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.

Comparison of three local frame definitions for the kinematic analysis of the fingers and the wrist.

Because the hand is a complex poly-articular limb, numerous methods have been proposed to investigate its kinematics therefore complicating the comparison between studies and the methodological choices. With the objective of overcoming such issues, the present study compared the effect of three local frame definitions on local axis orientations and joint angles of the fingers and the wrist. Three local frames were implemented for each segment. The "Reference" frames were aligned with global axes during a static neutral posture. The "Landmark" frames were computed using palpated bony landmarks. The "Functional" frames included a flexion-extension axis estimated during functional movements. These definitions were compared with regard to the deviations between obtained local segment axes and the evolution of joint (Cardan) angles during two test motions. Each definition resulted in specific local frame orientations with deviations of 15° in average for a given local axis. Interestingly, these deviations produced only slight differences (below 7°) regarding flexion-extension Cardan angles indicating that there is no preferred method when only interested in finger flexion-extension movements. In this case, the Reference method was the easiest to implement, but did not provide physiological results for the thumb. Using the Functional frames reduced the kinematic cross-talk on the secondary and tertiary Cardan angles by up to 20° indicating that the Functional definition is useful when investigating complex three-dimensional movements. Globally, the Landmark definition provides valuable results and, contrary to the other definitions, is applicable for finger deformities or compromised joint rotations.