Pressure distribution in carpometacarpal joint, due to step-off in operatively treated Bennett's fractures.

INTRODUCTION: The purpose of the current study was to investigate the effects of residual articular incongruity after Bennett's fracture on load distribution of the joint surface. Our aim was to investigate whether a residual joint step and the altered load distribution led to negative clinical outcomes or symptomatic degenerative osteoarthritis of the trapeziometacarpal joint. PATIENTS AND METHODS: Twenty-four patients were available for long-term follow-up examination and were contacted by phone, and they returned for follow-up examination. Computed tomography (CT) scans of both carpometacarpal (CMC) joints were performed. CT scans were taken in the sagittal plane of the forearms with a slice thickness of 0.625 mm for three-dimensional reconstruction. The CMC joints were analysed due to a residual step in the joint. Only patients with a residual step-off were included in this study. To determine the areas of maximum density in the joint, CT-osteoabsorptiometry was performed. RESULTS: Ten patients had the maximum loading area radial and two patients central. The second major position of mineralization was detected central in four patients, volar-ulnar in two patients, radial in one patient, dorso-radial in one patient, volar in one patient and volar-radial in two patients. CONCLUSION: Finally, no higher loading in the area of the beak fragment could be found. The Wagner technique, even if it results in a persistent 1-2-mm intra-articular step-off of the beak fragment, is still the favourable method for the treatment of Bennett's luxation fractures.

Brake response time returns to the pre-surgical level 6 weeks after unicompartmental knee arthroplasty.

PURPOSE: The objective of the study was to clarify whether driving abstinence should be recommended when patients are discharged from hospital after unicompartmental knee arthroplasty (UKA). We tested the hypotheses that there are differences in the peri-operative course of brake response time in patients undergoing right-sided (1) or left-sided (2) UKA. Additionally, we tested whether brake response time is significantly influenced by pain (3), driving experience (4) or age (5). METHODS: In 43 patients undergoing UKA, brake response time was measured with a custom-made driving simulator pre-operatively and 1 and 6 weeks after UKA. Patients' visual analogue scales for knee pain and their self-reported driving experience were also assessed. RESULTS: In patients with right-sided UKA, brake response time changed from 786 (261) ms pre-operatively to 900 (430) ms 1 week post-operatively (p = 0.029). At 6 weeks post-operatively, brake response time had returned to 712 (139) ms, which was deemed to be an insignificant change from the pre-operative reference benchmark. When surgery was performed on the contralateral left side, no effect was found onto the right side's brake response time. Knee pain and driving experience were significantly correlated with brake response time. No such correlations were found between brake response time and age. CONCLUSIONS: On the basis of the current findings, it is concluded that brake response time returns to pre-operative levels 6 weeks after UKA surgery. Therefore, it is proposed that driving be abstained from for that period.

The influence of distal locking on the need for fibular plating in intramedullary nailing of distal metaphyseal tibiofibular fractures.

Using human cadaver specimens, we investigated the role of supplementary fibular plating in the treatment of distal tibial fractures using an intramedullary nail. Fibular plating is thought to improve stability in these situations, but has been reported to have increased soft-tissue complications and to impair union of the fracture. We proposed that multidirectional locking screws provide adequate stability, making additional fibular plating unnecessary. A distal tibiofibular osteotomy model performed on matched fresh-frozen lower limb specimens was stabilised with reamed nails using conventional biplanar distal locking (CDL) or multidirectional distal locking (MDL) options with and without fibular plating. Rotational stiffness was assessed under a constant axial force of 150 N and a superimposed torque of ± 5 Nm. Total movement, and neutral zone and fracture gap movement were analysed. In the CDL group, fibular plating improved stiffness at the tibial fracture site, albeit to a small degree (p = 0.013). In the MDL group additional fibular plating did not increase the stiffness. The MDL nail without fibular plating was significantly more stable than the CDL nail with an additional fibular plate (p = 0.008). These findings suggest that additional fibular plating does not improve stability if a multidirectional distal locking intramedullary nail is used, and is therefore unnecessary if not needed to aid reduction.

