Search Results (15)

In men’s gymnastics, to build strength for static strength elements on rings (e.g., the Inverted Cross on Rings: ICR), general and ring-specific conditioning exercises are used. We aimed to examine the differences between elite and junior athletes in ring-specific strength in the ICR and the one-repetition maximum (1RM) in two conditioning exercises (Inverted Cross with Dumbbells: ICD; Seated Overhead Barbell Press: SOBP), to analyze the relationship between strength in the ICR and ICD and SOBP, and to establish preparatory strength benchmarks for ICR. Nine elite (20.97 ± 1.91 years, 66.01 ± 5.03 kg) and ten junior athletes (16.72 ± 0.55 years, 61.10 ± 7.9 kg) performed a maximum strength test for the ICR (five-second hold with pulley) and a 1RM test for the SOBP and ICD. Elite athletes were significantly stronger in the ICR and SOBP (22.36% and 33.2%; p < 0.001) but not in ICD (p = 0.13). Strong correlations (r > 0.65, p < 0.01) suggest that these exercises support strength development for the ICR. Although, the transfer into ring-specific strength must be trained separately, the benchmarks (SOBP: 150% body weight; ICD: 66%) offer coaches guidelines for optimizing training, prevent injury and promote physical resilience of elite athletes. Full article

Background: The aim of this biomechanical investigation was to evaluate a V-shaped three-point graft tenodesis technique using a free palmaris longus (PL) tendon for reconstructing traumatic A2 pulley lesions and to compare its biomechanical performance with two previously described reconstruction techniques. Methods: After A2 pulley lesion simulation in 27 fingers (index, middle and ring finger) from nine human anatomical hand specimens, reconstructions were performed using the innovative V-shaped graft tenodesis technique, a double-loop encircling technique and a suture anchor graft fixation technique. Load at failure and the failure mechanisms were evaluated. Results: The V-shaped graft tenodesis technique was superior biomechanically (p = 0.004) considering load at failure (mean: 299 N). The only observed failure mechanism in this group was the extrusion of the central tenodesis screw. In contrast, reconstructions in the other two groups failed due to suture cut-out. Conclusions: Patients may benefit from the new technique’s high load tolerance during early mobilization. Furthermore, a reduction in complications may be anticipated due to an absence of sutures and the sparing of extensor structures. Full article

Objectives: This systematic review addressed the following questions: what are the most recommended diagnostic criteria for pulley injuries in finger flexors among climbers? What is the best functional or classification clinical test for these injuries based on the available evidence? Materials and Methods: Following the PRISMA Statement checklist, a systematic literature review was conducted between August and September 2023, using a search on the PubMed database with a string of keywords and MeSH terms. The PEDro scale was used to analyze bias in the individual studies examined. Conclusions: Based on the exclusion criteria and research question, 14 articles with heterogeneous study designs were selected. Studies involving diagnosis through clinical examination or instrumental tests were analyzed. The data obtained provide an overview of different diagnostic and classification criteria for the injury under consideration. Ultrasounds remain the gold standard in diagnosing finger pulley injuries. The distance between the tendon and bone is the most used diagnostic criterion, with a distance greater than 2 mm corresponding to an A2 or A4 pulley injury. The clinical sign of bowstringing coincides with a multiple pulley injury involving A2, A3, and A4. Clinical signs, ultrasounds, and grip strength should be evaluated for a comprehensive diagnosis. A grip deficit of 41.4% corresponds to a pulley injury. Full article

Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley (“A” distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the “A” distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the “A” due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, −0.70 (−3.28–1.38), 0.98 (0.93 ± 1.04)), its validity for “A” distance is lower (LR, Y:O2, X:O3, −2.37 (−13.53–4.83), 1.02 (0.62–1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the “A” distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges. Full article

Climbing is a fast-growing sport, with one of the most common injuries being a rupture of the finger flexor tendon pulley. The strain on pulleys increases as finger joints flex. However, to our knowledge, no study has conducted a kinematic analysis of climbers’ fingers. Thus, this study aimed to examine finger kinematics during typical climbing tasks. Eleven elite climbers performed a sequence of four climbing moves, which were recorded by an optical motion capture system. Participants used crimp, half-crimp, and open-hand grips for three trials each, with the fourth condition involving campusing using any grip except crimp. Mean proximal interphalangeal joint (PIP) flexion during the holding phase was 87° (SD 12°), 70° (14°) and 39° (27°) for the crimp, half-crimp and open-hand grip, respectively. Hence, inter-individual PIP flexion ranges overlap between different gripping conditions. Two different movement patterns emerged in the open-hand grip, possibly influenced by the use of the little finger, leading to varying degrees of flexion in the middle and ring fingers. Avoiding little finger usage in the open-hand grip may reduce load during pulley rupture rehabilitation. The implications of PIP joint angle variability on individual pulley injury risk or prevention warrant further investigation. Motion capture proved effective for understanding finger kinematics during climbing and could guide future studies on pulley injury risk factors. Full article

Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Okutsu double- or triple-loop technique after iatrogenic or traumatic rupture of at least two adjacent flexor tendon pulleys in the finger and distal palm; mean age of injury was 4.77 years. The mean follow-up was 4.66 years after reconstruction of mostly A2 pulleys in a single surgeon setting. Outcome measures included ROM, NRS pain, satisfaction, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Krimmer score, Buck–Gramcko score, Jamar grip strength, pinch grip, and vigorimetry compared to the uninjured side. The median patient satisfaction score was 6.6/10. Hand function using the DASH score was 9.5. Grip strength on the Jamar Dynamometer showed only a slight reduction of 13% compared to the uninjured side. The resultant force of the operated fingers on the vigorimeter is almost 60% of that of the contralateral side, and the finger-palm distance of the operated finger was reduced from 2.2 cm to 1.45 cm. Other functional scores, such as Krimmer (82.2) and Buck-Gramcko (10.9), support these good results. The follow-up of patients more than 4.5 years after reconstruction of the A2 and A3 flexor tendon pulley using the double- or triple-loop technique showed acceptable patient satisfaction and good function of the finger in everyday life. Full article

Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years. Full article

The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations. Full article

The long head of the biceps tendon (LHBT) has been recognized as an important generator of anterior shoulder pain, causing a significant reduction in the shoulder flexion range. Various tendinous and ligamentous structures form the anchoring apparatus of the LHBT along its course to maintain its appropriate location during shoulder movements, including the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), subscapularis (SSC) tendon and supraspinatus (SSP) tendon as well as the less recognized tendons of pectoralis major (PM), latissimus dorsi (LD) and teres major (TM). Lesions of this stabilizing apparatus may lead to an instability of the LHBT, resulting in pain at the anterior shoulder. Ultrasonography (US) has been increasingly used in the assessment of shoulder injuries, including the anchoring apparatus of the LHBT. An accurate diagnosis of these injuries is often challenging, given the complex anatomy and wide spectrum of pathologies. In this review article, US anatomy and common pathologic conditions that affect the anchoring apparatus of the LHBT are discussed, including biceps pulley lesions, adhesive capsulitis, chronic pathology of SSC and SSP tendons, tears in the PM tendon and injuries to the LD and TM. Knowledge of a normal anatomy, an appropriate scanning technique and US findings of common pathologic conditions are the keys to accurate diagnoses. Full article

Injuries to the shoulder are very common in sports that involve overhead arm or throwing movements. Strength training of the chest muscles has the potential to protect the shoulder from injury. Kinematic and kinetic data were acquired in 20 healthy subjects (age: 24.9 ± 2.7 years) using motion capture, force plates for the bench press exercises and load cells in the cable for the cable pulley exercises with 15% and 30% of body weight (BW). Joint ranges of motion (RoM) and joint moments at the shoulder, elbow and wrist were derived using an inverse dynamics approach. The maximum absolute moments at the shoulder joint were significantly larger for the cable pulley exercises than for the bench press exercises. The cable cross-over exercise resulted in substantially different joint angles and loading patterns compared to most other exercises, with higher fluctuations during the exercise cycle. The present results indicate that a combination of bench press and cable pulley exercises are best to train the full RoM and, thus, intra-muscular coordination across the upper limbs. Care has to be taken when performing cable cross-over exercises to ensure proper stabilisation of the joints during exercise execution and avoid joint overloading. Full article

