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Wrist injuries aren't as common as finger injuries (from what I've seen), but can be just as serious, if not more serious, especially as climbers often focus on fingers, elbows and shoulders and seem to forget that wrist bit in between! I've been trying to find statistics on wrist injuries, and the most common wrist injuries, however, most articles lump wrist/finger/hand injuries all together, so after much digging, I decided to focus on 4 main wrist injuries, and these are: Carpal Tunnel syndrome Stress fracture to the hook of hamate TFCC (Triangular Fibrocartilage Complex) injuries Scapho-lunate ligament tear The latter two will come in a follow up post, Wrist Injuries Part 2 Statistics I did manage to find: 11% of 39 rock climbers had carpal tunnel (Rooks et al 1995) 50% had hand or wrist injuries (Rooks et al 1995) 7.1% of 42 climbers had undercling wrist injury and carpal tunnel (Rohrborough et al 2000) 9 out of 115 injuries = wrist (7.8%)(Bollen 1988) 12% wrist #, 5% wrist sprain (out of 545) (Logan et al 2004) Schwiezer (2012) has said that these injuries are frequently seen only several months after the initial trauma. A ligamentous injury is quite difficult to treat at such a late stage and the prognosis is much worse. It is recommended that you get your wrist thoroughly investigated if it has been painful for more than three weeks, to exclude such an injuries. Anatomy of wrist Bones Ligaments Carpal Tunnel anatomy Carpal Tunnel Cause Carpal tunnel symptoms arise from compression of the median nerve as enters through the carpal tunnel and into the hand. The median nerve controls the movement of the thumb, as well as sensation in the thumb and the next two-and-a-half fingers. This compression can be caused by swelling within the carpal tunnel, or changing the orientation of the structures around the carpal tunnel, that could be caused from: Damage to the flexor tendons usually occurs due to overuse of the forearm flexors. Injury to wrist – sprain, fractures, crush injuries RSI -from strenuous grip, repetitive wrist flexion Sudden increase in activities leading to strenuous grip Symptoms The main symptoms of carpal tunnel are: Numbness Tingling Pain ...within the affected hand Normally in a specific pattern of the thumb and first two and a half fingers (as this is where the median nerve supplies within the hand) However, other symptoms can include: a dull ache and discomfort in the hand, forearm or upper arm a burning, prickling sensation dry skin, swelling or changes in the skin colour of the hand becoming much less sensitive to touch (hypoaesthesia) weakness in the thumb when trying to bend it at a right angle, away from the palm (abduction) weakness and wasting away (atrophy) of the muscles in the thumb weakness to the hand and fingers, meaning it becomes difficult to perform dexterous tasks, such as typing or fastening buttons. The symptoms of carpal tunnel are often worse after using the affected hand. Any repetitive actions of the hand or wrist can aggravate the symptoms, as can keeping your arm or hand in the same position for a prolonged period of time. The symptoms of carpal tunnel tend to develop gradually and usually start off being worse at night or early in the morning. Treatment Initial treatment of carpal tunnel should consist of the POLICE principles. This will mean resting the wrist, ceasing all aggravating activities (yes, this means climbing), avoid ports that requires a large amount of stress on the forearm flexors (yes, this also means climbing!), as well as racquet sports, gripping activities, opening jars, cans or doors, carrying or lifting. This rest is to ensure that the body can begin the healing process and prevent causing any further damage. Only once these activities can be performed pain free, can you gradually build up the stresses applied to the wrist and return to activities. “No pain, no gain” attitude will cause the problem to become chronic, which then becomes a lot harder to treat and will take much longer to resolve. If your carpal tunnel syndrome is caused by an underlying health condition such as rheumatoid arthritis, treating the condition should improve your symptoms. Wrist splints Physiotherapy Corticosteroid injections Carpal Tunnel Release surgery I will discuss the first two Wrist splints A wrist splint can be worn at night to keep it in the same position and aid the rest required. A wrist splint prevents the bending of the wrist and further compression of the carpal tunnel. Wrist splints are widely available, but you must follow the other advice to ensure the problem resolves. If