[Correction of posttraumatic lower leg deformities using the Taylor Spatial Frame]. / Die Korrektur posttraumatischer Deformitäten am Unterschenkel mit dem "Taylor Spatial Frame"

OBJECTIVE: Correction of posttraumatic lower leg deformities using percutaneous osteotomy, external fixation with a ring fixator, and computer-assisted gradual correction with the Taylor Spatial Frame (TSF). INDICATIONS: Posttraumatic lower leg deformities not suitable for acute correction and internal fixation or deformities that are suitable but have a significantly increased risk for complications: deformities with poor soft tissue coverage, rigid deformities that require gradual correction, complex mulitplanar deformities, deformities with shortening, and periarticular juvenile deformities. CONTRAINDICATIONS: Posttraumatic lower leg deformities which are suitable for acute correction and internal fixation are also suitable for deformity correction using the TSF. In these cases, however, we recommend acute correction and internal fixation in order to improve the patient comfort. Lack of patient compliance for self-contained correction and pin care. SURGICAL TECHNIQUE: Percutaneous fixation of the TSF rings to the main fragments using transosseous K-wires and half pins (hybrid fixation). Percutaneous osteotomy of the tibia either by drilling across both cortices and completion of the osteotomy using an osteotome (DeBastiani method) or by using the Gigli saw with preservation of the periostal envelope. Connection of both rings with six oblique telescopic struts via universal joints (hexapod platform). Computer-assisted planning of the correction. POSTOPERATIVE MANAGEMENT: Gradual postoperative correction of the deformity by changing the strut lengths according to the correction plan. Strut changes, if required. Osseous consolidation of the osteotomy site with the TSF or revision to internal fixation. RESULTS: The correction of posttraumatic lower leg deformities using the TSF was performed in 6 cases. The mean deformity was 15° (12-22°) in the frontal plane and 6° (4-8°) in the sagittal plane. The correction time was 19 days (14-22 days). The deviation between planned and achieved correction was 0-3° in the frontal plane and 0-2° in the sagittal plane. The osseous consolidation of the osteotomy site was carried out in the TSF in 5 cases with a mean external fixation time of 112 days (94-134 days). In one case, the TSF was removed after the correction and the osteotomy site was fixed using an intramedullary nail. Pin site infections were observed in 3 cases. There were no further complications. The treatment goal was achieved in all cases. The examination at final follow-up was performed after 1 year. All patients were able to walk without walking aids and with no pain at that time. They were able to perform all of their activities of the daily life and their leisure activities without limitations.

Revision anterior cruciate ligament reconstruction: an update.

With the rising number of anterior cruciate ligament (ACL) reconstructions performed, revision ACL reconstruction is increasingly common nowadays. A broad variety of primary and revision ACL reconstruction techniques have been described in the literature. Recurrent instability after primary ACL surgery is often due to non-anatomical ACL graft reconstruction and altered biomechanics. Anatomical reconstruction must be the primary goal of this challenging revision procedure. Recently, revision ACL reconstruction has been described using double bundle hamstring graft. Successful revision ACL reconstruction requires an exact understanding of the causes of failure and technical or diagnostic errors. The purpose of this article is to review the causes of failure, preoperative evaluation, graft selection and types of fixation, tunnel placement, various types of surgical techniques and clinical outcome of revision ACL reconstruction.

[Anatomical double-bundle reconstruction of the medial patellofemoral ligament with a gracilis autograft]. / Anatomische Rekonstruktion des medialen patellofemoralen Bands mit gedoppelter Gracilissehne.

