Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers

Abstract

The purpose of this study was to document and evaluate patient characteristics, injury mechanisms and clinical outcomes of epiphyseal stress fractures of the finger phalanges in adolescent rock climbers to identify contributing factors to this injury. Twenty-eight climbers with epiphyseal pain treated at our clinic between 2006 and 2018 were included in the study. Sixteen patients completed a questionnaire addressing injury details as well as training regimen before and after the injury. The mean age at the time of injury was 13.7 years (± 1.9 years) with the injury occurring predominantly in male athletes. Middle (58%) and ring (30%) fingers were the most commonly affected sites out of a total of 67 fingers affected; 54% had a radiologically documented epiphyseal fracture (Salter Harris type II/III) while 46% suffered from a symptomatic sprain, which could potentially lead to a stress fracture. Mean time for radiological union of a fracture was 35 weeks. Recovery time for a symptomatic sprain was on average slightly shorter at 24 weeks. All patients were treated conservatively with load reduction for 3-12 months until the symptoms disappeared. Although most patients had a positive outcome when treated correctly, this injury can damage the growth plate when left untreated, resulting in articular surface incongruency (1 severe, 1 moderate, 6 mild) with permanent impairment of the affected finger. Therefore, pain on the dorsal aspect of the proximal interphalangeal joint in adolescent climbers must be assessed carefully.

Coaches’ Attitudes Toward Campus Board Training in Adolescent Climbers in the United States

“…7,8 The injury can occur after a clear, sudden event or insidiously, and climbers typically describe pain located at the dorsal PIP joint with point tenderness. [9][10][11] Left untreated, this injury can result in long-term disability, deformity, and pain. 6,9 The true incidence of stress fractures in the fingers of adolescent climbers is unknown owing to a scarcity of research investigating the subject.…”

“…[9][10][11] Left untreated, this injury can result in long-term disability, deformity, and pain. 6,9 The true incidence of stress fractures in the fingers of adolescent climbers is unknown owing to a scarcity of research investigating the subject. An estimated 100 cases have been reported in the literature.…”

“…An estimated 100 cases have been reported in the literature. 9 Type and quantity of training are likely critical factors in the development of this injury, yet specific training recommendations to guide climbers, climbing organizations, parents of climbers, and climbing coaches are essentially nonexistent.…”

“…Evidence, albeit limited, suggests campusing may lead to the development of finger epiphyseal stress fractures and may even result in the development of finger osteoarthritis. 6,9,10 Although many athletes and coaches see it as a useful and safe training modality when used correctly, some clinicians and climbing organizations advise entirely avoiding use in athletes aged 18 y and younger. 5,8,9 A recent study assessed adolescent climbers' knowledge of safe training practices, and slightly more than half (51%) of the 267 climbers involved were previously uninformed about growth plate injuries.…”

Sportkletter- und Boulderverletzungen

“…Auf diese Weise werden die Gelenke in mittlerer Position belastet, wobei die Gelenkkontaktfläche so groß wie möglich bleibt.Bei Schmerzen in den PIP-Gelenken bei jugendlichen Kletterern ohne offensichtliches Trauma sollte eine solche Läsion mittels Röntgen ausgeschlossen werden. Zu beachten ist, dass die meist schräg ausgerichteten Bruchlinien in konventionellen Röntgenaufnahmen nicht sichtbar sind und oft nur mittels MRI, CT oder ausprojizierten Aufnahmen unter Bildwandler dargestellt werden können[2].Die häufigsten störenden Schmerzen bei Kletterern rund um den Ellenbogen sind die radiale und oftmals die ulnare Epicondylitis. Der Verlauf ist in der Regel günstig, aber langwierig und hartnäckig.…”