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Anatomy and Biomechanics of the Hand

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Climbing Medicine

Abstract

For a profound understanding of finger and hand injuries in climbing, a detailed analysis of the specific anatomy of the hand and fingers and their biomechanics is important. The most important anatomical part in climbing is the functional unit of the finger flexor tendons and their pulleys. The main function of the finger flexor pulley system is to maintain the flexor tendons close to the bone, thus converting translation and force developed in the flexor muscle-tendon unit into rotation and torque at the finger joints. These pulleys receive the highest stress in a “crimping” position, which is frequently used in climbing. A loss of one or several of the pulleys will cause bowstringing which leads to a loss of strength and a decreased range of motion. An injury to the epiphyseal plate during growth can lead to serious damage of the finger function not only with concerns to climbing.

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References

  1. Schöffl V, Heid A, Küpper T. Tendon injuries of the hand. World J Orthop. 2012;3(6):62–9.

    Google Scholar 

  2. Straub G. Anatomie und Biomechanik der Hand und Finger. In: Schöffl V und Hochholzer, T., editor. Sportklettern—Aktuelle sportmedizinische Aspekte. 1. Ebenhausen: Lochner Verlag; 2004. p. 134–144.

    Google Scholar 

  3. Schöffl V, Schöffl I, Frank L, Küpper T, Simon M, Lutter C. Tendon injuries in the hands in rock climbers: epidemiology, anatomy, biomechanics and treatment—an update. Muscles Ligaments Tendons J. 2020;10:233–43.

    Article  Google Scholar 

  4. Lutter C, Schweizer A, Schöffl V, Römer F, Bayer T. Lumbrical muscle tear: clinical presentation, imaging findings and outcome. J Hand Surg Eur. 2018;43(7):767–75.

    Article  Google Scholar 

  5. Schöffl V, Winkelmann HP. [Traumatic and degenerative tendon lesions of the hand]. Der Orthopäde 2010;39(12):1108–1116.

    Google Scholar 

  6. Schweizer A. Lumbrical tears in rock climbers. J Hand Surg (Br). 2003;28(2):187–9.

    Article  CAS  Google Scholar 

  7. Schöffl V, Schöffl I. Injuries to the finger flexor pulley system in rock climbers—current concepts. J Hand Surg [Am]. 2006;31(4):647–54.

    Article  Google Scholar 

  8. Doyle JR. Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg [Am]. 1988;13(4):473–84.

    Article  CAS  Google Scholar 

  9. Hahn P, Lanz U. [Flexor pulleys of the fingers. Anatomy, biomechanics, reconstruction] Die Ringbänder der Fingerbeugesehnen. Anatmoie, Biomechanik, Wiederherstellung. Handchir Mikrochir Plast Chir. 1996;28(5):265–70.

    CAS  PubMed  Google Scholar 

  10. Schöffl I, Oppelt K, Jungert J, Schweizer A, Bayer T, Neuhuber W, et al. The influence of concentric and eccentric loading on the finger pulley system. J Biomech. 2009;42(13):2124–8.

    Article  PubMed  Google Scholar 

  11. Schöffl I, Oppelt K, Jungert J, Schweizer A, Neuhuber W, Schöffl V. The influence of the crimp and slope grip position on the finger pulley system. J Biomech. 2009;42(13):2183–7.

    Article  PubMed  Google Scholar 

  12. Manske PR, Lesker PA. Strength of human pulleys. Hand. 1977;9(2):147–52.

    Article  CAS  PubMed  Google Scholar 

  13. Roloff I, Schöffl VR, Vigouroux L, Quaine F. Biomechanical model for the determination of the forces acting on the finger pulley system. J Biomech. 2006;39(5):915–23.

    Article  PubMed  Google Scholar 

  14. An KN, Berglund L, Uchiyama S, Coert JH. Measurement of friction between pulley and flexor tendon. Biomed Sci Instrum. 1993;29:1–7.

    CAS  PubMed  Google Scholar 

  15. Lin GT, Cooney WP, Amadio PC, An KN. Mechanical properties of human pulleys. J Hand Surg (Br). 1990;15(4):429–34.

    Article  CAS  Google Scholar 

  16. Lin GT, Amadio PC, An KN, Cooney WP. Functional anatomy of the human digital flexor pulley system. J Hand Surg [Am]. 1989;14(6):949–56.