OBJECTIVE: Elimination of patellofemoral instability by reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis autograft. INDICATIONS: Recurring lateral luxation and subluxation of the patella, tibial tuberosity-trochlear groove distance (TTTG) < 20 mm, persistent positive apprehension test in up to 45° of flexion, low grade trochlear dysplasia. CONTRAINDICATIONS: Traumatic luxation of the patella without anatomical risk factors, isolated treatment if TTTG > 20 mm, and isolated treatment for high-grade trochlear dysplasia (type B, C, D). SURGICAL TECHNIQUE: Supine postion. Stripping of the gracilis tendon. Drilling of two tunnels into the medial margin of the patella. Insertion of both tendon ends into the tunnels and fixation with resorbable screwlocks. Undermining of the fascia of the medial oblique vastus muscle and insertion of the tendon loop into the femoral point of insertion located at the medial epicondyle. Preparation of the femoral point of insertion and drilling of the femoral tunnel. Insertion of the graft into the femoral tunnel. Positioning of the knee in 30° of flexion. Positioning of the patella and fixation of the graft with a resorbable screw. POSTOPERATIVE MANAGEMENT: Two weeks of partial weight bearing. Knee orthesis for 6 weeks. Passive motion up to 60° of flexion for the first 2 weeks. Three weeks postoperatively unrestricted motion exercises, strengthening of the quadriceps muscle. Unlimited activity is possible 3 months postoperatively. RESULTS: The method presented in this manuscript was performed on 32 patients with recurring patellar luxation; 27 patients were available for clinical assessment at 1 year postoperatively. There were no recorded events of reluxation; the Kujala score increased on average from 61 points preoperatively to 93 points postoperatively.

[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail]. / Marknagelung distaler Unterschenkelfrakturen am Beispiel des Expert(TM) Tibianagels.

OBJECTIVE: Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. INDICATIONS: Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) CONTRAINDICATIONS: Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. SURGICAL TECHNIQUE: Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. POSTOPERATIVE MANAGEMENT: Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. RESULTS: Between July 2004 and May 2005, 180 patients were included in a multicenter study. The follow-up rate was 81% after 1 year. Of these, 91 fractures (50.6%) were located in the distal third of the tibia. In this segment, the rate of delayed union was 10.6%. Malalignment of > 5° was observed in 5.4%. A secondary malalignment after initial good reduction was detected in only 1.1% of all cases. The implant-specific risk for screw breakage was 3.2%. One patient sustained a deep infection. If additional fibula plating was performed an 8-fold higher risk for delayed bone healing was observed (95%CI: 2.9-21.2, p< 0.001). If the fracture of the fibula was at the same height as on the tibia, the risk for delayed healing was even 14-fold (95% CI: 3.4-62.5, p< 0.001). Biomechanically plating of the fibula does not increase stability in suprasyndesmal distal tibia-fibular fractures treated with an intramedullary nail. Using the ETN with its optimized locking options, fibula plating is not recommended, thus, avoiding soft tissue problems and potentially delayed bone healing.

[Elastic stable intramedullary nailing after corrective osteotomy of symptomatic malunited midshaft clavicular fractures]. / Elastisch stabile intramedulläre Nagelung nach Korrekturosteotomie von symptomatisch fehlverheilten Klavikulafrakturen.

