Purpose
Rock climbing can lead to upper-extremity injuries, such as A2 pulley ruptures, leading
to the bowstringing of the flexor tendons. Climbing finger positions are specific
and can put undue stress on the pulley systems. This causes severe hand dysfunction
and is a difficult problem to treat, and prevention is important. Using a cadaveric,
experimental model, we evaluated the effectiveness of the H-taping method, commonly
used by rock climbers, to prevent and treat A2 pulley tears.
Methods
Using fourteen matched pairs of fresh-frozen cadaveric hands with forearms, four experiments
were conducted with 56 paired comparisons evaluating the failure force, fingertip
force, and mode of failure (112 total tests). Comparisons were as follows: index fingers-
intact versus 50% distal A2 pulley tears without H-taping (control); ring fingers-
intact versus H-taping as a prophylactic for A2 pulley tears; little fingers- 50%
distal A2 pulley tears with H-tape versus without tape; and middle fingers- H-taping
as a prophylactic versus H-taping as a stabilizing treatment of torn pulleys.
Results
The mean index finger failure force was significantly higher in intact vs torn A2
pulleys (control). Failure force for intact H-taped fingers was significantly higher
than torn H-taped fingers, but no other finger comparisons for failure force were
significant. There were no significant findings in comparison of mean fingertip force
values in any of the experiments.
Conclusions
We found that H-taping is not effective as prophylaxis against A2 pulley ruptures
or as a stabilizing treatment method for partially ruptured pulleys.
Clinical relevance
While H-taping has not been recommended as prophylaxis for preventing A2 pulley ruptures,
the climbing community has embraced this technique as a preventative measure. The
present study provides biomechanical evidence against H-taping for this purpose. Furthermore,
it does not appear to aid in increasing fingertip force after injury.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Injury patterns and safety practices of rock climbers.J Orthop Trauma. 2006; 61: 1517-1525
- Sport climbing: medical considerations for this new Olympic discipline.Br J Sports Med. 2017; 51: 2-3
- The influence of concentric and eccentric loading on the finger pulley system.J Biomech. 2009; 42: 2124-2128
- Injury to the A2 pulley in rock climbers.J Hand Surg Br. 1990; 15: 268-270
- Estimation of finger muscle tendon tensions and pulley forces during specific sport-climbing grip techniques.J Biomech. 2006; 39: 2583-2592
- Strength of human pulleys.Hand. 1977; 9: 147-152
- A new measuring technique for determining the forces acting on the pulley system of the finger.Sports Technol. 2009; 2: 32-38
- Biomechanical properties of the crimp grip position in rock climbers.J Biomech. 2001; 34: 217-223
- Biomechanical effectiveness of taping the a2 pulley in rock climbers.J Hand Surg Br. 2000; 25: 102-107
- The effect of circumferential taping on flexor tendon pulley failure in rock climbers.Am J Sports Med. 2000; 28: 674-678
- Impact of taping after finger flexor tendon pulley ruptures in rock climbers.J Appl Biomech. 2007; 23: 52-62
- Pulley injuries in rock climbers.Wilderness Environ Med. 2003; 14: 94-100
- How to prevent and treat finger flexor pulley injuries. Climbing.http://www.climbing.com/skills/how-to-prevent-and-treat-finger-flexor-pulley-injuries/Date accessed: April 5, 2020
- Soft tissue injury in extreme rock climbers.Br J Sports Med. 1988; 22: 145-147
- Upper limb injuries in elite rock climbers.J R Coll Surg Edinb. 1990; 35: S18-S20
- Hand injuries in competition climbers.Br J Sports Med. 1990; 24: 16-18
- Flexor tendon pulley injuries in rock climbers.Hand Clin. 2017; 33: 141-148
- Closed traumatic rupture of the ring finger flexor tendon pulley.J Hand Surg Am. 1990; 15: 745-747
- Kinetics of crimp and slope grip in rock climbing.J Appl Biomech. 2011; 27: 116-121
- Tendon excursion and moment arm of index finger muscles.J Biomech. 1983; 16: 419-425
- The flexor tendon pulley system and rock climbing.J Hand Microsurg. 2012; 4: 25-29
- Grip force safety margin in rock climbers.Int J Sports Med. 2008; 29: 168-172
- Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers.J Bone Joint Surg Am. 1998; 80: 1012-1019
- A2 and A4 flexor pulley biomechanical analysis: comparison among gender and digit.Hand (N Y). 2008; 3: 13-16
- Friction between finger flexor tendons and the pulley system in the crimp grip position.Clin Biomech (Bristol, Avon). 2009; 24: 20-25
- Middle and ring fingers are more exposed to pulley rupture than index and little during sport-climbing: a biomechanical explanation.Clin Biomech (Bristol, Avon). 2008; 23: 562-570
- Strength measurement and clinical outcome after pulley ruptures in climbers.Med Sci Sports Exerc. 2006; 38: 637-643
- Value of high-resolution ultrasound in the evaluation of finger injuries in extreme sport climbers.Ultraschall Med. 2000; 21: 73-78
- Sport climbing from a medical point of view.Swiss Med Wkly. 2012; 142w13688
- Pulley ruptures in rock climbers: outcome of conservative treatment with the pulley-protection splint- a series of 47 cases.Wilderness Environ Med. 2016; 27: 211-218
- Recovery of rock climbing performance after surgical reconstruction of finger pulleys.J Hand Surg Eur Vol. 2016; 41: 406-412
Article info
Publication history
Published online: July 20, 2022
Accepted:
May 11,
2022
Received:
April 10,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
