Finger injuries in extreme rock climbers - Assessment of high-resolution ultrasonography

Dynamic high-resolution ultrasonography findings obtained in 34 extreme roc k climbers with finger injuries were compared with those in 20 healthy volu nteers. Thicknesses of the flexor tendon and A-2 flexor tendon pulley syste m were measured at the base of the proximal phalanx. The distance between t he tendon and phalanx was evaluated with the finger in extension and in for ced ftexion as a measure of bowstringing. Gliding ability of the flexor ten dons was assessed during active and passive motion. Compared with healthy v olunteers, climbers showed a significantly increased thickness of the flexo r tendons and the flexor tendon pulley system but no impairment of the glid ing mechanism. Only in climbers did the distance between tendon and phalanx increase from 0.14 cm (+/-0.07) during extension to 0.30 cm (+/-0.09) duri ng forced flexion. In three climbers with complete A-2 pulley ruptures this distance was up to 0.51 cm (+/-0.15) during forced flexion. Clinically uns uspected synovial cysts, thickened joint capsules, fibrous tissue, or fluid collection were found only in climbers. We concluded that dynamic ultrason ography is a valuable tool for accurate assessment of early changes in "cli mber's finger." It provides useful information, especially in cases where c linical evaluation is difficult, and should be performed to select appropri ate therapeutic management.