A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature

Abstract

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.

Keywords: climbing; finger; load adaptation; osteoarthritis; osteophyte; overuse.

Figure 1

Clinical appearance of both hands of the climber (left) in contrast to hands of a non-climber (right). (A): View from dorsal. (B): View from radial with full finger extension. (C): View from radial with increasing finger extension for better radial view of the fingers. (D): View from radial with full finger flexion. Note the reduced finger flexion of the participant in contrast to the non-climber in (D).

Figure 2

(A,B): Left: Radiographs of the participant. Right: Height- and weight-matched non-climbing male: (A): Anteroposterior radiographs of digits II–V of both hands. (B): Lateral radiographs of digits II–V of both hands. Note the thinner intramedullary canal (white arrow; blue line) and the thicker cortical bone (orange line) in the climber in contrast to the non-climbing male. Furthermore, signs of osteoarthritis (e.g., right DIP digit II marked with +) and osteophytes (*) are demonstrated in the right digit II of the climber. More severe grades of osteoarthritis and bigger osteophytes are seen in fingers II and III. A normal DIP (+) without osteophytes (*) is demonstrated in the non-climbing male with an incidental finding of a plate osteosynthesis in the middle phalanx of the left digit II after a fracture years ago. (C): The 10-year-old lateral radiographs of digits II-V and anteroposterior radiographs of digits II-V of both fingers of the participant. Note the evolution of osteophytes over the course of 10 years (e.g., right DIP digit II marked with (+) in (B)).

Figure 3

Ultrasound examination. Left: participant; Right: height- and weight-matched non-climbing male: (A): Longitudinal view of flexor tendons (FDS and FDP) at their stoutest point under the A2 pulley (P). (B): Axial view of A2 pulley (P) and the flexor tendons (FDS and FDP). Note the thicker flexor tendons (orange line) and the thicker pulley (white line) in the elite climber. (C): Sagittal view of the palmar plate (PP) (marked with dotted line) of a DIP joint. Note the thicker palmar plate (orange line) in the climber. (D): Transverse plane of the DIP joint. Note the thicker cartilage (orange line) in the climber.