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Samara H, McCague A, Henken-Siefken A. Less Talk More Chalk: A Retrospective Review of Rock Climbing-Related Trauma. Cureus 2024; 16:e60033. [PMID: 38854189 PMCID: PMC11162811 DOI: 10.7759/cureus.60033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Climbing is a strength and strategy-driven sport that has greatly increased in popularity over the last decade, partially due to its debut in the Tokyo 2020 Summer Olympics. With an increasing number of new climbers and the emergence of recreational indoor climbing facilities, fall injury risk remains a legitimate concern within the climbing community. This study evaluates the pattern of injury in trauma patients presenting to the Desert Regional Medical Center, a level 1 trauma center in Palm Springs, CA, following falls from height while rock climbing. Methods Our study retrospectively investigated a de-identified dataset on trauma patients at the Desert Regional Medical Center, a level 1 trauma center located in Palm Springs, CA, from 2016 to 2021. This analysis focused on 75 patients who presented following falls from height while rock climbing. We reviewed several parameters, including patient demographics, Injury Severity Score (ISS), hospital length of stay (LOS), injury type, and patient outcomes. Descriptive statistics including median values, standard deviations (SD), and P-values were assessed via Microsoft Excel. Several paired, one-tailed t-tests and a Pearson's correlation test were also conducted to further evaluate the association between variables within the dataset. Results In this retrospective analysis of patients presenting to the emergency department post-fall from heights while rock climbing, the patient profile was predominantly younger or middle-aged climbers under 60 years old (65, 86.7%). The mean patient age was 37 years old. The majority of patients were non-Hispanic (69, 92%), noting a male predominance (57, 76%). Most patients (60, 80%) required partial trauma code status. Hospitalization was required for most individuals (67, 89.3%), with several requiring intensive care unit (ICU) admission (29, 38.7%). The average hospital LOS was 6.7 amongst all admissions. Patients requiring LOS greater than 10 days had a higher average ISS (12.9) when compared to climbers with shorter lengths of admission (ISS of 10.4). There was no significant difference in ISS between younger patients (ISS of 9.3) and those 60 and older (ISS of 10.6). The most common critical injury was lower extremity fracture (36, 48%), noting no significant increase in injury incidence over the last five years. Conclusion Rock climbers who experience falls from cliffs are most at risk for a lower extremity fracture. Demographically, a majority of injured climbers in this study were young males, who may exhibit risk-taking behavior. To better prevent critical injuries within the climbing sector, we encourage an increase in safety measures (crash mats, harnessing) and the implementation of a new climber education program.
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Affiliation(s)
- Hanien Samara
- General Surgery and Trauma Surgery, Western University of Health Sciences, Pomona, USA
| | - Andrew McCague
- Trauma and Acute Care Surgery, Desert Regional Medical Center, Palm Springs, USA
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Sjöman AE, Grønhaug G, Julin MV. A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury. Wilderness Environ Med 2023; 34:435-441. [PMID: 37550103 DOI: 10.1016/j.wem.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.
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Affiliation(s)
- Anna E Sjöman
- LAUREA University of Applied Science, Espoo, Finland.
| | - Gudmund Grønhaug
- Department of Sport, Food and Natural Sciences, Faculty of Education, Western Norway University of Applied Sciences, Campus Sogndal, Norway Arts and Sports, Sogndal, Norway
| | - Mikko V Julin
- LAUREA University of Applied Science, Espoo, Finland
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Schöffl V, von Schroeder H, Lisse J, El-Sheikh Y, Küpper T, Klinder A, Lutter C. Wrist Injuries in Climbers. Am J Sports Med 2023; 51:3416-3425. [PMID: 37800447 DOI: 10.1177/03635465231199671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Acute and chronic injuries to the wrist are among the most common sport-related complaints of climbing athletes but have not been extensively evaluated in this population. Therefore, it is important to categorize climbing injuries to the wrist, analyze risk factors, and assess treatment outcomes. PURPOSE To evaluate the distribution, outcomes, and influencing factors of wrist injuries in climbers. STUDY DESIGN Case series; Level of evidence, 4. METHODS Climbing athletes with wrist injuries who presented to our specialized sports medical center over the course of 4 years (2017-2020) were selected. All had prospectively completed questionnaires including their climbing-specific background (years of training, climbing level, training methods, etc). Injuries were analyzed (International Climbing and Mountaineering Federation [UIAA] grade and diagnosis), and treatment methods and outcomes were retrospectively assessed with a minimum follow-up of 2 years. Parameters included the climbing score, visual analog scale for pain score, Patient-Rated Wrist Evaluation (PRWE) score, and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score including the sport component (DASH-Sport) score before and after treatment as well as time to return to climbing. RESULTS A total of 69 patients (25 female, 44 male) with 78 wrist injuries were identified and analyzed. Of these, 7 injuries were bilateral, occurring at the same time, and 2 injuries were independent reinjuries to either the same or the contralateral side. In addition, 24 injuries (30.8%) were acute, while 54 (69.2%) were chronic. Overall, 2 injuries had a UIAA grade of 3; all others had a UIAA grade of 2. The most frequent injuries were synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains (joint capsular pain with stress, with no pathological finding on magnetic resonance imaging), and wrist ganglion cysts. Nonoperative treatment was performed for 61 of the injuries, while 17 were treated surgically. In 51 cases (65.4%), injuries healed without consequences; in 27 cases (34.6%), discomfort remained. The visual analog scale pain score decreased from 4.8 ± 1.9 before treatment to 0.7 ± 1.0 after treatment (P < .001), the PRWE score decreased from 53.6 ± 24.9 to 10.3 ± 13.1 (P < .001), the QuickDASH score improved from 53.0 ± 16.6 to 20.0 ± 20.2 (P < .001), and the DASH-Sport score improved from 82.0 ± 16.1 to 38.1 ± 23.5 (P < .001). The climbing score improved from 2.5 ± 1.1 to 4.3 ± 1.0 points (P < .001). The patient-reported number of days with pain was negatively correlated with changes in the PRWE score (r = -0.351; P < .001), QuickDASH score (r = -0.316; P = .007), and climbing score (r = -0.264; P = .025) as well as the number of days without climbing (r = -0.266; P = .025). The number of days without climbing was positively correlated with changes in the PRWE score (r = 0.369; P < .001). CONCLUSION Wrist injuries in climbers constituted a diverse set of diagnoses. Ulnar-sided injuries were most common, and many patients had >1 diagnosis. Outcomes for all treatment methods (surgery and nonoperative care) were favorable, but approximately one-third of climbers had persistent wrist discomfort after treatment, underscoring the need for accurate diagnoses and acute and expert care.
