Sports and Traumatology

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1 Sports and Traumatology Series editor Philippe Landreau, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar More information about this series at

3 Sébastien Gnecchi François Moutet Hand and Finger Injuries in Rock Climbers

4 Sébastien Gnecchi Marseille France François Moutet Grenoble France Translated by Lucette Cayol Original French edition published by Springer, Paris, ISSN ISSN (electronic) Sports and Traumatology ISBN DOI / ISBN (ebook) Library of Congress Control Number: Springer Cham Heidelberg New York Dordrecht London Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (

5 Collection Sports and Traumas S upervised by Philippe Landreau People, whatever their age, keep practicing sports, and consequently, injuries resulting from sports practice have become more and more specific, which accounts for a new field to be highly considered. Indeed, each joint or part of the body can suffer from any kind of injury. Moreover, each sport has its own specific lesions. This is why Sports and Injury Collection insists on developing each topic according to the sport practiced. This documentation is addressed to all readers, doctors, surgeons, or physicians looking for information about injuries and treatments. This collection is co-published by the French Society of Sports Traumas (FSST) and the European Federation of National Associations of Orthopaedic sports Traumatology (EFOST). v

7 Prologue Photo 1 Jacky Godoffe climb to Fontainebleau vii

8 viii Prologue Nimble fingers eyes like a hawk As a child, fingers are first used to pick one s nose after the entire house is hand painted with some leftover found at the back of the garage. And next, they are gradually easier to handle once you realize how useful they can be. Especially in rock climbing, since, as Edlinger put it, you can t climb but bare-handed. From that moment, it s just like a musician who couldn t live without his music; the hand becomes indispensable; a failure in one of the fingers, and everything would go wrong; no more sensation, no more pleasure. In a word, especially for a passionate person, the world would be falling apart, and that really sucks! I ve been rock climbing for more than 20 years now, so what should I tell you to take care of yourself? Perhaps should I mention a slight straining at la Rose et le Vampire in Buoux 15 years ago. I shouldn t have tried a hard route after going through the pressure of a former competition because even if I won it, my body eventually failed me. It served me right. For 3 months, I went on climbing, and when I felt better, I became careless. So don t count on me to give you wise advice! I just told myself that crimp grip wasn t my cup of tea, though I knew it already. But it pushed me to only work on my main strengths to get even better and not give a damn for the rest. So I said goodbye to rock grinding. The greatest problem is that the higher you get, the more invincible you feel, and the only thing you want is to reach the sky and merge in its magic. At that point comes the question of natural abilities since at their birth, each individual isn t provided with the same physical abilities. This matter still remains a mystery, and no one can explain why some athletes, whatever the sport, are always injured whereas others are never. I personally feel that nature has been good to me. Well, I m not boasting about it, but I just try to make the most of it. Sure I don t drink over the top Pastis or whatever I ve never smoked either, but it doesn t mean that my life is the one of an ascetic. Actually, I just feel my life, and that s the first thing I realized when I started climbing. Some days, I didn t feel good; I felt like I was nailed to the ground, so each time I feel this way, I pack my stuff and do something else. Indeed, it s great to have other interests such as a family, a pleasant job, studies, music, reading, or anything else. Whatever the genetic legacy, I really think that sometimes, you have to listen to your body even if your mind says no. Because deep in my heart, I know that climbing is a real addiction. Without my weekly fix, I become unbearable, but this fix has to be a pure pleasure and not a fight against myself. Obviously, today s training has completely changed, including a higher intensity in the repetition of traumatizing movements, especially on resin. I personally don t think that today, we are climbing much more than 20 years ago, when we happened to climb nonstop for several months nearly every day of course when the weather was fine! I believe that you have to smile at life and enjoy the present time because no matter how careful you may be, anything can happen at any time, so seize the day! Jacky Godoffe