    Article  CAS  Google Scholar 

  17. Doyle JR. Anatomy of the flexor tendon sheath and pulley system: a current review. J Hand Surg [Am]. 1989;14(2 Pt 2):349–51.

    Article  CAS  Google Scholar 

  18. Marco RA, Sharkey NA, Smith TS, Zissimos AG. Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. J Bone Joint Surg Am. 1998;80(7):1012–9.

    Article  CAS  PubMed  Google Scholar 

  19. Rispler D, Greenwald D, Shumway S, Allan C, Mass D. Efficiency of the flexor tendon pulley system in human cadaver hands. J Hand Surg [Am]. 1996;21(3):444–50.

    Article  CAS  Google Scholar 

  20. Hamman J, Ali A, Phillips C, Cunningham B, Mass DP. A biomechanical study of the flexor digitorum superficialis: effects of digital pulley excision and loss of the flexor digitorum profundus. J Hand Surg [Am]. 1997;22(2):328–35.

    Google Scholar 

  21. Zao CF, Amadio PC, L.B.K. A. The A3 pulley. J Hand Surg [Am]. 2000;25:270–6.

    Article  Google Scholar 

  22. Bollen SR. Injury to the A2 pulley in rock climbers. J Hand Surg (Br). 1990;15(2):268–70.

    Article  CAS  Google Scholar 

  23. Bowers WH, Wolf JW Jr, Nehil JL, Bittinger S. The proximal interphalangeal joint volar plate. I. An anatomical and biomechanical study. J Hand Surg [Am]. 1980;5(1):79–88.

    Article  CAS  Google Scholar 

  24. Verdan CE. Primary and secondary repair of flexor and extensor tendon injuries. In: Flynn JE, editor. Hand surgery. Baltimore: Williams & Willkins; 1966. p. 220–42.

    Google Scholar 

  25. Voigt C. Sehnenverletzungen an der Hand. Chirurg. 2002;73:744–67.

    Article  CAS  PubMed  Google Scholar 

  26. Nilsson O, Marino R, De Luca F, Phillip M, Baron J. Endocrine regulation of the growth plate. Horm Res. 2005;64(4):157–65.

    CAS  PubMed  Google Scholar 

  27. Abad V, Meyers JL, Weise M, Gafni RI, Barnes KM, Nilsson O, et al. The role of the resting zone in growth plate chondrogenesis. Endocrinology. 2002;143(5):1851–7.

    Article  CAS  PubMed  Google Scholar 

  28. Hunziker EB. Mechanism of longitudinal bone growth and its regulation by growth plate chondrocytes. Microsc Res Tech. 1994;28(6):505–19.

    Article  CAS  PubMed  Google Scholar 

  29. Gerber HP, Vu TH, Ryan AM, Kowalski J, Werb Z, Ferrara N. VEGF couples hypertrophic cartilage remodeling, ossification and angiogenesis during endochondral bone formation. Nat Med. 1999;5(6):623–8.

    Article  CAS  PubMed  Google Scholar 

  30. Werdin F, Schaller HE. [Combined flexor tendon and nerve injury of the hand]. Der Orthopade. 2008;37(12):1202–1209.

    Google Scholar 

  31. Schweizer A, Frank O, Ochsner PE, Jacob HA. Friction between human finger flexor tendons and pulleys at high loads. J Biomech. 2003;36(1):63–71.

    Article  CAS  PubMed  Google Scholar 

  32. Taras JS, Gray RM, Culp RW. Complications of flexor tendon injuries. Hand Clin. 1994;10(1):93–109.

    Article  CAS  PubMed  Google Scholar 

  33. Boyer MI, Strickland JW, Engles D, Sachar K, Leversedge FJ. Flexor tendon repair and rehabilitation: state of the art in 2002. Instr Course Lect. 2003;52:137–61.