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Affiliation(s)
- Volker Schöffl
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- School of Health, Leeds Beckett University, Leeds, UK
| | - Herb von Schroeder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Hand Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Dovigi Orthopaedic Sports Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jens Lisse
- Department of Trauma Surgery, Klinikum Forchheim, Forchheim, Germany
| | - Yasser El-Sheikh
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Küpper
- Institute for Occupational, Social & Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Annett Klinder
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Yu E, Lowe J, Millon J, Tran K, Coffey C. Change in grip strength, hang time, and knot tying speed after 24 hours of endurance rock climbing. Front Sports Act Living 2023; 5:1224581. [PMID: 37601165 PMCID: PMC10433161 DOI: 10.3389/fspor.2023.1224581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Background Non-professional climbers are increasingly attempting long routes in a single day. Many suffer injury or rely on search and rescue teams when they become too fatigued to finish. Predicting fatigue is difficult, and existing studies have only studied climbers over durations less than an hour, while many outdoor multipitch climbs require more than an hour of climbing. Objectives To determine how strength, endurance, and dexterity reflect fatigue after 24 h of continuous climbing. Methods Volunteer competitors completed measurements of grip strength, static hang time to failure, and time to tie a figure-eight follow-through knot. Measurements were taken during the registration period before the competition and again within an hour after the competition ended. Measurements were compared using the paired t-test. Subgroup analysis was applied to competitors by division. Linear regression was applied to determine the relationship between vertical feet climbed and the number of routes climbed during the competition on each metric. Results Thirty-six total climbers (average age 29.4 years old) completed pre- and post-competition measurements. After 24 h of climbing (n = 36), mean grip strength decreased by 14.3-15 lbs or 14.7%-15.1% (p < 0.001) and static hang time decreased by 54.2 s or 71.2% (p < 0.001). There was no significant change in time to tie a figure-eight-follow-through knot. Grip strength and hang time decreases were significant in climbers with outdoor redpoints of 5.10a and above. Hang time decreased by 5.4 s per 1,000 vertical feet climbed (p = 0.044). Conclusion Climbers can expect to experience a 14.7%-15.1% decrease in grip strength and 71.2% decrease in static hang time after 24 h of continuous climbing. These changes may make it difficult to climb consistently over a long objective, and climbers can use these measures at home to train for longer climbing routes. Future studies on shorter climbing intervals can help determine rates of decline in performance measures.
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Affiliation(s)
- Elaine Yu
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States
| | - Jacques Lowe
- Carle Illinois College of Medicine, University of Illinois Urbana-Champagne, Urbana, IL, United States
| | - Jasmin Millon
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | - Kristi Tran
- Department of Emergency Medicine, State University of New York Downstate, Brooklyn, NY, United States
| | - Christanne Coffey
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States
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Luiggi M, Lafaye P, Martha C. Epidemiology of sport climbing injuries caused by a climbing fall among climbers of the French Federation of Mountain and Climbing. J Sports Med Phys Fitness 2023; 63:452-460. [PMID: 36321816 DOI: 10.23736/s0022-4707.22.14388-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Fall-related injuries (FRIs) are the most severe sport climbing injuries. The main objective of this study was to measure FRI prevalence and risk factors in a representative sample of climbers of the French Federation of Mountain and Climbing. The second objective was to explore FRI mechanisms. METHODS The study included 3919 climbers aged 16+. They were invited to fill out an online questionnaire where they reported sociodemographics, sport-related characteristics and whether they had sustained an FRI in the past 12 months (12-FRI), and over their entire career (ALL-FRI). The mechanisms of 12-FRI were asked for. Multivariable logistic regression analyses were performed to evaluate the association between sport-related characteristics and FRI. RESULTS Nine per cent of the participants reported a 12-FRI and 29% an ALL-FRI. No statistically significant effect of sex, context of climbing, or onsight level was observed on 12-FRI. Climbers with 0-3 years of experience (YE) were 1.7 (95% CI: 1.2-2.6) and 3.6 (95% CI: 2.2-6.3) times more likely to have sustained a 12-FRI compared with those with 5-8 YE and 14-23 YE, respectively. An interaction effect was found between YE and onsight level. Among climbers with 0-8 YE, those with a higher onsight level had a higher risk of 12-FRI. Natural falls, unexpected falls and static belaying were the most commonly reported 12-FRI mechanisms. CONCLUSIONS These results highlight that future FRI prevention programs should target priority-inexperienced climbers who have progressed rapidly. Climbers should be taught as a priority to stay focused while belaying even in the least difficult passage, and to belay dynamically.
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Affiliation(s)
| | - Pascal Lafaye
- Prevention and Security Correspondent, Ligue Occitanie, Fédération Française de la Montagne et de l'Escalade, Toulouse, France
| | - Cécile Martha
- Institut des Sciences du Mouvement (ISM), Aix-Marseille University CNRS, Marseille, France
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Yoon JH, Armstrong W, Philippopolous E, Dilworth N, Cheng I. Head Injuries in Rock Climbing: A Scoping Review. Wilderness Environ Med 2022; 33:479-487. [PMID: 36202720 DOI: 10.1016/j.wem.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
Abstract
Rock climbing was recognized as a sport at the 2020 Tokyo Olympics. Despite its increasing participation, there is no knowledge synthesis of head injuries (HIs), defined as any injury to the head, associated with climbing, making it challenging for clinicians to provide evidence-based care. Our aim was to synthesize HI literature within rock climbing and identify knowledge gaps. Six databases (Medline, Embase, Sports Medicine & Education Index, SPORTDiscus, CINAHL, and Cochrane) were searched. Two reviewers screened 345 studies and 31 studies were selected for data abstraction. We found the quality of individual studies mainly "fair" to "good." Both HI and traumatic brain injury (TBI) had inconsistent definitions and categorization. The HIs represented between 0 to 36% of reported climbing injuries. Between 11 to 100% of HIs were TBIs, defined as an HI with permanent or temporary neurological sequelae. The most common causes of HIs were outdoor falls and falling objects. Climbing-specific factors associated with the causes were infrequently examined in the literature. Data sources of safety practices were incomplete. Overall, there was a lack of literature examining HIs, mechanisms of injury, and safety practices associated with climbing. To improve the tracking of HIs in climbing, we suggest the use of consistent reporting standards and the creation of a climbing injury surveillance system.
