Isabelle Schöffl

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing

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.

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

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.

Impact of taping after finger flexor tendon pulley ruptures in rock climbers.

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.

Surgical Repair of Multiple Pulley Injuries—Evaluation of a New Combined Pulley Repair

PURPOSE We report on a combined repair of multiple annular pulley tears using 1 continuous palmaris longus tendon graft to restore strength and function. METHODS We treated 6 rock climbers with grade 4 pulley injuries (multiple pulley injuries) using the combined repair technique and re-evaluated them after a mean of 28 months. RESULTS All patients had excellent Buck-Gramcko scores; the functional outcome was good in 4, satisfactory in 1, and fair in 1. The sport-specific outcome was excellent in 5 and satisfactory in 1. Proximal interphalangeal joint flexion deficit slightly increased in 1 patient and remained the same in the other 5. Climbing level after the injury was the same as before in 4 and decreased slightly in 2 climbers. CONCLUSIONS The technique is effective with good results and has since become our standard treatment. Nevertheless, it is limited in patients with flexion contracture of the proximal interphalangeal joint. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.

“Vodka Energy”: Too Much for the Adolescent Nephron?

We report here the case of a 17-year-old boy who suffered acute renal failure after consuming 3 L of energy drink (ED) in combination with 1 L of vodka amounting to 4600 mg of taurine and 780 mg of caffeine mixed with 380 g of alcohol. The consumption of this mixture is extremely popular in adolescents, because the joint effects of caffeine and taurine reduce the effect of alcohol. Although there have been case reports of deaths linked to the consumption of EDs with and without alcohol, awareness of the possible dangers is still low. The fact that athletes and major sports events are sponsored by ED manufacturers implies that they may even be healthy and performance-enhancing.

Extensor Hood Syndrome—Osteophytic Irritation of Digital Extensor Tendons in Rock Climbers

OBJECTIVE Injuries to the flexor tendons and flexor tendon pulleys are frequently reported in rock climbers. Osteoarthritic changes with bone spurs are also well known. We report on the less commonly described extensor tendon irritation caused by such osteophytes. METHODS Thirteen high-level rock climbers (12 men, 1 woman; average age 33.8 years [range 17-55]; average years of climbing experience 19 [range 5-30]; average climbing level 10.2) with extensor hood irritation caused by dorsally located osteophytes of proximal interphalangeal (n = 10) or distal interphalangeal joints (n = 3) were evaluated and managed. Twelve climbers received conservative therapy and 1 climber was treated surgically. RESULTS Before treatment, the climbers were unable to achieve their normal climbing ability due to extensor tendon irritations with resultant effusion noted in the ultrasound examinations. After conservative treatment, and in 1 case surgery, all patients achieved their previous climbing ability. CONCLUSION While all climbers were able to achieve their former climbing level after treatment, the condition is progressive and the osteoarthritic changes will likely cause further problems for these individuals in the future. Extensor hood irritation must be considered in the differential diagnosis of finger pain in rock climbers.

Isolated cruciate pulley injuries in rock climbers.

flexor carpi radialis (FCR) tendon. He had no relevant medical history and did not take any medication. On examination there was no swelling or deformity. There was tenderness along the FCR tendon and over the scaphotrapeziotrapezoidal (STT) joint. The scapholunate ligament (SLL) was not tender. There was normal wrist extension, pronation and supination, and mildly reduced flexion. There was no evidence of scaphoid instability. A provisional diagnosis of FCR tendinitis was made. Ultrasound and MRI scans showed a small ganglion near the pisiform. The FCR tendon was shown to be of normal size. Triamcinolone (10mg) was injected into the FCR tendon sheath. He was still symptomatic a few months later, so the MRI scan was repeated. This showed small perforations within the SLL. An arthroscopy was then performed and a complete SLL rupture was found. SLL reconstruction was carried out 1 year after the original steroid injection. We planned for a Brunelli reconstruction using a portion of the FCR tendon, but at the time of operation the FCR tendon was found to be attenuated and thus unsuitable for use (Fig 1). A reverse Blatt capsulodesis was done instead. It is well recognized that steroid use can damage tendons and is associated with spontaneous ruptures (Haraldsson et al., 2006; Kramhøft and Solgaard, 1986; Mahler and Fritschy, 1992). FCR tendinitis is a fairly common condition which is routinely treated with local steroid infiltration. The FCR tendon is often harvested for use in reconstruction of other soft tissues, as its absence has little effect on wrist function (Tomaino and Coleman, 2000). We present this case to highlight the importance of preoperative history-taking, with particular emphasis on any earlier steroid infiltrations, when planning to use tendons for reconstructions.