OBJECTIVE: To restore alignment and length of the clavicle, to relieve typical symptoms of malunion, and to improve functional outcome and aesthetic results. INDICATIONS: Symptomatic malunion after clavicular fractures, including local pain and tenderness, weakness and rapid fatigability of the shoulder girdle muscles, impairment of overhead mobility, numbness, parasthesia, and pain of the arm and fingers during overhead movements due to brachial plexus irritation (thoracic outlet syndrome), and dissatisfaction with the appearance of the shoulder girdle. CONTRAINDICATIONS: Atrophic nonunions, osteoporosis, asymptomatic malunion. SURGICAL TECHNIQUE: A 5-cm skin incision is made above the deformity of the malunited clavicle. The osteotomy plane is determined under fluoroscopic guidance, within the callus separating the two original main fracture fragments. Under fluoroscopic guidance, the medullary canal is reopened on both sides with a 2.7 mm drill bit. Afterwards a 1.5 cm skin incision is made just above the sternal end of the clavicle. The anterior cortex is drilled and a titanium nail (diameter 2.5 mm) is introduced. Under rotational movement, the nail is advanced to the osteotomy site. The nail is inserted into the lateral fragment. Then the inserted nail is cut back as far as possible on the medial entry point. Wound closure. POSTOPERATIVE MANAGEMENT: No immobilization, movement not restricted. Patients are encouraged to use the arm in daily activities. Heavy weight bearing is not allowed until osseus consolidation. RESULTS: In 5 patients (3 men, 2 women) with a mean age of 34 years (range, 23-44 years) with symptomatic malunion after clavicular fractures, a corrective osteotomy and elastic stable intramedullary nailing (ESIN) was performed. After 6 months (mean 4.4 months), all osteotomies were healed and the nails were removed. There were no complications. At final follow-up (12 months), the DASH and Constant scores were significantly improved compared to preoperative values. Patients were significantly more satisfied with the appearance of the shoulder girdle and overall outcome.

Real-time sonoelastography: findings in patients with symptomatic achilles tendons and comparison to healthy volunteers.

PURPOSE: Real-time sonoelastography (SE), a newly introduced ultrasound technique, has already shown conclusive results in breast, prostate, and thyroid tumor diagnostics. This study investigated the performance of SE for the differentiation of Achilles tendon alterations of tendinopathy compared to clinical examination and conventional ultrasound (US). MATERIALS AND METHODS: Achilles tendons in 25 consecutive patients with chronic Achilles tendinopathy and 25 healthy volunteers were examined clinically by US and by SE. RESULTS: In the healthy volunteers, SE showed the tendon to be hard (93 %), while distinct softening was found in 57 % of the patients. SE showed more frequent involvement of the distal (64 %) and middle third (80 %) than the proximal third (28 %) of the Achilles tendon. Using SE a mean sensitivity of 94 %, specificity of 99 %, and accuracy of 97 % were found when clinical examination was used as the reference standard. The correlation to US was 0.89. Mild softening was found in 7 % of the healthy volunteers and in 11 % of the patients. CONCLUSION: Our results emphasize that only distinct softening of Achilles tendons is comparable to clinical examination and US findings. However, mild softening might be explained by very early changes in tissue elasticity in the case of Achilles tendinopathy, which should be assessed in follow-up studies.

The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties.

The medial periosteal hinge plays a key role in fractures of the head of the humerus, offering mechanical support during and after reduction and maintaining perfusion of the head by the vessels in the posteromedial periosteum. We have investigated the biomechanical properties of the medial periosteum in fractures of the proximal humerus using a standard model in 20 fresh-frozen cadaver specimens comparable in age, gender and bone mineral density. After creating the fracture, we displaced the humeral head medial or lateral to the shaft with controlled force until complete disruption of the posteromedial periosteum was recorded. As the quality of periosteum might be affected by age and bone quality, the results were correlated with the age and the local bone mineral density of the specimens measured with quantitative CT. Periosteal rupture started at a mean displacement of 2.96 mm (SD 2.92) with a mean load of 100.9 N (SD 47.1). The mean maximum load of 111.4 N (SD 42.5) was reached at a mean displacement of 4.9 mm (SD 4.2). The periosteum was completely ruptured at a mean displacement of 34.4 mm (SD 11.1). There was no significant difference in the mean distance to complete rupture for medial (mean 35.8 mm (SD 13.8)) or lateral (mean 33.0 mm (SD 8.2)) displacement (p = 0.589). The mean bone mineral density was 0.111 g/cm(3) (SD 0.035). A statistically significant but low correlation between bone mineral density and the maximum load uptake (r = 0.475, p = 0.034) was observed. This study showed that the posteromedial hinge is a mechanical structure capable of providing support for percutaneous reduction and stabilisation of a fracture by ligamentotaxis. Periosteal rupture started at a mean of about 3 mm and was completed by a mean displacement of just under 35 mm. The microvascular situation of the rupturing periosteum cannot be investigated with the current model.