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Affiliation(s)
- Joo Hyung Yoon
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
| | - Wes Armstrong
- Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | | | - Neil Dilworth
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Halton Healthcare, Georgetown, Canada
| | - Ivy Cheng
- Division of Emergency Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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Pirruccio K, Shin M, Ganley TJ, Kelly JD, Parisien RL. Rock climbing confers distinct injury risk in pediatric versus adult populations: an analysis of twenty-year national trends. PHYSICIAN SPORTSMED 2022; 50:343-348. [PMID: 34029496 DOI: 10.1080/00913847.2021.1932631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES The sport of rock climbing has recently gained in popularity due in part to its adoption by noncompetitive athletes as a physical activity with a level of intensity that can be self-regulated. However, the epidemiology of rock climbing injuries is poorly described at the national level. METHODS We report demographic and injury characteristics from 85,235 national weighted estimates of rock climbing injuries presenting to United States (US) emergency departments (EDs) between 2000 and 2019 in the National Electronic Injury Surveillance System, stratifying by whether patients were ≤18 years of age (A) or ≥19 years of age (B). RESULTS The national weighted estimate of patients presenting to US EDs with injuries associated with rock climbing rose significantly (p < 0.001) from 2000 (2,667, CI 1,777-3,557) to 2019 (7,087, CI 4,544-9,630). Patients ≤18 years of age were significantly less likely to be male (A: 56.3%, CI 52.0-60.6%; B: 64.7%; CI 60.4-69.0%; p = 0.003), sustain injuries on weekends (A: 29.8%, 24.5-35.1%; B: 64.7%, CI 60.4-69.0%; p = 0.002), or sustain injuries during summer seasons (A: 26.6%, CI 22.1-31.1%; B: 33.2%, CI 28.1-38.3%; p = 0.049). Multivariate logistic regression demonstrated that patients ≤18 years of age were significantly more likely to present to EDs with head and neck (OR: 1.52, CI 1.04-2.21; p = 0.032) or upper extremity (OR: 1.55; CI 1.24-1.93; p < 0.001) injuries associated with rock climbing. CONCLUSION We identified a significant increase in the annual estimated number of patients presenting to US EDs with rock climbing injuries compared to what has previously been reported. As the number of climbers continues to grow, standardized safety policies may be implemented that specifically target injury mechanisms and patterns unique to both adult and pediatric populations.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Theodore J Ganley
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennylvania
| | - John D Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Harvard Medical School and Boston Children's Hospital, Boston, USA
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Gabl M, Kaiser P, Benedikt S, Schmidle G, Haselbacher M, Arora R. Risk profiles in two different alpine rock climbing styles. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2022; 36:145-154. [PMID: 35973437 DOI: 10.1055/a-1833-8840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate the injury risk profile of the two different styles of rock climbing, alpine climbing with minor route protection (AC) and alpine sport climbing on well-protected routes (SC), in order to develop preventive strategies for risk management. PATIENTS AND METHODS : 18 SC and 12 AC rock climbing accidents were evaluated retrospectively with a focus on climbers` demographics (age, experience, training intensity, performance level), accident demographics (unforeseen events preceding the injury, ascending or descending, fall height), injury patterns (injury severity, pathologies, pathomechanism) and environmental conditions (rock characteristics, route frequency, route grade, weather). RESULTS : Injuries were mainly sustained by male lead climbers during ascent (80%). The lower extremity was injured in 46%, the upper extremity in 40%, the pelvis in 6% and the head, chest and spine in 3%. Climbers were significantly older (43 vs. 31 years; p=0.03) and more experienced (21.5 vs. 5.7 climbing years) in AC. Falling height was significantly greater in AC (14.8 vs. 4.7m). Unforeseen events preceding the injury differed significantly between both groups. Slipping off and letting go preceded the fall in 78% in SC, while rock dislodging occurred only in AC. There was a tendency that climbers in SC climbed near or above their performance level, while climbers in AC climbed below their level. SC climbers tended to show more ankle fractures while AC climbers tended to present more cases with multiple injuries. DISCUSSION AC and SC climbers differ in their risk profiles. Poorer route protection in AC resulted in more severe injuries. Yet in SC routes, good protection alone was not enough to avoid severe injuries. For prevention, climbers should be aware of the specific risks in AC and SC routes and should adjust their behaviour accordingly. Athletic skills were overestimated in SC, while alpine demands were underestimated in AC. A higher focus on visual and haptic grip control may help to prevent loss of hold. A careful lining of the rope into solid rock can reduce rockfalls for the seconder. Continuous attention is mandatory in rope handling and belaying. Applying more mobile pros is recommended in AC because they may shorten fall heights.
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Affiliation(s)
- Markus Gabl
- Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
| | - Peter Kaiser
- Orthopädie und Traumatologie, Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
| | - Stefan Benedikt
- Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
| | - Gernot Schmidle
- Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
| | - Matthias Haselbacher
- Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
| | - Rohit Arora
- Medical University of Innsbruck: Medizinische Universitat Innsbruck, Innsbruck, AUSTRIA
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Sims LA. Upper Extremity Injuries in Rock Climbers: Diagnosis and Management. J Hand Surg Am 2022; 47:662-672. [PMID: 35256226 DOI: 10.1016/j.jhsa.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.
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Affiliation(s)
- Laura A Sims
- University of Saskatchewan, Saskatoon Orthopedic and Sports Medicine Centre, Saskatoon Saskatchewan, Canada.
