Alexis Kantor's poster on hand flexor tendon injuries in the climbing community

Kantor, Alexis

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IntroductionHand Flexor Tendon Injuries Involving the A2 and A4 Pulleys in Rock ClimbersAlexis KantorCollege of ChiropracticUniversity of Bridgeport, Bridgeport, CTAdvisor: Christopher Good, DC, MA(Ed)An otherwise uncommon injury is prevalent in the climbing community• Approximately 1.6% of Americansparticipate in the sport of RockClimbing (5 million people)1• Soft tissue strain in the upperextremity is intensified whileclimbing.• Approximately 40% of all reportedclimbing injuries occur at the A2and A4 pulleys of the flexortendons2,5• Mechanism of injury is predictable• Closed crimp hand position• Repetitive motion• Excess force• Acute loading1. Wagner N. Rock Climbing Industry Analysis (2016). Small Business, Houston Chronicle. (Accessed 18Feb17)  Available at: http://smallbusiness.chron.com/hunting-industry-analysis-71160.html.2. Schneeberger M and Schweizer A Pulley ruptures in rock climbers: outcome of conservative treatment with pulley-protection splint- a series of 47 cases. Wilderness and Environmental Medicine. June 2016; 27(2): 211-18.3. Warme WJ and Brooks D. The effect of circumferential taping on flexor tendon pulley failure in rock climbers. Am J Sports Med. 2000; SepOct 28(5):4-8.4. Rainer VS, Einwag F, Wolf S, and Schoffl I. Strengthmeasurement and clinical outcome after pulley ruptures inclimbers. Medicine and Science in Sports and Exercise.2006; April 38(4):637-43.5. Kubiak EN, Klugman JA, and Bosco JA. Hand Injuries inRock Climbers. Bulletin of the NYU Hospital for JointDiseases. 2006; 24(3,4).6. Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. Journal of Biomechanics. 2001; 34(2): 217-23.7. Klauser A, Frauscher FM, Bodner G, Halpern EJ, Schocke MF, Springer P, et. Al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology. March 2002: 222(3): 755-61.8. Van der Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother. 2003;49(3):183-8.9. Yang TH, Lu SC, Lin WJ, Zhao K, Zhao C, An KN, et al. Assessing finger joint biomechanics by applying equal force to flexor tendons in vitro by using novel simultaneous approach. PLoS One. August 2016;11(8).Key QuestionsHow can the injury be treatedconservatively?How can Chiropractors work torehab this injury, and work withathletes to prevent further injury?• Many climbers prophylactically tape their digits attempting to prevent injury however this method has proved ineffective3• Climbing with a ”closed” crimp as opposed to an open crimp yields higher rate of injury.• As technology for climbing equipment improves, people are training harder and climbing more technical routes.  Fall related injuries are less common, but soft tissue injuries are more common.• Initial treatment includes NSAIDs, ice,and some occupational modalities• Immobilization of the pulley for 2-6weeks• Gradual loading of the finger in flexion;climbing can begin at six weeks pastinjury, beginning on less than verticalwalls.• Crimp grips should be avoided untilfinger strength is at 80% or more 6• Oppositional stretching as part ofrehab strengthens extensor muscles• Soft tissue therapies have showneffective on muscular and tendinousstructures and may increase bloodflow to the area8,9• Graston, Massage, ART• Prevention of injury is paramount• As a community, climbers benefit fromchiropractic care, as well as manyother soft tissue treatmentDiscussion• The crimp grip position is unique to rockclimbing• The hand position induces up to 116N offorce on the A2 pulley, and 30N ofexternal force at the finger tip• A study on cadaveric hands shows theresulting tear and bowstringing of pulleytendons after acute loading 4• Pulley ruptures most commonly affect theA2 and A4 sheaths, often in the third andfourth digit. 2-7• Training modification and prevention ofinitial injury is paramount in buildingstrength to tendons, and minimizingrecovery time in the case of injury.• A pulley protector splint provides optimalimmobilization of the pulleys 2Treatment ProtocolsReferencesConclusion

Hand Flexor Tendon Injuries Involving the A2 and A4 Pulleys in Rock Climbers

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Hand Flexor Tendon Injuries Involving the A2 and A4 Pulleys in Rock Climbers

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