there is no change within your symptoms after 4 weeks, definitely seek professional help. Physiotherapy The cause for your carpal tunnel could be due to: excessive training or activity muscle weakness muscle tightness joint tightness poor sporting technique or equipment inadequate warm-up Injury to the neck, upper back and nerves Exercises to target muscle tightness and weakness would be extensor and flexor stretches, and extensor/flexor stengthening (see medial epicondylitis post and the images below). As with all exercises, these should be performed pain-free. They are generic wrist flexibility and strengthening exercises for the wrist. A physiotherapist may use other modalities and treatment techniques to resolve your carpal tunnel Prognosis can be more than 6 months for a carpal tunnel problem to resolve Climbing technique and carpal tunnel Changes in climbing pattern may reduce the recurrence of carpal tunnel, especially if it was climbing that caused the carpal tunnel in the first place. This may involve: training planning with warming up and cooling down stretching exercises, longer rest periods, use of different hand positions, appropriate climbing shoes (Peters 2001) Differential Diagnosis Please bear in mind that although your symptoms are portrayed as carpal tunnel syndrome, there may be a different cause to your symptoms, such as radial nerve at the elbow and proximal forearm may be an origin of pain (supinator tunnel syndrome). Since this is purely a motor nerve, only weakness of the wrist and finger extensors and a dull pain are perceived. Stretching exercises and deep friction massage of the supinator muscle are usually helpful and surgery is rarely necessary. median nerve at its passage through the pronator teres and the ulnar nerve at the elbow (cubital tunnel syndrome) and at the hypothenar, but this is rare. Digital nerves may also be compressed but rather acutely (neuropraxia) when squeezed into cracks or holes, activating a sharp electrifying pain directly over the nerve with a hyposensitivity and numbness below the injury. These symptoms usually disappear after a few weeks. (Schwiezer 2012) Hook of hamate stress fracture Cause A hook of hamate fracture is quite rare, but is quite a climbing-specific injury (can occur in golfers too) that has been observed during a repeated attempt of an under-cling-grip on a difficult boulder. The fracture was caused by the climber holding his wrist in an ulnar-abduction where the FDP-tendons of the small and ring-finger are deflected by the hamate hook. The high forces at the hamulus finally led to a basal-fracture of the hamate (indirect fracture type). Similar to the scaphoid, hamate fractures cannot be picked up on normal x-rays. This means this type of injury is rarely diagnosed Symptoms Ulnar nerve symptoms such as: Numbness or tingling (‘pins and needles’) in the little and ring fingers Numbness or tingling in the heel of the hand Weakness in the hand when performing fine motor movements, straightening the ring and little fingers, and spreading the fingers Muscle atrophy localisation of tenderness over the hook of hamate pain on movement of the ring and/or little finger due to the proximity of the flexor tendons to the hook (Barton ) Treatment The fracture can be treated successfully with a special splint in ulnar and radial deviation of the wrist if picked up early enough. (Schwiezer 2012 and Barton ) Otherwise, an excision of the fragment, but this is quite a delicate operation, with mixed results. References Bayer T, Schweizer A. 2009 Stress fracture of the hook of the hamate as a result of intensive climbing. J Hand Surg Eur Vol. 34:276–7. Peters P. 2001 Nerve compression syndromes in sport climbers. Int J Sports Med 22:611–7. Rooks MD, Johnston RB , Ensor CD, McIntosh B, James S. 1995 Injury patterns in recreational rock climbers. Am J Sports Med 23(6): 683-685 Barton N 1997 Sports injuries of the hand and wrist. Br J Sports Med 31: 191-196 Schwiezer A 2012 Sport climbing from a medical point of view. Swiss Medical Weekly Rohrbough, J. T., M. K. Mudge, R. C. Schilling 2000 Overuse injuries in the elite rock climber. Med. Sci. Sports Exerc., 32(8):1369–1372. Logan AJ, Makwana N, Mason G, Dias J. 2004 Acute hand and wrist injuries in experienced rock climbers.Br J Sports Med. 38(5):545-8. Bollen 1988 Soft tissue injury in extreme rock climbers. British Journal of Sports Medicine 22(4): 145-147 Next post: Wrist injuries part 2: Scapholunate injuries and instability and TFCC Injuries

The Shift is a docu-series produced and hosted by Katherine Maslen. In this engaging series, each season takes you through an area of health.