    PubMed  Google Scholar 

  34. Strickland JW. The scientific basis for advances in flexor tendon surgery. J Hand Ther. 2005;18(2):94–110; quiz 1.

    Article  PubMed  Google Scholar 

  35. Choueka J, Heminger H, Mass DP. Cyclical testing of zone II flexor tendon repairs. J Hand Surg [Am]. 2000;25(6):1127–34.

    Article  CAS  Google Scholar 

  36. Stein T, Ali A, Hamman J, Mass DP. A randomized biomechanical study of zone II human flexor tendon repairs analyzed in a linear model. J Hand Surg [Am]. 1998;23(6):1043–5.

    Article  CAS  Google Scholar 

  37. Werber KD. Beugesehnenverletzungen der Hand. Unfallchirurg. 2005;108(10):873–82.

    Article  CAS  PubMed  Google Scholar 

  38. Schöffl V, Schweizer A. Sportclimbing related injuries and overuse syndromes. In: Seifert L, Wolf P, Schweizer A, editors. IRCRA handbook of climbing & mountaineering from science to performance. Research in sport and exercise science. London, New York: Routledge; 2016. p. 59–75.

    Google Scholar 

  39. Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers. Wilderness Environ Med. 2003;14(2):94–100.

    Article  PubMed  Google Scholar 

  40. Schöffl V, Schöffl I, Hochholzer T, Lutter C. Klettermedizin—Grundlagen, Unfälle. Verletzungen und Therapie: Springer; 2020.

    Book  Google Scholar 

  41. Hume EL, Hutchinson DT, Jaeger SA, Hunter JM. Biomechanics of pulley reconstruction. J Hand Surg [Am]. 1991;16(4):722–30.

    Article  CAS  Google Scholar 

  42. Schöffl V, Jüngert J. Closed flexor pulley injuries in non-climbing activities. J Hand Surg [Am]. 2006;31(5):806–10.

    Article  Google Scholar 

  43. Schöffl V, Schöffl I. Isolated cruciate pulley injuries in rock climbers. J Hand Surg Eur. 2010;35(3):245–6.

    Google Scholar 

  44. Burtscher M, Jenny E. Häufigste trainingsbedingte Beschwerden und Verletzungen bei Sportkletterern. Prakt Sport Trauma Sportmed. 1987;2:15–21.

    Google Scholar 

  45. Lin GT, Amadio PC, An KN, Cooney WP, Chao EY. Biomechanical analysis of finger flexor pulley reconstruction. J Hand Surg (Br). 1989;14(3):278–82.

    Article  CAS  Google Scholar 

  46. Widstrom CJ, Doyle JR, Johnson G, Manske PR, McGee R. A mechanical study of six digital pulley reconstruction techniques: Part II. Strength of individual reconstructions. J Hand Surg [Am]. 1989;14(5):826–9.

    Article  CAS  Google Scholar 

  47. Widstrom CJ, Johnson G, Doyle JR, Manske PR, Inhofe P. A mechanical study of six digital pulley reconstruction techniques: Part I. Mechanical effectiveness. J Hand Surg [Am]. 1989;14(5):821–5.

    Article  CAS  Google Scholar 

  48. Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S. Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med. 1998;26(5):651–5.

    Article  CAS  PubMed  Google Scholar 

  49. Moutet F. [Flexor tendon pulley system: anatomy, pathology, treatment]. Chir Main. 2003;22(1):1–12.

    Google Scholar 

  50. Haffner M. A tendon-locking mechanism in two climbing rodents, Muscardinus avellanarius and Micromys minutus (Mammalia, Rodentia). J Morphol. 1996;229(2):219–27.

    Article  CAS  PubMed  Google Scholar 

  51. Schöffl V, Hochholzer T, Winkelmann HP, Roloff I, Strecker W. [Pulley injuries in sport climbers] Verletzungen des Ringbandapparates bei Sportkletterern. Handchir Mikrochir Plast Chir. 2004;36(4):224–30.

    Article  PubMed  Google Scholar 

  52. Quaine F, Vigouroux L, Martin L. Effect of simulated rock climbing finger postures on force sharing among the fingers. Clin Biomech (Bristol, Avon). 2003;18(5):385–8.

