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.

Rock Climbing-Related Bone Marrow Edema of the Hand: A Follow-up Study.

OBJECTIVE: Sport climbers strain passive and active anatomical structures of their hands and fingers to the maximum during training or competition. This study was designed to investigate bone marrow edema (BME) in rock climbing athletes. DESIGN: Systematic detection, treatment, and follow-up investigation of rock climbing athletes with BME of the hand. SETTING: Primary-level orthopedic surgery and sports medicine division of a large academic medical center. PATIENTS: Thirty-one high-level climbers with diffuse pain in the hand and wrist joint caused by rock climbing were included in this study. INTERVENTIONS: The therapy consisted of consequent stress reduction and a break from sports. MAIN OUTCOME MEASURES: Reduction of BME shown through magnetic resonance imaging (MRI) and regaining of preinjury climbing levels (Union Internationale des Associations d' Alpinisme metric scale). RESULTS: In 28 patients, MRI revealed osseous edema because of overload at the respective area of interest, mainly in the distal radius, the distal ulna, or the carpal bones, which could not be otherwise diagnosed as inflammations, tumors, or injuries. We classified these edemas and fractures of the hamate because of overload. The edema was a stress reaction to highly intensive training and climbing with presumably high traction to the wrist area. The control MRIs demonstrated that even with a consequent stress reduction, the edemas required 3 to 4 months to disappear completely. CONCLUSIONS: Climbers with nonspecific, diffuse pain in the wrist and/or the fingers should be examined with MRI to detect or exclude the diagnosis of a BME.

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.

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.

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.

Epiphyseal fractures of the finger middle joints in young sport climbers.

OBJECTIVE: As competition climbing becomes increasingly popular, younger climbers are entering the sport, and some are among the top-level athletes. This early start combined with intensive training methods can lead to radiographic changes in the fingers and even osteoarthrosis. Since 1994, we have been observing an increasing number of nontraumatic epiphyseal fractures in young athletes. METHODS: Twenty-four cases of young climbers with nontraumatic epiphyseal fractures of the finger middle joints are presented. RESULTS: The average age of the climbers was 14.5 (+/- 0.9) years; 23 were boys, and 1 was a girl. Eight (33%) fractures were in an early stage, whereas in 16 (67%) a longer time interval elapsed between the onset of symptoms and the presentation for evaluation. All radiographs showed an epiphyseal fracture of the dorsal base of the middle phalanx of the finger; 20 patients presented a Salter-Harris III fracture and 4 presented a Salter-Harris II epiphysiolysis. An acute injury was not evident in any of the patients. All fractures were thus fatigue fractures caused by repetitive stress. CONCLUSIONS: Chronic finger pain in young and intensively training climbers must be carefully evaluated, and radiographic studies need to be performed. The risk of epiphyseal injuries must be minimized by eliminating intensive power training in the schedules of athletes of this age.

Radiographic changes in the hands and fingers of young, high-level climbers.

BACKGROUND: In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport. HYPOTHESIS: Although the radiographic changes in long-term climbers are known, there are little data available on young 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 osteoarthrosis in the finger joints. STUDY DESIGN: Cross-sectional study. METHODS: Nineteen members of the German Junior National Team and 18 recreational climbers were examined clinically and through radiographs. For comparison, radiographs of 12 young nonclimbers (control group) were collected. Radiographs were evaluated using a standard protocol. For evaluation of the physiologic adaptation, the cortical thickness of the middle phalanx and the Barnett Nordin index were analyzed. The results were compared between the 3 groups and against radiographs of 140 long-term, experienced climbers. RESULTS: Six climbers (32%) of the German Junior National Team presented a decreased range of motion for the small finger joints; none of the recreational climbers showed this decrease. In 47% of the German Junior National Team and 28% of the recreational climbers, stress reactions could be found: cortical hypertrophy (26% German Junior National Team, 11% recreational climbers), subchondral sclerosis (47% German Junior National Team, 6% recreational climbers), broadened base of the proximal interphalangeal joint (42% German Junior National Team, 28% recreational climbers), and broadened base of the distal interphalangeal joint (16% German Junior National Team, 0 recreational climbers). Signs of an early stage of osteoarthrosis were seen in 1 climber in each group. The control group showed no radiologic abnormalities. The Barnett Nordin index was 0.49 +/- 0.05 in German Junior National Team, 0.49 +/- 0.07 in recreational climbers, and 0.48 +/- 0.08 in the control group. There was no statistically significant difference on the Barnett Nordin index between the groups (German Junior National Team/recreational climbers: P = .89; German Junior National Team/control group: P = .58; recreational climbers/control group: P = .55). CONCLUSIONS: Intensive training and climbing lead to adaptive reactions; nevertheless, osteoarthrotic changes are rare.

Pulley injuries in rock climbers.

OBJECTIVE: The closed traumatic rupture of finger flexor tendon pulleys in rock climbers appeared as a new complex finger trauma in the mid 1980s. The objectives of this study are to characterize this injury and to describe diagnostic and therapeutic guidelines. A grading system for the severity of pulley injuries was developed and used to set therapeutic pathways. METHODS: Six hundred four injured rock climbers were prospectively evaluated from January 1998 to December 2001 with a questionnaire and standard examination protocol. Diagnostic ultrasound was performed in all rock climbers with finger injuries; if necessary, an additional magnetic resonance imaging was done. All pulley injuries were graded according to an introduced pulley-injury score (grade 1-4). RESULTS: Three of four of the most frequent injuries were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%. One hundred twenty-two (20.2%) rock climbers presented an injury of the flexor tendon pulley system, 48 had pulley strains, and 74 had ruptures (a single rupture in 90.5% and multiple pulley ruptures in 9.5%). According to the pulley-injury score, 39% were grade 1, 25% were grade 2, 30% were grade 3, and 6% were grade 4 injuries. CONCLUSION: Pulley injuries were the most frequent injuries in rock climbers. Whereas grade 1-3 injuries respond well to conservative treatment, grade 4 injuries require surgical repair. We recommend the "loop and a half" technique of Widstrom and colleagues and, alternatively, the Weilby repair. We also recommend postoperative initial immobilization and early functional treatment under external pulley protection.