Volker Schöffl

The “Heel Hook”—A Climbing-Specific Technique to Injure the Leg

Acute injuries in rock climbing either come from a fall onto the lower leg or from performing a hard move and injuring the upper extremity. Further evaluations of lower leg injuries in rock climbing athletes have been performed recently finding sport characteristics such as peroneal tendon dislocations or chronic deformations of the feet. One injury mechanism described in case reports is the so-called heel hook position, which is used more frequently today compared with the beginngs of rock climbing. In addition, the number of these injuries is expected to rise with the increase in popularity of climbing and bouldering. Therefore, it is important to further analyze this pathology. We investigated 17 patients with injuries of the lower extremities after performing a heel hook.

Rock climbing-related subclavian vein thrombosis.

Paget-Schroetter syndrome, also known as upper extremity deep venous thrombosis (UEDVT), is a rare condition, characterised by a (sub-) total occlusion of the axillary-subclavian venous system due to thrombosis. UEDVT is the most common vascular condition among athletes so far; although the general incidence is low, this problem will become more frequent as a result of increased participation in climbing sports. The purpose of this report is to illustrate two cases in rock climbers where UEDVT developed during rock climbing or bouldering. Fortunately, both patients were diagnosed relatively early after the symptoms began, despite the ambiguity of UEDVT symptoms. This relatively unfamiliar condition may become more highly recognised as a potentially serious differential diagnosis of unspecific pain of the shoulder. Rock climbers are disposed to develop UEDVT due to frequent stress on the upper extremities during training or competition.

Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering

OBJECTIVE Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. Climbing athletes seem to be affected more frequently than others, as they strain the passive and active anatomical structures of their hands and fingers to maximum capacity during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which creates high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by contact pressure of the anatomical structures, are rare and occur nearly exclusively during climbing. METHODS We diagnosed 12 athletes with hamate hook fractures who presented with diffuse pain in the wrist joint, which occurred either during or after climbing. Radiographs or computed tomography revealed fractures in the hamate bones in most of the patients; therapy consisted of consequent stress reduction. RESULTS Follow-up investigations found that all athletes were free of symptoms after 10.7 ± 5.1 (6-24) (mean ± standard deviation with range) weeks. Resection of the hamate hook was necessary in 3 patients. All patients regained their preinjury climbing level. CONCLUSION Climbers with an unspecific, diffuse pain in the wrist need to be examined by radiograph and, if radiograph is unclear, computed tomography or magnetic resonance imaging to detect or exclude the diagnosis of hamate fracture in order to avoid severe complications.

The Bamberg Plate: An Alternative Procedure for Tibial TubercleFractures

Atypical fractures are challenging for surgeons, as standard procedures are not applicable [1,2]. An interesting alternative for avulsion fractures of the tibial tubercle is the Bamberg Plate, a selfadjusted calcaneus titanium plate [3,4]. This simple and inexpensive implant was originally developed for displaced fractures of the greater humerus-tuberosity, but has already proved its advantage in various other locations, such as the tibial head or the posterior collum of the acetabulum [3,4].

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.

Knee injuries in Rock climbing and Bouldering - An Update

Aims and Objectives: Rock climbing and bouldering is undergoing a worldwide “boom” and has recently been selected for the next Olympic summer games. Besides ground falls, an injury mechanism in this sport is the so-called heel hook position, which is used more frequently today due to changing training and competition modes, especially in indoor bouldering. With the rising number of knee injuries in climbing and bouldering, we now aimed to analyze this specific injury mechanisms and its underlying pathologies. Materials and Methods: Among 50 climbing athletes with unspecific knee pain, we identified 9 patients with injuries of the lower extremities after performing a heel hook. The outcome was evaluated at a minimum of 6 months after the injury and classified in a sport-specific score. After clinical examination and exclusion of the minor injuries we performed ultrasound and/or magnetic resonance imaging. Patients were treated conservatively with initial partial immobilization and early functional therapy with physiotherapy. Only one patient with a partial meniscus tear needed a surgical procedure. Results: All patients reported sudden dorsal-sided pain in the knee while performing the hook. Seven also reported hearing a snapping sound, similar to those reported in achilles tendon tears. Walking was difficult in all cases and all were limping. Five patients were diagnosed a strain of the lateral collateral ligament and two patients a lateral meniscus tear. The other patients had either a partial tear of the PCL, or a strain of the distal hamstring tendons. In 8 of 9 cases, we received “good” to “excellent” outcomes with a conservative approach. The popping sound at the time of injury may correspond to a change of the pivot of the tractus ileotibialis that then “jumps” over the condyle. While the hook is performed, there is frequently an active knee flexion involved, which thus changes the pivot of the tractus. Conclusion: In climbing and bouldering, injuries of the knee will further increase due to modern training and competition modes requiring the use of heel hooks. MRI shows the proper diagnosis and the proper therapeutic approach is conservative treatment. The outcome after heel hook injuries is good to excellent in most of the cases. Warm-up routine, an avoidance of muscular imbalances, and flexibility training can help to avoid injuries during heel hook.

Functional and Sports-Specific Outcome After Surgical Repair of Rotator Cuff Tears in Rock Climbers

OBJECTIVE The purpose of this study was to analyze the general (Constant Murley score) and sports-specific (change in International Climbing and Mountaineering Federation [UIAA] grade) outcome after surgical repair of rotator cuff injuries in rock climbers. METHODS In a retrospective study, 12 rock climbers (10 men, 2 women; age 55 years; SD±9; range 28-66 years [mean±SD with range] with rotator cuff lesions were re-evaluated 27±16 (12-72) months after arthroscopic surgical repair of the rotator cuff of the shoulder. The etiology of the rotator cuff pathology was equally chronic (age 61±12 [28-66] years) and acute (age 53±5 [51-65] years). The postoperative general outcome, including the Constant Murley score, was assessed with a standardized questionnaire and clinical examination. The postoperative sports-specific outcome was analyzed using the UIAA metric scale. RESULTS The postoperative Constant Murley score was 92±7 (80-98). All participants had already started climbing again; 11 of 12 climbers regained a climbing level within ±1.33 UIAA metric grades of their initial capability. CONCLUSION Arthroscopic repair of acute and chronic rotator cuff tears shows a good functional outcome, enabling most patients to regain a high level of rock climbing ability.

Slap lesions in high level sport climbers. Outcome after primary surgical long biceps tenodesis

Objectives: Shoulder injuries are on a rising numbers in rock climbers. Over a time frame of 4 years we found 17.2 % of all climbing injuries to be on the shoulder. SLAP lesions (superior labral lesion anterior to posterior) are herebye the most common injury. In our previsous analysis they accounted[for full text, please go to the a.m. URL]