Climbers' hands: injuries, treatment and prevention. Prevention is better than cure! Part 3
By Tim Halsey
Consultant Hand & Orthopaedic Surgeon
Honorary Senior Lecturer, University of Sheffield, Visiting Research Fellow, Leeds Beckett University
Teenage climbers should not train on campus boards until their physes are closed. They should be encouraged to climb open handed, avoiding deep crimps where possible. Coaches and parents should be aware that unexplained PIPJ pain which does not settle after two weeks of rest requires investigation: initially with a plain film (PA, lateral and oblique) looking for a Salter-Harris III fracture to the base of the middle phalanx. If no fracture is seen and the pain persists then they should have further imaging with MRI as the current modality of choice. Training should be modified, or stopped altogether, until the fracture heals and the pain settles. There is a small group of patients, resistant to non-surgical treatment who have benefitted from epiphyseal spot drilling to induce physeal fracture healing.
Figure 5: Periphyseal plate injury
We are trying to raise awareness of this condition among climbers, parents, coaches, surgeons and physios. It is very difficult to collect incidence data for this condition, but those of us who are interested in teenage climbers hands have seen a steady stream of these cases over the last few years. It may be that you see more of what you look for. I hope that with a greater understanding of how these injuries occur and are treated that young climbers will be directed to avoid this painful condition, which has unfortunately stopped several promising young climbers from enjoying their sport.
Figure 6: Forces applied to Epiphyseal plate
Climbing is an excellent way to unwind after a busy day at work. You have to concentrate fully on the task in hand so as not to fall off which is strangely relaxing in a very active way! I have found that pushing myself outside my comfort zone and trying difficult things that I often fail at has been a refreshing counterpoint to work as a surgeon. Most cities now have climbing walls, which are worth exploring, just make sure you actively engage your DIPJs and ensure that any teenagers in your care don’t over-do it!
Bibliography
Hochholzer T, Schöffl V, (eds.) Lightner Jr, S. (2003) One Move Too Many… How to Understand the Injuries and Overuse Syndromes of Rock Climbing. Sharp End Publishing.
Schöffl V, Schöffl I, Hochholzer T, Lutter C (eds.) (2022) Climbing Medicine: A Practical Guide. Springer.
MacLeod D, (2009) 9 Out Of 10 Climbers Make The Same Mistakes, Rare Breed Productions,.
MacLeod D, (2015) Make or Break: Don’t Let Climbing Injuries Dictate Your Success, Rare Breed Productions.
About the author: Tim Halsey
MB ChB, MFST(Ed), FRCS(Tr&Orth), Dip Hand Surg, Consultant Hand & Orthopaedic Surgeon
Honorary Senior Lecturer, University of Sheffield, Visiting Research Fellow, Leeds Beckett University