Hand Injuries in Rock Climbers

Bulletin of the NYU Hospital for Joint Diseases • Volume 64, Numbers 3 & 4, 2006

Erik N. Kubiak, M.D., Jeffrey A. Klugman, M.D., and Joseph A. Bosco, III, M.D.

Abstract:
Rock climbing, whether practiced in nature on cliffs and
boulders or indoors on walls made of resin and wood, has
grown in popularity in recent years. An estimated five million
people participate in “rocking” at least three times a year.
Climbing places unique demands on the upper extremity,
especially the hands. The flexor tendons and flexor pulleys
are prone to sprains and ruptures. Pulley injuries occur in
up to 20% of climbers. The A2 pulley of the ring finger is
the most frequently injured. Most pulley injuries can be suc-
cessfully treated with a week of immobilization, followed by
a range of motion (ROM) exercises for one week. Isometric
training on a finger board can be started once ROM exercises
are painless. A return to climbing can be initiated when the
climber is able to avoid grip positions that produce pain;
however, the closed crimp grip should be avoided at this
time. Surgical reconstruction using the technique described
by Widstrom is recommended for acute injuries with clinical
evidence of bowstringing. Ultrasound and MRI are the cur-
rent modalities best suited for confirming clinical findings.