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So, this post started as a request by my old man, who is an "older" climber! However, he didn't elaborate on what he wanted me to discuss with regards to the hips, so I'm going to explain some anatomy, the function, the relevance of the hips to climbers, potential pathologies you may come across, treatment/preventative measures that can be taken, and any other relevant information I encounter along the way! Anatomy The hip joint is a basic ball and socket joint that has a large range of movement. It is also a very stable joint due to the majority of the head of femur being encapsulated by the acetabulum of the pelvis I won't bore you with naming them individually, but the primary role of the muscles of the hip are to flex and extend the hip, as well as adduct and abduct it. A combination of these movements bring about rotational movements about the joint. Function The main function of the hip is to provide a strong, weight bearing joint in which provides enough movement to walk, stand, and other functional movements. Relevance to climbers The relevance of the hips to rock climbers is bigger than you might think. A lot of climbers focus on the upper limb - getting stronger shoulders or fingers, and some may contemplate the feet, for example their shoes and how tight they are, however, not many think about anything else in the lower limb region. This is because much of the strength built up in the legs is from weight bearing exercises such as....walking, sit to stand, climbing stairs etc etc, but aren't nessecarily transferable strengths to climbing. Copyright Seve Graepel The hips are key in climbing, for example, being able to actively extend the hips to bring your body closer to the wall, so your centre of gravity is in line with your feet. This is in order to take some of the weight off the arms. Also, the range of movement about the hip is key, and can be a hinderance in many an older climber, as the infamous rock over move requires a high step with the hip joint flexed excessively than would be done in normal, everyday activities. This high step then has the weight of the climber transferred across to it, then the climber has to stand on the rocked-over leg with all the weight of the climber being supported on that leg (with or without some holds for the arms). This means the hip has been flexed to it's end range, and then has to extend from this end-range position. Copyright BMC This can be quite a difficult move, and in reality, the best exercises for this is the movement itself: to practice rock-overs; but starting from a lesser degree of flexion and gradually building it up. Single leg squats and other such weight bearing exercises will build up muscles around the hip and knee that aid this movement, but does not cover the same range of movement a rock-over requires. Pathologies So, pathologies of the hip. There are no real hip pathologies that are common, or more likely in climbers, unlike other joints such as fingers. Therefore, hip problems are usually similar issues found with Joe non-climber Bloggs out there. So, generally, pain around your hip could be caused by a tightness in the hip stabilizers, such as the piriformis. A deep rub with an elbow in the buttocks region, at the midpoint between the head of femur and PSIS (posterior superior iliac spine) will often resolve the pain, minus the pain you will experience from the deep rub initially! A lot of people I know rave about yoga as a great adjunct to most therapies, and for the hip it seems to be in a league of it's own. This is a good preventative measure for injuries. Other hip pain could be referred from elsewhere, such as the lumbar spine, and needs checking out further by an expert. Finally, issues related to older climbers and the hips would be that of osteoarthritis of the joint. So, osteoarthritis is a disease that normally occurs for the over 50's and is a degenerative joint disease that causes break down of the cartiledge of joints and produces bony spurs, both of which cause pain upon movement of the joint, along with swelling and inflammation. There is no "cure", as it were, for osteoarthritis, but can be managed with exercise and medication, however, some do require surgical intervention (which will be saved for a later post) Treatment and Preventative Measures I've already discussed treatment and preventative measures along the way, but here I will summarise them: Build up hip strength for exercises such as rockovers by gradually building up the exercise from a lower level and working up Hip issues can come from other areas such as the spine - work on your core to prevent this Explore other options to maintaining your strength and flexibility such as yoga Tight piriformis and other hip stabilizers can be solved via stretches or soft tissue release (deep rub!) Exercise and medication can aid reduce the pain caused by osteoarthritis

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