A Biomechanical Analysis of the H-Taping Method Used by Rock Climbers as Prophylactic or Stabilizing Fixation of Partial A2 Pulley Tears.

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.

A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury.

INTRODUCTION: Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS: A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS: No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS: We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.

Analysis of the Effects of Early Rehabilitation Treatment Conducted by Nurses on the Prevention of Tendon Adhesion after Finger Flexor Tendon Rupture: A Randomized Clinical Trial.

Objective: This study aims to analyze the application of predictive nursing in the prevention of tendon adhesion, after the anastomosis of finger flexor tendon rupture, so as to provide a basis for clinical nursing. Methods: A total of 80 patients with anastomoses of flexor tendon ruptures, investigated in our hospital from December 2017 to December 2018, were enrolled in this study. Their data formed the basis of this research. They were divided into two groups, the routine (control) group (n = 40) and the nursing group (n = 40), by the random number table method. Basic nursing methods only were used in treating the routine group, while the nursing group received basic nursing in combination with early active function exercise. The contrast indices between the two groups were recovery quality of finger flexion and extension, incidence of tendon adhesion, and nursing satisfaction rate. Results: The probability of tendon rupture and adhesion in the (predictive) nursing group was lower than that found in the control group. The outcomes with predictive nursing were more desirable. The levels of finger flexion and extension in the nursing group were significantly better than those of the control group(P < 0.05). Conclusion: The application of predictive nursing, after the anastomosis of finger flexor tendon rupture, is good for preventing tendon adhesion. Better levels of finger flexion and extension after the operation are guaranteed, and the overall recovery outcomes are better. The satisfaction levels of patients who received predictive nursing were also high, and this method is highly valued and promoted within clinical practice.

Olympic competition climbing: the beginning of a new era-a narrative review.

Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.

[Injury to the upper limbs and prevention in equestrian sports]. / Verletzungen der oberen Extremität und Prävention im Reitsport.

The upper limb is one of the most frequently injured body regions in equestrian sports, but it is unclear which injuries are involved, and there are no data on the associated accident mechanism. The present study is aimed at evaluating the accident mechanisms, injuries of the upper limbs, and the circumstances of the accident in equestrian sports. We included 218 patients who were all treated between 2006 and 2014 at the level I trauma center at the Medical University in Hannover because of equestrian-related accidents. The most frequent injuries were fractures and bruising in the shoulder area, fingers and hands, and the distal area of the lower arm, which were mostly caused by the horse kicking. To prevent hand injuries it is recommended that gloves are worn; the potential introduction of strengthened materials could protect the bones from severe bumping. Training in falling techniques to prevent serious injury to the upper limb would be useful. In general, primary prevention in equestrian sports should be extended to counteract the increasing neglect of protective equipment.

Preventing musculoskeletal injuries among recreational adult volleyball players: design of a randomised prospective controlled trial.

BACKGROUND: Both acute and overuse injuries are common among recreational volleyball players, especially finger/wrist, ankle, shoulder and knee injuries. Consequently, an intervention ('VolleyVeilig') was developed to prevent or reduce the occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational volleyball players. This article describes the design of a study evaluating the effectiveness of the developed intervention on the one-season occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational adult volleyball players. METHODS: A randomized prospective controlled trial with a follow-up period of one volleyball season will be conducted. Participants will be healthy recreational adult volleyball players (18 years of age or older) practicing volleyball (training and/or match) at least twice a week. The intervention ('VolleyVeilig') consists of a warm-up program based on more than 50 distinct exercises (with different variations and levels). The effect of the intervention programme on the occurrence of injuries will be compared to volleyball as usual. Outcome measures will be incidence of acute injury (expressed as number of injuries per 1000 h of play) and prevalence of overuse injuries (expressed as percentage). DISCUSSION: This study will be one of the first randomized prospective controlled trials evaluating the effectiveness of an intervention on the occurrence of both acute and overuse injuries among recreational adult volleyball players. Outcome of this study could possibly lead to the nationwide implementation of the intervention in all volleyball clubs in The Netherlands, ultimately resulting in less injuries. TRIAL REGISTRATION: Dutch Trial Registration NTR6202 , registered February 1st 2017. PROTOCOL: Version 3, February 2017.

Reducing the risk of injury from table saw use: the potential benefits and costs of automatic protection.

The use of table saws in the United States is associated with approximately 28,000 emergency department (ED) visits and 2,000 cases of finger amputation per year. This article provides a quantitative estimate of the economic benefits of automatic protection systems that could be designed into new table saw products. Benefits are defined as reduced health-care costs, enhanced production at work, and diminished pain and suffering. The present value of the benefits of automatic protection over the life of the table saw are interpreted as the switch-point cost value, the maximum investment in automatic protection that can be justified by benefit-cost comparison. Using two alternative methods for monetizing pain and suffering, the study finds switch-point cost values of $753 and $561 per saw. These point estimates are sensitive to the values of inputs, especially the average cost of injury. The various switch-point cost values are substantially higher than rough estimates of the incremental cost of automatic protection systems. Uncertainties and future research needs are discussed.