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Mohn S, Spörri J, Mauler F, Kabelitz M, Schweizer A. Nonoperative Treatment of Finger Flexor Tenosynovitis in Sport Climbers—A Retrospective Descriptive Study Based on a Clinical 10-Year Database. BIOLOGY 2022; 11:biology11060815. [PMID: 35741336 PMCID: PMC9220062 DOI: 10.3390/biology11060815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
Simple Summary Finger flexor tenosynovitis is among the most frequent overuse injuries in sport climbers. Targeted therapy is currently based mostly on reports of the anecdotal practical experience of single centers rather than scientific investigations, as there is very little research available on this pathology. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis treatments in sport climbers by retrospectively asking patients about injury triggers, therapy contents and outcomes. All patients were initially treated conservatively, and only one of the patients needed further therapy in the form of a single injection with hyaluronic acid; none of them underwent further operative treatment. The average symptom duration was 30.5 weeks, and all patients were able to resume climbing, with approximately 75% of them regaining or exceeding their initial climbing level. These good to excellent outcomes and no correlation between particular therapy contents and therapy outcome suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations from this study. Abstract The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.
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Affiliation(s)
- Sabrina Mohn
- Division of Hand Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland; (M.K.); (A.S.)
- Correspondence:
| | - Jörg Spörri
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, 8008 Zurich, Switzerland;
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Lengghalde 5, 8008 Zurich, Switzerland
| | - Flavien Mauler
- Department of Plastic Surgery and Hand Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland;
| | - Method Kabelitz
- Division of Hand Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland; (M.K.); (A.S.)
| | - Andreas Schweizer
- Division of Hand Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland; (M.K.); (A.S.)
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Krieger CS, Vesa DV, Ziegenhorn S, Exadaktylos AK, Klukowska-Rötzler J, Brodmann Maeder M. Injuries in outdoor climbing: a retrospective single-centre cohort study at a level 1 emergency department in Switzerland. BMJ Open Sport Exerc Med 2022; 8:e001281. [PMID: 35450112 PMCID: PMC8971760 DOI: 10.1136/bmjsem-2021-001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives Outdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland. Methods A retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012-December 2018. Results 78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1-38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF. Conclusions Accidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.
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Affiliation(s)
- Chantal Selina Krieger
- Department of Emergency Medicine University Hospital, Inselspital University Hospital Bern, Bern, Switzerland
| | - Doris-Viviana Vesa
- Department of Emergency Medicine University Hospital, Inselspital University Hospital Bern, Bern, Switzerland
| | - Stephan Ziegenhorn
- Department of Emergency Medicine University Hospital, Inselspital University Hospital Bern, Bern, Switzerland
| | | | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine University Hospital, Inselspital University Hospital Bern, Bern, Switzerland
| | - Monika Brodmann Maeder
- Department of Emergency Medicine University Hospital, Inselspital University Hospital Bern, Bern, Switzerland.,Institute for Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
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12
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Characteristics of bouldering injuries based on 430 patients presented to an urban emergency department. Injury 2022; 53:1394-1400. [PMID: 35144805 DOI: 10.1016/j.injury.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bouldering is a climbing sport that has been attracting a greater number of recreational and professional athletes over recent decades, which has led to an increase in sport-related injuries. The aim of this study was to determine the characteristics and the types of acute injuries caused by bouldering. Further athlete-specific factors and covariates for the trauma types were investigated. MATERIALS AND METHODS In this retrospective analysis, all patients presented to the level 1 trauma center at the hospital of the Technical University of Munich after an acute trauma related to bouldering were identified via the hospital documentation system. The period of observation was ten years, from 2010 until 2020. Epidemiological and injury-specific information as well as the initial treatment were registered. In a second step, the affected patients were invited to participate in an online survey in order to collect information about their skills, experience, and details about the trauma. RESULTS A total of 430 patients with 447 acute injuries were identified. There were 244 injuries among female and 203 injuries among male patients. The most common anatomical region affected was ankle (36.7%), knee (16.8%), elbow (12.3%), spine (7.2%) and shoulder (6.3%). The majority of 273 (61.1%) injuries were located at the lower extremities. The most frequent types of injury were sprains (53.0%), fractures (22.8%) or joint dislocations (11.9%). Surgical treatment was necessary for 89 (19.9%) patients. A return to bouldering was more likely in male patients 50 (75.8%) than in females 47 (59.5%) (p = 0.038). Subjectively, inexperienced boulderers were also less likely to return to the sport than advanced boulderers with greater experience (p = 0.001) CONCLUSION: The incidence of bouldering injuries is rising. Typical bouldering injuries could be identified and quantified at least for those patients who were presented to a hospital emergency department. Injuries in this setting do differ from the injury types known from rock climbing injuries as they are located on the lower extremity more often. Injuries of the fingers and hand, which are common climbing injuries, have been barely encountered in the emergency center.
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13
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Grohnert LS, Bonato M, Schöffl V. Evaluation of a four-week Adjunct Compensatory Training for the treatment of climbing-specific overstrain syndromes of the shoulder. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:138-144. [PMID: 35016244 DOI: 10.1055/a-1397-1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although climbing is an increasingly popular sport, there is a lack of scientific evaluation of suitable training methods for climbers, especially with a view to prevention and rehabilitation. A specific rehabilitation program, Adjunct Compensatory Training (ACT), has recently been presented, but it has not been evaluated scientifically to date. OBJECTIVE To investigate the effects of Adjunct Compensatory Training on climbing-specific overstrain syndromes of the shoulder. METHODS Twenty active boulderers and climbers with an average age of 28.9 (± 7.4) years performed a guided shoulder program of six specific exercises from the ACT program over a period of four weeks. They were examined before and after the intervention. Pre- and post-interventional measurements included the Constant-Murley Score, the QuickDASH Score and the measurement of shoulder ROM (range of motion). RESULTS The Constant-Murley Score increased from 82 (± 10.0) to 104.1 (± 8.2) at follow-up (p < 0.001). The VAS value for bouldering and climbing decreased from 5.25 (± 1.4) before to 2.4 (± 1.6) after the intervention (p < 0.001). Shoulder flexion increased from 167.5 (± 14.9) to 173.1 (± 7.7) after the intervention (p < 0.05), abduction from 172.5 (± 14.9) to 179.6 (± 5.9) (n. s.), external rotation from neutral zero position from 77.6 (± 16.8) to 86.3 ± (8.3) (p < 0.05). Feasibility and acceptance of the intervention were good. Ninety-five percent of the participants continued to exercise, and 100 percent recommended the program to others. CONCLUSION The ACT led to an improvement in pain, activities of daily living, range of motion and strength in boulderers and climbers with overstrain symptoms of the shoulder. It is also classified as a realistically feasible workout. The extent to which this effect will continue, and whether or not the program can prevent injuries, remains to be seen. It can only be presumed that regular exercises prevent shoulder injuries in the climbing population.