9 Acknowledgements Thanks to all the people who took part in that project. Equipment Céfar Compex Society and Pascal Adam, scientific director. Snap Climbing Society and Fred Noé in particular. Eb Society and Fred Tuscan, manager. Reading-correction Émilie Verdier, Laurent Vigouroux -extensors-, Magali Chabod, Fred Noé electro- stimulation-, Pascal Adam -electro-stimulation-, Cécile Martha, Evelyne Gnecchi, Marie-Françoise Sembresq, Christine Parano. Translation Lucette Cayol Photos Fred Noé, Laurent Vigouroux, Dominique Thomas MCMK, Loïc Gaidioz, Jacky Godoffe, Rémi Samyn, Juliette Danion, François Lombard, Michel Azabant, Mélanie Son, Ludivine Harmand, Fred Labreveux, Marc Daviet, Violaine Beuque, John Evans. Interviews Jacky Godoffe, Loïc Gaidioz, François Lombard, Émilie Verdier, Mélanie Son, Juliette Danion, Rémi Samyn. ix

10 x Acknowledgements Photo 2 Targasonne boulder area

11 Contents 1 Introduction Different Terms Will Be Used Throughout This Publication The Anatomy of the Hand Bone Structure Structures Finger Mechanics Joint Structures Mediocarpal Joints Carpometacarpal Joints Intermetacarpal Joints Thumb Carpometacarpal Joints (Metacarpal and Trapezoid) Finger Joints Muscle and Tendon Structures What Is a Tendon? Various Muscles of the Hand Synovial Sheaths Ligament Structures MCP Joints PIP Joints DIP Joints Fibrous Structures: Digital Pulleys Structural Adaptations Climber s Hand Skin Various Injuries Tendon Injuries Tendinopathy Synovial Cyst xi

12 xii Contents 3.2 Pulley Injuries Introduction Pulley Rupture Factors Clinical Data Treatment and Behavior Medical Scanning Ligament Lesions Sprains Dislocations Bone Injuries Introduction Clinical Data Fracture Factors Treatment Scanning Images Scaphoid Fracture Muscle Injuries Lumbrical Muscle Tearing Off Other Injuries Ring Finger Trigger Finger Surgical Techniques Tendon Lesions Ganglion Cysts Flexor Tendon Pulley Ruptures Sprains and Dislocations of the Long Fingers Sprains and Dislocations of the Thumb Metacarpal and Phalangeal Fractures Carpal Bones Fractures Ring Finger Trigger Finger Remarque Training and Back to Training Climbing Different Grips Strains of the Various Grips Crimp Grip or Open Hand Posture: Which One to Choose? Training Basics Intensity Principles Alternative Principles Progressive Principles Constancy and Continuity Principles Specificity and Characterization Principles Knowing and Listening to One s Body

13 Contents xiii 5.3 Climbing Various Efforts Alactic Anaerobic Efforts Lactic Anaerobic Efforts Aerobic Efforts Various Competitions of Rock Climbing Lead Competitions Bouldering Competitions Speed Competitions Outdoor Climbing Training Safety and General Precautions Training Safety Training on Specific Tools Return to Training After an Injury Therapy Tendon Injuries Digit Pulley Injuries Bones Injuries Ligament Injuries Recap Table Interviews Assessment and Safety Assessment Warm-Up Warm-Up: First Part Warm-Up: Second Part Warm-Up: Third Part Warm-Up: Fourth Part Stretching Exercises Stretching Exercises: What For? Stretching Basics Finger Flexors Finger: Common Extensors Interosseous Muscles Dehydration Causes of Dehydration Injuries Food Diet Macronutrient Classification: Carbohydrates, Proteins, and Lipids Carbohydrates Proteins Lipids (Fats) Extreme Malnutrition Symptoms Vitamins Mineral Salts

14 xiv Contents 6.6 Extensors Common Finger Extensor Work Extensor Muscles: Strengthening Exercises Electrostimulation Introduction Electrode Setting Osteoarthritis Icing Treatment Icing Bag Partial Immersion RICE Method Rest Ice Compression Elevation Conclusion Abbreviations Climbing Lexicon Bibliography

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