Imaging of Rock Climbing Injuries

ABSTRACT

Competition climbing has grown increasingly in popularity, and many people are being drawn to this sport with a parallel increase in the occurrence of sport-related injuries. One of the most common and unique lesions occurring in the rock climbing population is the closed rupture of the flexor pulley system of the fingers. This lesion is strictly related to some climbing techniques in which the entire body weight is placed on fingerholds, which causes bowstringing of the flexor tendons with subsequent loss of strength across the full range of motion of the finger. This article summarizes the current literature regarding the application of imaging modalities in the diagnosis of rock climbing injuries with a specific focus on ultrasound and magnetic resonance imaging. Biomechanics of the sporting activity and resultant pathophysiologic and clinical considerations concerning flexor pulley system injuries are also discussed.

KEYWORDS

Annular pulleys - hand injuries - rock climbing - ultrasound - MR imaging

REFERENCES

• 1 Haas J C, Meyers M C. Rock climbing injuries.  Sports Med. 1995;  20 199-205
• 2 Schöffl V, Hochholzer T, Imhoff A. Radiographic changes in the hands and fingers of young, high-level climbers.  Am J Sports Med. 2004;  32 1688-1694
• 3 Logan A J, Makawana N, Mason G et al.. Acute hand and wrist injuries in experienced rock climbers.  Br J Sports Med. 2004;  38 545-548
• 4 Bollen S R, Gunson C K. Hand injuries in competition climbers.  Br J Sports Med. 1990;  24 16-18
• 5 Rohrbough J T, Mudge M K, Schilling R C. Overuse injuries in the elite rock climber.  Med Sci Sports Exerc. 2000;  32 1369-1372
• 6 Rispler D, Greenwald D, Shumway S et al.. Efficiency of the flexor tendon pulley system in human cadaver hands.  J Hand Surg [Am]. 1996;  21 444-450
• 7 Bollen S R. Injury to the A2 pulley in rock climbers.  J Hand Surg [Br]. 1990;  15 268-270
• 8 Lin G T, Amadio P C, An K N et al.. Functional anatomy of the human digital flexor pulley system.  J Hand Surg [Am]. 1989;  14 949-956
• 9 Lin G T, Cooney W P, Amadio P C et al.. Mechanical properties of human pulleys.  J Hand Surg [Br]. 1990;  15 429-434
• 10 Marco R A, Sharkey N A, Smith T S, Zissimos A G. Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers.  J Bone Joint Surg. 1998;  80 1012-1019
• 11 Hauger O, Chung C B, Lektrakul N et al.. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT and US with and without contrast material distension of the tendon sheath.  Radiology. 2000;  217 201-212
• 12 Manske P R, Lesker P A. Strength of human pulleys.  Hand. 1977;  9 147-152
• 13 Wyatt J P, McNaughton G W, Grant P T. A prospective study of rock climbing injuries.  Br J Sports Med. 1996;  30 148-150
• 14 Gabl M, Rangger C, Lutz M et al.. Disruption of the finger flexor pulley system in elite rock climbers.  Am J Sports Med. 1998;  26 651-655
• 15 Quaine F, Vigouroux L, Martin L. Effect of simulated rock climbing finger postures on force sharing among the fingers.  Clin Biomech (Bristol, Avon). 2003;  18 385-388
• 16 Seiler III J G, Lerversedge F J. Digital flexor sheath: repair and reconstruction of the annular pulleys and membranous sheath.  J South Orthop Assoc. 2000;  9 81-90
• 17 Bodner G, Rudish A, Gabl M et al.. Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI.  Ultraschall Med. 1999;  20 131-136
• 18 Klauser A, Bodner G, Frauscher F et al.. Finger injuries in extreme rock climbers. Assessment of high resolution ultrasonography.  Am J Sports Med. 1999;  27 733-737
• 19 Klauser A, Frauscher F, Bodner G et al.. Finger pulley injuries in extreme rock climbers: depiction with dynamic US.  Radiology. 2002;  222 755-761
• 20 Martinoli C, Bianchi S, Derchi L E et al.. Sonographic evaluation of digital annular pulleys tears.  Skeletal Radiol. 2000;  29 387-391
• 21 Le Viet D, Rousselin B, Roulot E et al.. Diagnosis of digital pulley rupture by computed tomography.  J Hand Surg [Am]. 1996;  21 245-248
• 22 Parellada J A, Balkissoon A R, Hayes C W, Conway W F. Bowstring injury of the flexor tendon pulley system: MR imaging.  AJR Am J Roentgenol. 1996;  167 347-349