Effectiveness of participatory training for prevention of musculoskeletal disorders: a randomized controlled trial.

PURPOSE: Health and safety training program has been applied to prevent work-related musculoskeletal disorders (MSDs) in workplace. We evaluated the effectiveness of participatory training and didactic training programs on MSD prevention among frontline workers in Shenzhen, China. METHODS: The authors randomly assigned 918 workers from intervention factories to receive participatory training (intervention group), and 907 workers from intervention factories and 1,654 workers from control factories to receive didactic training (control_1 group, control_2 group, respectively) from June 1, 2008 to November 30, 2009. Participants were asked to report experience of ache, pain or discomfort in 10 body parts at baseline and 1 year after training. Data were analyzed to compare the MSD prevalence 1 year before and 1 year after training in different groups from 2009 to 2010. RESULTS: The follow-up rate was 61 % (2,120/3,479) at 1 year after training. In the year after training, there were no statistically significant changes in the proportion of workers who reported MSD in any body part. MSD prevalence rates in the intervention group reduced from 16.8 to 9.9 % for lower extremities (χ(2) = 13.102, p < 0.001) and from 12.9 to 8.3 % (χ(2) = 9.433, p = 0.002) for wrist and finger at 1 year after training. However, the rates did not change significantly for upper back, lower back, neck, shoulder and elbow in the intervention group and for all 10 body parts in two control groups. CONCLUSIONS: Overall, the training programs did not seem to prevent the occurrence of MSD among frontline workers. However, participatory training might be effective to reduce MSD in the lower extremities and wrist and finger.

Traumatic hand amputations among children in Greece: epidemiology and prevention potential.

BACKGROUND: Traumatic hand and finger amputations frequently lead to permanent disability. OBJECTIVE: To investigate their epidemiological characteristics and estimate the prevention potential among children 0-14 years old, through a cross-sectional survey. METHODS: Nationwide extrapolations were produced based on data recorded between 1996 and 2004 in the Greek Emergency Department Injury Surveillance System and existing sample weights. Incident and injury related characteristics were analysed to identify preventable causes. RESULTS: Among 197,417 paediatric injuries, 28,225(14%) involved the hand and fingers resulting in 236 amputations (∼1% of hand injuries). The annual probability to seek emergency department care for a hand injury was 3%. The estimated incidence rate (IR) of hand amputations was 19.7/100,000 person-years. Over 50% concerned children 0-4 years old (male:female=2:1), peaking at 12-24 months. Male preschoolers suffered the highest IR (38.7/100,000). Migrant children were overrepresented among amputees. Of all amputations, 64% occurred in the house/garden and 14% in day-care/school/sports activities, usually between 08:00 and 16:00 (61%). Doors were the product most commonly involved (55% overall; 72% in day-care/school/gym) followed by furniture/appliances (15%) and machinery/tools (7%). Crushing was the commonest mechanism. Inadequate supervision and preventive measures were also frequently reported. 5% of the amputees were referred to specialised units for replantation/reconstructive surgery. CONCLUSIONS: The majority of paediatric hand and finger amputations could be prevented in Greece, particularly among preschoolers, by a single product modification, namely door closure systems, coupled with improved supervision. Paediatricians should incorporate this advice into their routine child-safety counselling. This country-specific profile supports the need for maintaining similar databases as an indispensable tool for assisting decision-making and preventing disabling and costly injuries.

Snowblower injuries to the hand: epidemiology, patterns of injury, and strategies for prevention.

Snowblowers injure approximately 5000 people a year and can cause devastating hand injuries. Even with added safety measures and warnings on modern snowblowers, hand injuries are still occurring at an alarming rate. We have reviewed our series of snowblower-related hand injuries to elucidate the epidemiology, patterns of injury, and strategies for prevention.Questionnaires and treatment records of 22 individuals with snowblower injuries to the hand between 2002 and 2005 were reviewed. All patients were treated by a single hand surgeon at Hartford Hospital in Hartford, CT.Eleven of the 22 held upper level educational degrees. Averaged results include operator experience of 15.17 years, machine age of 21.38 years, temperature of 29.05 degrees F (-1.51 degrees C), precipitation of 8.60 cm (3.38 in), and duration of use of 20.59 minutes excluding 3 outliers. Three patients consumed 1 alcoholic drink and 1 consumed 2 alcoholic drinks before injury. The majority of patients were aware of safety warnings (77.20%) and injured themselves with the machine running (82.35%) resulting in multiple digit injury (2.0 on average) on the dominant hand (68.18%).Operator inexperience, low operator intelligence, and excessive alcohol consumption do not seem to contribute to injury. Instead, significant experience, older machines, short durations of use before injury, characteristic weather patterns, and underlying misperceptions about snowblower design and function typically set the stage for injury. Injuries may be prevented in the future by improving snowblower design and/or by making brief public service announcements.