Proximal humeral fractures: what is semi-rigid? Biomechanical properties of semi-rigid implants, a biomechanical cadaver based evaluation.

INTRODUCTION: Proximal humerus fractures remain challenging especially in the elderly. Biomechanical data put semi-rigid implants in favour of osteopenic or osteoporotic situation. Little surgical side damage is associated with a minimal invasive approach of these implants. The aim of this study was to evaluate the mechanical properties of three such implants. MATERIAL AND METHODS: Fresh frozen cadaver specimens were mounted as proposed by the distributors. Three different implants were used: LCP-PH (locking compression plate proximal humerus, Synthes, Austria), HB (humerus block, Synthes, Austria), and IMC (intramedullary claw, ITS, Austria). Subcapital fracture was simulated by resecting a 5 mm gap. All specimens were comparable in "B" (one), "M" (ineral) and "D" (ensity). Four load cases were tested: varus bending, medial shearing and axial torque. A cyclic test (1,000 cycles) was performed in the first load case (varus stress) for all three implants. RESULTS: The LCP-PH was the most rigid in all three load cases, always followed by the HB. The IMC was the most elastic device with almost immeasurable values in axial torque. In the cyclic setting, the load reduction of the HB followed by the LCP-PH was significantly better than that for the IMC. CONCLUSION: The differences in stiffness are varying tremendously. The IMC is the implant with the lowest stiffness in all load cases and the highest load reduction. New "semi-rigids" claim good clinical performance, yet prospective clinical studies have to prove this. It is unlikely that the IMC can maintain fracture reduction in fracture situations of complex nature (no ligamentotaxis).

[Sagittal wrist motion following dorsal radiocarpal fracture dislocations]. / Sagittaler Bewegungsumfang nach dorsalen radiokarpalen Luxationsfrakturen.

PURPOSE: Radiocarpal fracture dislocation is a rare, complex injury characterised by dislocation of the radiocarpal joint with avulsion of the dorsal or palmar cortical margin of the distal radius. To evaluate the sagittal motion at the radiocarpal and midcarpal levels following dorsal radiocarpal fracture dislocation (Moneim type I) nine cases were investigated clinically and radiologically. PATIENTS AND METHOD: In a retrospective follow-up examination, eight patients could be included. The average follow-up was 4.1 years. One patient had a bilateral injury. The operative approach was bilateral in all cases. Restoration of the radial articular surface, filling metaphyseal defect zones with cancellous bone graft and internal fixation with a special T-plate were performed from dorsal. For refixation of the radiocarpal ligaments a small palmar approach was used. Standard anteroposterior and lateral radiographs, as well as lateral views in full extension and flexion were taken at follow-up. Clinical investigation included measurement of active range of motion, grip strength and pain evaluation using the VAS. RESULTS: Radiological evaluation of the standard lateral view turned out a mean angle between scaphoid and lunatum of 55.6 degrees, capitatum and lunatum of -11.6 degrees and radius and capitatum of 10.5 degrees. In full flexion the following angles were measured: radius/lunatum 15.3 degrees, capitatum/lunatum 18 degrees and between radius and capitatum 30 degrees. In full extension the angles averaged: radius/lunatum -23.9 degrees, capitatum/lunatum -31 degrees and between radius and capitatum -55 degrees. According to the Knirk and Jupiter classification system, five patients presented arthritis stage 1, three arthritis stage 2 and one a stage 3 arthritis. Clinical evaluation showed a mean wrist motion of 55 degrees for extension, 35 degrees for flexion, 88 degrees for pronation, 70 degrees for supination and 25.5 degrees for the mean radial as well as the mean ulnar motion. The average Mayo Wrist Score was 76.1 points. CONCLUSION: Operative treatment of dorsal radiocarpal fracture dislocation using a bilateral approach led to satisfying results in eight of nine cases with decreased but radiologically evaluated sagittal motion of the proximal row.