The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations. Full article

Research Highlights: The felling of hung up trees is considered by literature in the field as an activity with a high injury risk. The low work productivity in the felling of hung up trees is wrongly cited by workers in order to justify various more or less safe work techniques. Background and objectives: The purpose of this paper was to determine work productivity in the felling of hung up trees when this activity has a well-defined structure with stages and specific activities that would allow workers to assess injury risk correctly. In addition, this paper aims to identify the moment when workers should give up the manual felling of hung up trees with a hand winch and start using specialized logging equipment. Materials and methods: The research was conducted in the Eastern Carpathians in a spruce (Picea abies (L.) H. Karst.) tree stand where clear cutting normally takes place. A single team of workers was used consisting of two chainsaw operators—a main one and a secondary one. This team had a high level of qualification and experience in the operations performed. For the felling of hung up trees, the technique based on rotating the tree around a pivot with a hand winch was used. Time was measured in seconds by using the continuous time study method. Results: The results indicated that work productivity decreases with the number of times the traction line needs to be repositioned. It decreases from 3.477 trees·h⁻¹ (in trees where no repositioning is necessary) to 1.402 trees·h⁻¹ (when the repositioning takes place twice). In trees that needed the repositioning of the traction line, safety rules were broken in the following ways: crossing over the tensioned cable of the traction line, the main chainsaw operator being positioned inside the triangle formed by the hung up trees and the anchorage points of the pulley and the hand winch as well as the operator being positioned very close to the hung up tree stem base while the latter is being tied. That is why, if the repositioning of the traction line is necessary, the question is—would it be better to give up the manual felling of hung up trees and start using specialized equipment? Conclusion: The felling of hung up trees must be regarded and understood, first and foremost, through the perspective of reducing injury risk and protecting workers. Thus, the work productivity of 3.477 trees·h⁻¹ can be considered acceptable for trees that need no extra repositioning of the traction line or when the time consumed does not go over 17 min·tree⁻¹. Full article

The ability of finger flexors to generate force has been studied in relation to climbing performance. However, not much attention has been paid to the decrease in finger grip force in relation to annular pulley injuries. The purpose of the present study was to determine if an injured annular pulley implies a finger flexor force decrease, as well as its relation to clinical and sonographic changes. We performed an observational study in 39 rock climbers with A2 or A4 pulley injuries to the 3rd or 4th fingers. The variables considered were pain upon palpation, ultrasound tendon–bone distance, and finger grip strength decrease. Three rock climbing grip types were considered: the one finger crimp, open crimp, and close crimp. Injured rock climbers presented a decrease in finger grip strength compared to non-injured controls when performing a one finger crimp (p < 0.001). There exists a significant correlation between a tendon–bone distance at the level of the injured pulley and a decreased finger grip strength measured by performing a one finger crimp (p = 0.006). A decrease in finger grip strength could be considered in the diagnostic and follow-up process of A2 and A4 pulley injuries to the 3rd and 4th fingers. Full article

Finger growth plate injuries are the most common youth climbing injuries. The purpose of our study was to understand youth awareness of the most common youth climbing injury and safe training practices. We surveyed climbers, ages eight to 18 years old, at the 2017 USA Climbing Sport and Speed Youth National Championships. A total of 267 climbers completed the survey (mean age = 14 ± 2.7 years; 52% male). The A2 pulley injury was reported as the most common youth climbing injury by the largest portion of participants, 36%. The second most commonly identified injury was at the growth plate of the finger, 15% of participants, which was reported as significantly less than the A2 pulley injury, p < 0.001. Six percent of climbers reported the correct safe age to start double dyno campus board training. Roughly 18% of athletes identified growth plate injuries exclusively as a stress fracture, whereas 29.2% of those climbers self-reported as informed about finger growth plate injuries, but only 7.4% of climbers who self-reported as uninformed answered this question correctly. Misperceptions about skeletally-immature climbing injuries are prevalent amongst youth climbers. Education on the prevalence of finger growth plate injuries and the scarcity of A2 pulley injuries in youth climbers can increase diagnostic accuracy, improve care, and reduce long-term complications. Full article

The back is an extremely common site of injury among both athletes and sedentary people. Furthermore, low back pain has become prevalent in our society. Maintaining strong back muscles can help prevent future pain or injuries. Here, the aim is therefore to assess the kinetic and kinematic movements of four pulling exercises with different external loading directions. Fifteen healthy subjects were analyzed using a 3D motion capture system. The pulley machine was equipped with a load cell for force data acquisition. The exercises consisted of 8 repetitions each of the lat pulldown (25% and 50% body weight (BW) extra load), the lat pulldown with 45° incline (10% and 25% BW), the seated cable row (25% and 50% BW) and the upright row (standing, 10% and 25% BW). The minimum and maximum curvature angle in the thoracic as well as the lumbar spine was larger during the upright row than during the other exercises. Furthermore, during the upright row, the sagittal moment in the shoulder joint is opposed to the other exercises in the direction of retroversion. Due to the higher lumbar curvature observed in low back patients, to avoid overload, it is not advisable for patients with back pain to perform upright rows. Full article