A Novel Restraint Device for Injection of Galleria mellonella Larvae that Minimizes the Risk of Accidental Operator Needle Stick Injury.

Larvae of the insect Galleria mellonella are increasingly being used for studying pathogenic microbes and their virulence mechanisms, and as a rapid model for screening novel antimicrobial agents. The larvae (waxworms) are most frequently infected by injection of pathogenic organisms into the haemocoel through the insect's prolegs. The mostly widely used method for restraining the waxworms for injection is by grasping them between the operator's fingers, which puts the operator at risk of needle stick injury, an important consideration when working with highly pathogenic and/or drug-resistant microorganisms. While use of a stab proof glove can reduce this risk of injury, it does so at the loss of manual dexterity and speed, resulting in a more labor-intensive, and cumbersome assay. We describe a simple cost effective device (the so-called "Galleria Grabber") for restraining waxworms for injection that keeps the operator's fingers clear of the needle thus reducing the risk of injury.

Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience.

CONTEXT: Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play. EVIDENCE ACQUISITION: Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient. CONCLUSION: Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care.

[Prevention of school sport injuries--an analysis of ballsports with 2234 injuries]. / Prävention von Schulsportverletzungen -- Analyse von Ballsportarten bei 2234 Verletzungen.

PURPOSE: Ball sport school injuries account for a significant morbidity among children and adolescents. MATERIALS AND METHODS: During a school year 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) Niedersachsen, Germany. RESULTS: Regarding the non-gender-specific distribution of the ball sport disciplines, basketball leads with 32 % (n = 431), followed by soccer (24 %, n = 316), volleyball (17 %, n = 232), handball (8.3 %, n = 110) and hockey (4.9 %, n = 65). Sprains (27 %) dominate in basketball, followed by ligament distorsions and ruptures (23 %) and fractures (21 %), with frequent finger injuries (61 %) without contact of an opponent, and injuries of the lower extremity (28 %). Soccer leads to contusions (29 %), in 52 % of the lower extremity frequently after collision with an opponent (22 %) or the ball (20 %). In volleyball upper extremity injuries (71 %) dominate with 53 % finger sprains in individual volleyball play. CONCLUSION: Ball school sport injuries account for a significant morbidity with frequent finger injuries. Proprioceptive deficits may play a role in those finger injuries in basketball, volleyball and handball. During hockey, severe dental and facial injuries were apparent. A prospective proprioceptive training program aiming on fingers and the ankle region may therefore be a preventive measure such as helmets with facial protection in hockey school sport.

Estimated cost of needlestick injuries for six major needled devices.

A major factor in the introduction of new products designed to decrease the risk of needlesticks to healthcare workers (HCWs) is whether the increased expense of a safer device is offset by the savings of preventing needlesticks. The itemized costs of needlestick injuries associated with six major needled devices were estimated and compared to the cost of the devices causing the injuries, based on 1988 dollars. Included was the cost of treatment, prophylaxis and employee health department personnel time. The average cost of needlestick injury was $405, with a narrow range of $390 to $456 for different devices. As a percent of the cost of the devices, needlesticks cost as little as 10% of the cost of the device, for the intravenous (IV) catheter, to as much as 457%, for needles used to connect IV lines. On the average, needlesticks cost 36% of the devices' cost. These data may be used to weigh the potential economic benefits of safer needle technology or other strategies intended to reduce the incidence of needlesticks.

Prevention and treatment of ligamentous sports injuries to the hand.

Sports-related injuries to the intricate small joints of the hand are quite frequent. The majority of such injuries result in joint contusions, partial tears or ligament sprains which do not jeopardise the basic stability of the joint and readily respond to a short course of protective splinting with rapid recovery of motion, strength and function. In fact, many patients never seek medical attention unless persisting pain, chronic swelling or restriction of motion persuade them to do so. Partial tears or sprains need to be distinguished from more serious injuries that cause profound ligamentous and capsular disruption resulting in dislocations, articular incongruency, joint instability or fracture-dislocations. While simple dislocations are readily reducible and generally stable, a complex dislocation by definition implies irreducibility by closed means. This category of complex joint injury requires prompt diagnosis, as optimal management warrants active surgical intervention to achieve a stable and congruous reduction. Following surgical repairs the injured joint is immobilised for a variable length of time, determined by the type, extent and the nature of the specific injury, prior to initiating remobilisation efforts. A supervised and well-executed rehabilitation programme should encompass all the various modalities of physical therapy that are effective in increasing mobility, correcting deformity and restoring strength and function to the injured hand. The ultimate goal of treatment is to enable the athlete to resume sports, unimpaired with the same skill, dexterity and competitive edge as before.