[Long-term results following ORIF of dorsal dislocated distal intraarticular radius fractures]. / Langzeitergebnisse operativ versorgter distal intraartikulärer Speichenfrakturen.

PURPOSE: To evaluate the sequelae of distal intraarticular radius fracture with regard to the development of arthritis and clinical symptoms. PATIENTS AND METHOD: In a retrospective follow-up examination, 72 patients with a distal intraarticular radius fracture could be included for clinical and radiological investigation 9 years following the trauma. All fractures were treated by ORIF and cortico-cancellous bone grafting. RESULTS: Radiological evaluation revealed 5.1 degrees palmar tilt, 19.1 degrees radial tilt and the ulnar variance amounted to -0.5 mm. The articular cavity depth in the sagittal plane measured with 4.6 mm, 1.2 mm more than the non-involved side. Articular step-off was noticed in 6 patients. According to the Knirk and Jupiter classification system, two patients healed without arthritis, 43 patients presented arthritis stage 1, and 27 stage 2. Evaluation of the data showed a significant correlation between arthritis and articular cavity depth. But arthritis had neither influence on the DASH, nor the pain level. On the other hand, arthritis led to decreased sagittal wrist motion. CONCLUSION: ORIF of distal intraarticular radius fractures led to predictable results concerning restoration of length and form of the distal radius. Arthritis had a minor influence on the clinical end result.

[Sonography of synovial and erosive inflammatory changes]. / Sonographie synovialer und erosiver entzündlicher Veränderungen.

High-frequency sonography enables excellent detection of early erosions and synovial proliferations. Power Doppler sonography (PDUS) allows for an improved characterization of articular and peritendinous augmented volume, because detection of hypervascularity correlates with inflammatory activity and further is helpful in differentiation from effusion and inactive pannus. The use of contrast media improves the sensitivity of vascularity detection, because they allow for a delineation of vessels at the microvascular level. This is of increased interest, as the development of new therapeutic options targeting the microvascular level calls for earlier diagnosis and optimal assessment of disease activity. Because of good availability, cost effectiveness, and patient acceptance, sonography facilitates early diagnosis of synovial proliferations and erosions as well as therapy follow-up.

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

[Value of high-resolution ultrasound in the evaluation of finger injuries in extreme sport climbers]. / Stellenwert der hochauflösenden Sonographie in der Abklärung von Fingerbeschwerden bei Extremsportkletterern.

AIM: To determine the value of high-resolution ultrasound in the evaluation of finger injuries and changes due to strain in the fingers of extreme rock climbers. METHODS: High-frequency ultrasound was performed on 208 fingers of 52 extreme rock climbers (mean age: 29.7 yrs) and on 80 fingers of 20 healthy volunteers (mean age: 28.5 yrs). The following parameters were sonographically assessed: thickness of the pulley-system A2, distance between phalanx and tendon (PS distance), gliding ability of the flexor tendons, and the periarticular and peri-tendinous space. The examination was performed on the handling in a supinated position with extended fingers, followed by active and passive flexion of about 40 degrees. All climbers also underwent clinical examination. RESULTS: The pulley-system of climbers showed a significantly increased thickness of 0.17 (+/- 0.09) cm compared with the healthy volunteers (p < 0.001). PS-distances of up to 0.51 (+/- 0.15) cm were found only in symptomatic climbers and proved to be a sign of tendon bow-stringing. No impairment of gliding ability was seen in both groups. Tendon sheath cysts were detected in 76% (62) of symptomatic fingers of the climbers. CONCLUSIONS: Non-invasive high-resolution ultrasound examination of fingers proved to be a very helpful method for diagnosing changes due to strain as well as finger injuries in rock climbers, especially in cases where the clinical examination was difficult to perform.