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Affiliation(s)
| | | | - Volker Schöffl
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Germany.,Klinik für Unfallchirurgie und orthopädische Chirurgie, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany.,Section Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA.,School of Clinical and Applied Sciences, Leeds Becket University, UK
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14
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Identeg F, Orava E, Sansone M, Karlsson J, Hedelin H. Patterns of traumatic outdoor rock-climbing injuries in Sweden between 2008 and 2019. J Exp Orthop 2021; 8:89. [PMID: 34628554 PMCID: PMC8502181 DOI: 10.1186/s40634-021-00407-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden. Methods Patients that experienced a climbing related traumatic injury during outdoor climbing between 2008 and 2019 and who submitted a self-reported questionnaire to the Swedish Climbing Association were included in the study. Medical records were retrieved, and the International Climbing and Mountaineering Federation injury classification system was used for injury presentation. Results Thirty-eight patients were included in the study. Seven (18%) injuries occurred during traditional climbing, 13 (34%) during sport climbing and 9 (24%) during bouldering. Varying with climbing discipline, 84–100% injuries were caused by falls. Injuries of the foot and ankle accounted for 72–100% of the injuries. Fractures were the most common injury (60%) followed by sprains (17%) and contusions (10%). Conclusions Traumatic injuries sustained during outdoor climbing in Sweden were predominantly caused by falls and affected the lower extremities in all major outdoor climbing disciplines. Rope management errors as a cause of injury were common in sport climbing and in activity surrounding the climbing, indicating there is room for injury-preventing measures.
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Affiliation(s)
- Fredrik Identeg
- Orthopaedic department, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ebba Orava
- Orthopaedic department, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- Orthopaedic department, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Orthopaedic department, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Hedelin
- Orthopaedic department, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Meltzer JH, Forrester JD. Human-Factor Risk Mitigation in Outdoor Climbing Areas: Survey of Existing Policies in Regulated Climbing Areas. Wilderness Environ Med 2021; 32:457-462. [PMID: 34563453 DOI: 10.1016/j.wem.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Popular climbing areas in the United States are frequently on public lands under administrative purview of land management entities. During climbing, climbers may be subject to injury. This study aimed to describe existing climbing risk mitigation tactics used to protect climbers by oversight agencies responsible for these public climbing areas and to identify strategies perceived by the oversight agency to be successful. METHODS We identified publicly managed US bouldering, sport, or traditional climbing areas through a state-by-state search of Mountain Project. We assessed climbing-related visitation, injury, rescue, and risk mitigation strategies using a 10-item survey targeting land-use managers, rangers, outdoor recreation planners, and park managers. Quantitative analysis included univariate and multivariate analysis. Qualitative analyses of survey responses with thematic grouping of mitigation interventions were performed. RESULTS One hundred fifty-seven publicly managed US climbing areas were contacted, and 76 (48%) provided data. Thirty-six (47%) of those that provided data stated that programs are in place to reduce climbing-related injury. There were no associations between demographic variables and the presence of risk mitigation strategies. Four themes of climbing risk mitigation strategies emerged: coordination with climbing coalitions (25% of respondents), permitting (22% of respondents), publication of accident reports (22% of respondents), and preventative search and rescue (17% of respondents). CONCLUSIONS Nearly half of survey respondents reported having climbing risk mitigation programs. There is opportunity to assess the efficacy of risk mitigation strategies through intra-area and inter-area assessments. A centralized climbing injury database may prove useful for assessing the efficacy of and need for risk mitigation techniques.
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Affiliation(s)
- Jourdan H Meltzer
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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16
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Lullini G, Belvedere C, Ortolani M, Ruzzi S, Mazzotti A, Leardini A. Custom-Made Total Talonavicular Replacement in a Professional Rock Climber: Functional Evaluation With Gait Analysis and 3-Dimensional Medical Imaging in Weightbearing at 5 Years' Follow-Up. J Foot Ankle Surg 2021; 59:1118-1127. [PMID: 32684404 DOI: 10.1053/j.jfas.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
With the goal to restore ankle and foot function also in the long term, custom-made prostheses are becoming more frequently possible solutions for severe bone loss and avascular necrosis of the talus. A young professional rock climber was implanted with a custom-made talonavicular prosthesis, and short-term (30 months) assessment has been published. A thorough assessment at the intermediate term (60 months), with state-of-the-art gait and medical imaging analyses, is reported here. Level walking and more demanding motor tasks were analyzed with both a full-body and a multisegment foot protocol on the operated and contralateral limbs. Cone-beam computer-tomography was also used to obtain 3-dimensional (3D) position and orientation of bone models on the operated ankle. These models were also used for a 3D video fluoroscopy analysis, with the ankle in 3 joint positions at the extremes of motion. Distance map analysis was performed to check for possible changes over time of bone morphology and joint contact areas, in all 3 joint positions. Very satisfactory functional results were observed, with large and symmetric joint motion and physiological muscular recruitment even in demanding motor tasks. Distance map analyses revealed that very small morphologic and contact patterns changes occurred in the replaced ankle between 30 and 60 months. Concerns about possible wear of the cartilage in the tibial mortise are not yet supported by experimental evidence.
