Wrist Injuries in Climbers

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.