Pediatric and adolescent injury in rock climbing

ABSTRACT Rock climbing is a fast-growing sport performed by athletes in all age groups, especially youths. While epidemiological data are available for injuries in adults, these data are lacking for young climbers. The current literature shows it being a comparably safe activity, mostly in indoor and sport climbing. Age related self-responsibility is necessary under guided supervision by an adult. Injuries are mostly related to a fall (e.g. alpine environment) or overstrain. Epiphyseal stress fractures of the fingers are a major concern, especially during the pubertal growth spurt. A critical evaluation of finger pain in young climbers as well as a neglect of certain training exercises is crucial. Suggestions for injury prevention and further research are provided.

Strength Measurement and Clinical Outcome after Conservatively Treated Pulley Ruptures in Climbers

Ruptures of the finger flexor pulleys are the most frequent injuries in rock climbers. While 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. 21 rock climbers (age: 34±9 years) with a grade 2–4 pulley injury were re-evaluated 3.46 (range: 0.25 – 18) years 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 doorframe. while standing on a force platform, which measured the relative release. The 21 subjects had old (3.46 years, range: 0.25 –18) pulley injuries on 27 fingers (10 A2, 1 A3, 11 A4, 3 A2/3, 2 A3/4). The clinical outcome was excellent (Buck-Gramcko-Score) 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 healty finger in either the hanging or the crimping finger position.

Long-Term Radiographic Adaptations to Stress of High-Level and Recreational Rock Climbing in Former Adolescent Athletes: An 11-Year Prospective Longitudinal Study

Background: In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport. Purpose: While radiographic changes in long-term climbers are known, there are little data available on adolescent climbers. The question arises as to whether climbing at high levels at a young age leads to radiographic changes and possibly an early onset of osteoarthritis of the finger joints. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 19 members of the German Junior National Team (GJNT group) and 18 recreational climbers (RC group) were examined clinically and radiographically in 1999. In 2011, these climbers were re-examined (mean follow-up, 11.3 ± 1.2 years). Radiographs were evaluated using a standard protocol, searching for physiological adaptations such as cortical thickness of the middle phalanx and an increased adopted Barnett-Nordin index, as well as for early-onset osteoarthritic changes of the hand. In contrast to the Kellgren-Lawrence scale, subchondral sclerosis was added to the group of physiological, adaptive stress reactions and was not defined as osteoarthritis. Osteoarthritis was defined by a Kellgren-Lawrence grade ≥2. Results: Overall, 15 of 19 (follow-up rate, 78.9%) climbers in the GJNT group and 13 of 18 in the RC group (follow-up rate, 72.2%), with a mean age of 26.8 years, were examined at the 11-year follow-up. Five climbers (33%) in the GJNT group presented with a decreased range of motion for the finger joints, in contrast to only 1 climber (8%) in the RC group. Radiographic stress reactions of the hand were found in 80% of the GJNT group and 46% of the RC group, including cortical hypertrophy (GJNT: 73%; RC: 23%), subchondral sclerosis (GJNT: 80%; RC: 31%), a broadened proximal interphalangeal joint base (GJNT: 67%; RC: 38%), and a broadened distal interphalangeal joint base (GJNT: 53%; RC: 31%). Training intensity in 1999 and body weight in 1999 were significant for the development of radiographic stress reactions in 2011 (P < .05 for both). Signs of early-stage osteoarthritis were seen in 6 climbers: 4 (27%) in the GJNT group and 2 (15%) in the RC group. Significant statistical influences for the development of early-onset osteoarthritis were found for overall total training years (P = .024), use of campus board training in 1999 (P = .033), and climbing level (P = .030). Conclusion: One-quarter of climbers who performed at a high level in their youth showed a “mild” form of osteoarthritis (Kellgren-Lawrence grade 2). In analyzing the training regimens of our climbers for longer than 10 years, we conclude that intensive finger training (eg, campus board training) can lead to early-onset osteoarthritis of the hand. We also demonstrate that a high Union Internationale des Associations d’Alpinisme (UIAA) climbing level correlates with the risk for early-onset osteoarthritis of the hand and therefore must be seen as a risk factor for developing early-onset osteoarthritis of the finger joints.