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Affiliation(s)
- Giada Lullini
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Senior Biomedical Engineer Researcher, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maurizio Ortolani
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Ruzzi
- Laboratory Computer Technician, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Executive Orthopaedic Surgeon, I Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Laboratory Director, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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Sabbagh RS, Hoge C, Kanhere AP, Coscia AC, Grawe BM. The epidemiology of indoor and outdoor rock climbing injuries presenting to United States emergency departments. J Sports Med Phys Fitness 2021; 62:1095-1102. [PMID: 34132515 DOI: 10.23736/s0022-4707.21.12578-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The popularity of both indoor and outdoor rock climbing has dramatically increased over the last decade. The purpose of this study is to evaluate trends in United States climbing injury rates as well as assess specific injury characteristics, especially in the context of indoor and outdoor climbing. METHODS The National Electronic Injury Surveillance System database was queried (2010-2019) to compare national weighted injury estimates and compare various injury characteristics from climbers presenting to US emergency departments. RESULTS The annual national estimates of rock climbing-related injuries presenting to US emergency rooms increased significantly (p=0.030) from 2010 (N=2,381; CI 1,085-3,676) to 2019 (N= 4,596; CI 492-8,699). 58.7% of the injuries in this study that could be classified by location occurred climbing outdoors. Ankle injuries were 2.25 times more likely (CI 1.03-3.08) to occur indoors than outdoors. Outdoor climbers were 2.25 times more likely to sustain an injury via falling and 13.8 times more likely to be injured by being struck by an object than indoor climbers (CI 1.05-2.42, CI 10.67-17.78). CONCLUSIONS Indoor and outdoor rock climbing are associated with different injury characteristics and risks. Therefore proper safety precautions, equipment, and training specific to terrain should be observed by all climbers in order to help decrease the rising trend of rock climbing-related injuries in the United States.
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Affiliation(s)
- Ramsey S Sabbagh
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA -
| | - Connor Hoge
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Arun P Kanhere
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Atticus C Coscia
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA
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18
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McMullen CW, Mugleston BJ, Booker LN. Coaches' Attitudes Toward Campus Board Training in Adolescent Climbers in the United States. Wilderness Environ Med 2021; 32:168-175. [PMID: 33972161 DOI: 10.1016/j.wem.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/09/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Campus board training in adolescent climbers is controversial. Evidence, albeit limited, suggests this type of training may lead to the development of finger epiphyseal stress fractures. The purpose of the present study was to investigate coaches' attitudes toward campus board training in the United States. METHODS Surveys were sent to 116 coaches at gyms across the United States with affiliated adolescent climbing teams. Outcomes collected included demographic information, training time, campus board use prevalence, coaches' attitudes toward campus board use, and willingness to participate in future research. RESULTS Seventy-three coaches representing 3090 adolescent climbers completed the survey. Forty-six coaches (63%) reported using full weight (no foot contact) campus board training in some or all of their climbers. A variety of factors were cited by coaches when deciding which climbers should or should not use the campus board, including physical maturity, climbing ability, and age, among others. CONCLUSIONS Climbing coaches in the United States disagree on the use of campus board training in adolescent climbers. Some coaches avoid using this training modality entirely, whereas others believe certain climbers can use it safely. There is lack of consensus in determining who those certain climbers are.
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Affiliation(s)
- Christopher W McMullen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Brian J Mugleston
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lyndsey N Booker
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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19
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Miro PH, vanSonnenberg E, Sabb DM, Schöffl V. Finger Flexor Pulley Injuries in Rock Climbers. Wilderness Environ Med 2021; 32:247-258. [PMID: 33966972 DOI: 10.1016/j.wem.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Finger flexor pulley system injuries are the most common overuse injury in rock climbers. These injuries occur rarely outside of rock climbing, owing to the sport's unique biomechanical demands on the finger. As rock climbing continues to grow and earn recognition as a mainstream sport, an understanding of how to diagnose and treat these injuries also has become important. Our purpose is to describe current concepts in anatomy, biomechanics, clinical evaluation, imaging, prevention, and treatment strategies relating to finger flexor pulley system injuries. Our literature search was performed on PubMed with MeSH terms and keywords as subject headings to meet the objectives of this review. The "crimp grip" used in rock climbing is the mechanism for these injuries. The A2, A3, and A4 pulleys are at the highest risk of injury, especially when loaded eccentrically. Physical examination may reveal clinical "bowstringing," defined as the volar displacement of the flexor tendons from the phalanges; however, imaging is required for characterization of the underlying injury. Ultrasound is highly sensitive and specific for diagnosis and is recommended as the initial imaging technique of choice. Magnetic resonance imaging is recommended as an additional imaging study if ultrasound is inconclusive. Properly warming up increases the amount of physiologic bowstringing and is thought to prevent injury from occurring. Pulley injuries may be classified as grade I through IV. Conservative treatment, including immobilization, the H-tape method, and the use of a protective pulley splint, is recommended for grade I to III injuries. Surgical repair is reserved for grade IV injuries that are not amenable to conservative treatment.
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Affiliation(s)
- Paulo H Miro
- University of Arizona College of Medicine, Phoenix, AZ.
| | | | - Dylan M Sabb
- University of Arizona College of Medicine, Phoenix, AZ; University of California, Davis, Department of Family & Community Medicine, Sacramento, CA
| | - Volker Schöffl
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany; Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, FRG, Germany; Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO; School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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20
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Auer J, Schöffl VR, Achenbach L, Meffert RH, Fehske K. Indoor Bouldering-A Prospective Injury Evaluation. Wilderness Environ Med 2021; 32:160-167. [PMID: 33966976 DOI: 10.1016/j.wem.2021.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Bouldering has become a sport of growing interest, but little prospective evidence exists about injury proportions and patterns. The purpose of this study was to prospectively evaluate the cause of injuries sustained during indoor bouldering, proportion of affected body location, and injury severity. METHODS Proportions and patterns of injury among German-speaking indoor boulderers were evaluated prospectively in an explorative cohort study. Participants completed a baseline questionnaire assessing anthropometric data and sport-specific potential preventive and risk factors, followed by monthly injury questionnaires including injury location and injury severity over a period of 12 mo. RESULTS Out of 507 boulderers, 222 (44%) sustained 305 injuries. Of those, 78% (n=238) were classified as Union Internationale de Associations d'Alpinisme (UIAA) 1, 19% (n=57) as UIAA 2, and 3% (n=10) as UIAA 3. Injuries of the upper extremities accounted for 63% (n=191) of all injuries. Injuries of the lower extremities accounted for 23% (n=71) but were more often classified as UIAA≥2 (P=0.0071; odds ratio [OR] 2.23; 95% CI 1.23-4.04) and were more often caused by falling (P=0.0005; OR 2.92; 95% CI 1.57-5.42) and jumping off the wall (P<0.0001; OR 4.39; 95% CI 2.25-8.56) than injuries of other body locations. There was no statistically significant protective effect of the evaluated potential preventive measures. Participants who used heavily downturned climbing shoes had a higher risk of sustaining a UIAA ≥2 injury (P=0.0034; OR 2.58; 95% CI 1.34-4.95). CONCLUSIONS Injuries in indoor bouldering are common. Lower extremity injuries are associated with higher injury severity. Preventive measures need to be established to reduce bouldering injuries, especially during falls and landings.
