injuries

To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries. Design: retrospective cross-sectional study. web-based survey. 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. none. 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. 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. 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.

A 1-Year Prospective Analysis of Ice Climbing Injuries.

To describe rates, patterns, and causes of acute injuries in an increasingly popular outdoor sport. Prospective cohort study. One winter season ranging from November 2011 to March 2011. Seventy ice climbers from 13 different countries and various performance levels. Participants were asked to complete a monthly Internet-based survey regarding their completed hours of training and competitions and eventual sustained injuries. During 4275 hours of ice climbing, 42 injuries occurred, of which 81.0% were defined as mild, 16.6% as moderate, and 2.4% as severe. The calculated injury rate was 9.8 injuries per 1000 hours of sports exposure. Intermediate ice climbers had a significantly higher injury risk compared with advanced ice climbers (odds ratio, 2.55; 95% confidence intervals, 1.17-5.54; P = 0.018). About 73.8% of all injuries occurred on a frozen waterfall, icicles, or icefalls, whereas 4.8% occurred on artificial ice walls. The head was the most injured body part (47.6%), followed by the knee (14.3%) and the shoulder (11.9%). The most common types of injuries were abrasions (38.1%), contusions (35.7%), and joint sprains (7.1%). Falling ice was the main circumstance leading to injury (59.5%). All athletes with a head injury wore a helmet; however, only 35.0% mentioned they used protective goggles. Ice climbing is a sport with moderate risk for injury with most of the reported injuries being of minor severity. However, severe and fatal injuries, although less common, also occur. Advanced ice climbers with greater experience and skill level have a lower overall injury risk.