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Affiliation(s)
- Jonas Auer
- Department of Trauma, Hand, Plastics and Reconstructive Surgery, University Clinics Würzburg, Würzburg, Germany
| | - Volker R Schöffl
- Department of Sports Medicine-Sports Orthopedics, Klinikum Bamberg, Bamberg, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastics and Reconstructive Surgery, University Clinics Würzburg, Würzburg, Germany
| | - Rainer H Meffert
- Department of Trauma, Hand, Plastics and Reconstructive Surgery, University Clinics Würzburg, Würzburg, Germany
| | - Kai Fehske
- Department of Trauma, Hand, Plastics and Reconstructive Surgery, University Clinics Würzburg, Würzburg, Germany.
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21
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Into the wild and on to the table: A Western Trauma Association multicenter analysis and comparison of wilderness falls in rock climbers and nonclimbers. J Trauma Acute Care Surg 2021; 89:570-575. [PMID: 32265389 DOI: 10.1097/ta.0000000000002705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation and to further distinguish climbing as a unique pattern of injury. METHODS Data were collected from 17 centers in 11 states on all wilderness falls (fall from cliff: International Classification of Diseases, Ninth Revision, e884.1; International Classification of Diseases, 10th Revision, w15.xx) from 2006 to 2018 as a Western Trauma Association multicenter investigation. Demographics, injury characteristics, and care delivery were analyzed. Comparative analyses were performed for climbing versus nonclimbing mechanisms. RESULTS Over the 13-year study period, 1,176 wilderness fall victims were analyzed (301 climbers, 875 nonclimbers). Fall victims were male (76%), young (33 years), and moderately injured (Injury Severity Score, 12.8). Average fall height was 48 ft, and average rescue/transport time was 4 hours. Nineteen percent were intoxicated. The most common injury regions were soft tissue (57%), lower extremity (47%), head (40%), and spine (36%). Nonclimbers had a higher incidence of severe head and facial injuries despite having equivalent overall Injury Severity Score. On multivariate analysis, climbing remained independently associated with increased need for surgery but lower odds of composite intensive care unit admission/death. Contrary to studies of urban falls, height of fall in wilderness falls was not independently associated with mortality or Injury Severity Score. CONCLUSION Wilderness falls represent a unique population with distinct patterns of predominantly soft tissue, head, and lower extremity injury. Climbers are younger, usually male, more often discharged home, and require more surgery but less critical care. LEVEL OF EVIDENCE Epidemiological, Level IV.
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22
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Rock Climbing Emergencies in the Austrian Alps: Injury Patterns, Risk Analysis and Preventive Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207596. [PMID: 33086551 PMCID: PMC7589766 DOI: 10.3390/ijerph17207596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
To elucidate patterns of and risk factors for acute traumatic injuries in climbers in need of professional rescue, a retrospective evaluation was performed of the Austrian National Registry of Mountain Accidents regarding rock climbing incidents over a 13-year timeframe from 2005 to 2018. From 2992 recorded incidents, 1469 were uninjured but in need of recovery, mainly when alpine climbing. Acute traumatic injuries (n = 1217) were often classified as severe (UIAA ≥ 3; n = 709), and commonly involved fractures (n = 566). Main injury causes were falls (n = 894) frequently preceded by rockfall (n = 229), a stumble (n = 146), a grip or foothold break-out (n = 143), or a belaying error (n = 138). In fatal cases (n = 140), multiple trauma (n = 105) or head injuries (n = 56) were most common, whereas lower extremity injuries (n = 357) were most common in severely injured patients. The risk for severe or fatal injuries increased with age and fall height when ascending or bouldering, during the morning hours, and when climbing without a helmet or rope. The case fatality rate was 4.7%, and the estimated total mortality rate was 0.003–0.007 per 1000 h of rock climbing. Acute traumatic injuries requiring professional rescue when rock climbing are often severe or fatal. Consequent use of a helmet when sport climbing, consistent use of a rope (particularly when ascending), proper spotting when bouldering, and proper training, as well as high vigilance when belaying are likely to help prevent such injuries.
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Lutter C, Tischer T, Schöffl VR. Olympic competition climbing: the beginning of a new era-a narrative review. Br J Sports Med 2020; 55:857-864. [PMID: 33036996 DOI: 10.1136/bjsports-2020-102035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.
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Affiliation(s)
- Christoph Lutter
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Volker Rainer Schöffl
- Section of Sports Medicine, Department of Trauma and Orthopedic Surgery, Klinikum Bamberg, Bamberg, Germany.,Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen-Nuremberg, Germany.,Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.,School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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Hospital Readmission After Climbing-Related Injury in the United States. Wilderness Environ Med 2020; 31:298-302. [PMID: 32800446 DOI: 10.1016/j.wem.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Rock climbing and mountaineering may result in injury requiring hospital admission. Readmission frequency after climbing-related injury is unknown. The aim of this study was to assess readmission frequency, morbidity, and mortality after admission for climbing-related injury. METHODS We performed a retrospective analysis of the 2012 to 2014 national readmission database, a nationally representative sample of all hospitalized patients. Rock climbing, mountain climbing, and wall climbing injuries were identified using International Classification of Diseases-Ninth Revision-Clinical Modification codes (E004.0). Outcomes evaluated included readmission frequency, morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. Data are presented as mean±SD. RESULTS A weighted-estimate 1324 inpatient admissions were associated with a climbing-related injury. Most patients were aged 18 to 44 y (64%), and 68% (n=896) were male. Isolated extremity injures were more common than other injuries (49%, n=645). Sixty-five percent (n=856) underwent a major operative procedure. Less than 1% of all climbing-related visits resulted in death. Within 6 mo of the index hospitalization, 2% (n=23) of the patients had at least 1 readmission, with a time to readmission of 9.9±6.6 (95% CI 4.5-15.4) d. Only female sex was associated with increased odds of readmission (odds ratio=5.5; 95% CI 1.5-20.1; P=0.01). CONCLUSIONS There is a very low frequency of readmissions after being admitted to the hospital for climbing-related injury. A considerable opportunity to describe the long-term burden of climbing-related injury exists, and further research should be done to assess injury burden treated in the outpatient setting.
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Effort Thrombosis Presenting as Unilateral "Pumped" Arm in a Climber. Wilderness Environ Med 2020; 31:344-349. [PMID: 32773353 DOI: 10.1016/j.wem.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023]
Abstract
Upper extremity injuries are common among the growing population of climbers. Although conditions affecting musculoskeletal structures are the most common causes of symptoms, a comprehensive differential diagnosis is necessary to avoid the misdiagnosis of high-morbidity conditions in this patient population. We present a case of a climber with acute edema, erythema, and pain of the entire right upper extremity. After confirmation of an upper extremity deep vein thrombosis by ultrasound, and in the absence of secondary causes for his thrombotic process, he was diagnosed with effort thrombosis. The patient was treated acutely with anticoagulation, catheter thrombectomy, direct thrombolysis, and balloon angioplasty followed by surgical decompression of the subclavian vein. Owing to the importance of early diagnosis and initiation of treatment, it is critical to keep disorders affecting the upper thoracic vascular structures in consideration.
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Chou DW, Kshirsagar R, Liang J. Head and Neck Injuries from Rock Climbing: A Query of the National Electronic Injury Surveillance System. Ann Otol Rhinol Laryngol 2020; 130:18-23. [DOI: 10.1177/0003489420936710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: We describe the incidence and characteristics of patients with head and neck injuries from rock climbing who present to United States emergency departments and evaluate predictors of hospitalization. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for rock climbing injuries to the head, face, mouth, neck, and ear under product code “mountain climbing” from the years 2009 to 2018. Demographics, injury characteristics, and disposition data were reviewed. Data were evaluated using chi-square analysis with Cochran-Mantel-Haenszal odds ratios (ORs). Results: An estimated 5067 patients (from 129 raw NEISS case numbers) suffered head and neck injuries from rock climbing nationally from 2009 to 2018. Concussion/closed head injury was the most common injury (44%), followed by laceration (23%), soft tissue injury (15%), neck strain/sprain (6%), skull fracture (3%), facial fracture (3%), intracranial hemorrhage (3%), cervical spine fracture (2%), unspecified facial trauma (1%), and dental trauma (0.3%). Males more frequently suffered lacerations (OR 1.6), soft tissue injuries (OR 23.3), cervical spine fractures (OR 336.7), intracranial hemorrhage (OR 582.0), and skull fractures (OR 6.2) than females. Compared to shorter falls, falls over 20 ft were more commonly associated with laceration (OR 2.0), soft tissue injury (OR 3.5), facial fracture (OR 7.5), dental trauma (OR 6.6), intracranial hemorrhage (OR 951.8), skull fracture (OR 81.2), and hospitalization (OR 3.8). Injuries associated with hospitalization included facial fracture (OR 23.7), cervical spine fracture (OR 24.6), intracranial hemorrhage (OR 2210.2), and skull fracture (OR 9.8). Conclusions: Concussions and facial lacerations are the most common head and neck injuries from rock climbing. Males more commonly suffer severe injuries. Falls over 20 ft are associated with more severe injuries and an increased likelihood of hospitalization.
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Affiliation(s)
- David W. Chou
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Rijul Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jonathan Liang
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Lutter C, Tischer T, Cooper C, Frank L, Hotfiel T, Lenz R, Schöffl V. Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes. Am J Sports Med 2020; 48:730-738. [PMID: 32004071 DOI: 10.1177/0363546519899931] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes. PURPOSE To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores. RESULTS Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5). CONCLUSION Increased attention should be placed on the climber's knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.
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Affiliation(s)
- Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | | | - Luisa Frank
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Thilo Hotfiel
- Department of Orthopedics, Trauma and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany.,Department of Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Lenz
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Volker Schöffl
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Section Sports Orthopedics & Sports Medicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany.,Wilderness Medicine Section, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.,School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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Rauch S, Wallner B, Ströhle M, Dal Cappello T, Brodmann Maeder M. Climbing Accidents-Prospective Data Analysis from the International Alpine Trauma Registry and Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010203. [PMID: 31892182 PMCID: PMC6981967 DOI: 10.3390/ijerph17010203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 01/17/2023]
Abstract
Climbing has become an increasingly popular sport, and the number of accidents is increasing in parallel. We aim at describing the characteristics of climbing accidents leading to severe (multisystem) trauma using data from the International Alpine Trauma Registry (IATR) and at reporting the results of a systematic review of the literature on the epidemiology, injury pattern, severity and prevention of climbing accidents. We found that climbing accidents are a rare event, since approximately 10% of all mountain accidents are climbing related. Climbing accidents mainly affect young men and mostly lead to minor injuries. Fall is the most common mechanism of injury. Extremities are the most frequently injured body part. However, in multisystem climbing-related trauma, the predominant portion of injuries are to head/neck, chest and abdomen. The fatality rate of climbing accidents reported in the literature varies widely. Data on climbing accidents in general are very heterogeneous as they include different subspecialties of this sport and report accidents from different regions. A number of risk factors are accounted for in the literature. Appropriate training, preparation and adherence to safety standards are key in reducing the incidence and severity of climbing accidents.
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Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac research, Viale Druso 1, 39100 Bolzano, Italy; (B.W.); (M.B.M.)
- Department of Anesthesia and Intensive Care Medicine, “F. Tappeiner” Hospital, Via Rossini 12, 39012 Merano, Italy
- Correspondence:
| | - Bernd Wallner
- Institute of Mountain Emergency Medicine, Eurac research, Viale Druso 1, 39100 Bolzano, Italy; (B.W.); (M.B.M.)
- Department of Anesthesiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Anichstraße 356020 Innsbruck, Austria;
| | - Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Anichstraße 356020 Innsbruck, Austria;
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac research, Viale Druso 1, 39100 Bolzano, Italy; (B.W.); (M.B.M.)
| | - Monika Brodmann Maeder
- Institute of Mountain Emergency Medicine, Eurac research, Viale Druso 1, 39100 Bolzano, Italy; (B.W.); (M.B.M.)
- Department of Emergency Medicine, Bern University Hospital and Medical University of Bern, 3010 Bern, Switzerland
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