    Article  Google Scholar 

  53. Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. [Therapy of injuries of the pulley system in sport climbers] Zur Therapie von Ringbandverletzungen bei Sportkletterern. Handchir Mikrochir Plast Chir. 2004;36(4):231–6.

    Article  PubMed  Google Scholar 

  54. Dotter WE. Little leaguer’s shoulder: a fracture of the proximal epiphysial cartilage of the humerus due to baseball pitching. Guthrie Clin Bull. 1953;23(1):68–72.

    CAS  PubMed  Google Scholar 

  55. Carson WG Jr, Gasser SI. Little Leaguer’s shoulder. A report of 23 cases. Am J Sports Med. 1998;26(4):575–80.

    Article  PubMed  Google Scholar 

  56. Rettig AC, Wurth TR, Mieling P. Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes. Am J Sports Med. 2006;34(4):653–6.

    PubMed  Google Scholar 

  57. Adams JE. Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers. Calif Med. 1966;105(1):22–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Read MT. Stress fractures of the distal radius in adolescent gymnasts. Br J Sports Med. 1981;15(4):272–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Carter SR, Aldridge MJ, Fitzgerald R, Davies AM. Stress changes of the wrist in adolescent gymnasts. Br J Radiol. 1988;61(722):109–12.

    Article  CAS  PubMed  Google Scholar 

  60. Roy S, Caine D, Singer KM. Stress changes of the distal radial epiphysis in young gymnasts. A report of twenty-one cases and a review of the literature. Am J Sports Med. 1985;13(5):301–8.

    Article  CAS  PubMed  Google Scholar 

  61. Bak K, Boeckstyns M. Epiphysiodesis for bilateral irregular closure of the distal radial physis in a gymnast. Scand J Med Sci Sports. 1997;7(6):363–6.

    Article  CAS  PubMed  Google Scholar 

  62. Hochholzer T, Schöffl V, Krause R. Finger-Epiphysenverletzungen jugendlicher Sportkletterer. Sport Ortho Trauma. 1997;13(2):100–3.

    Google Scholar 

  63. Chell J, Stevens K, Preston B, Davis TR. Bilateral fractures of the middle phalanx of the middle finger in an adolescent climber. Am J Sports Med. 1999;27(6):817–9.

    Article  CAS  PubMed  Google Scholar 

  64. Hochholzer T, Schöffl V, Bischof B. [Epiphyseal fractures of the middle phalanx in sportclimbers] Epiphysenfrakturen der Fingermittelgelenke bei Sportkletterern. Sport Ortho Trauma. 2002;18:87–92.

    Google Scholar 

  65. Lipp EJ. Athletic physeal injury in children and adolescents. Orthop Nurs. 1998;17(2):17–22.

    CAS  PubMed  Google Scholar 

  66. Caine D, DiFiori J, Maffulli N. Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med. 2006;40(9):749–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Laor T, Wall EJ, Vu LP. Physeal widening in the knee due to stress injury in child athletes. AJR. 2006;186(5):1260–4.

    Article  PubMed  Google Scholar 

  68. Flachsmann R, Broom ND, Hardy AE, Moltschaniwskyj G. Why is the adolescent joint particularly susceptible to osteochondral shear fracture? Clin Orthop Relat Res. 2000;381:212–21.

    Article  Google Scholar 

  69. Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res. 1999;14(10):1672–9.

    Article  CAS  PubMed  Google Scholar 

  70. DiFiori JP, Mandelbaum BR. Wrist pain in a young gymnast: unusual radiographic findings and MRI evidence of growth plate injury. Med Sci Sports Exerc. 1996;28(12):1453–8.

    Article  CAS  PubMed  Google Scholar 

  71. Micheli LJ. Overuse injuries in children’s sports: the growth factor. Orthop Clin North Am. 1983;14(2):337–60.

    Article  CAS  PubMed  Google Scholar 

  72. Bright RW, Burstein AH, Elmore SM. Epiphyseal-plate cartilage. A biomechanical and histological analysis of failure modes. J Bone Joint Surg. 1974;56(4):688–703.

    Article  CAS  PubMed  Google Scholar 

  73. Morscher E. Strength and morphology of growth cartilage under hormonal influence of puberty. Animal experiments and clinical study on the etiology of local growth disorders during puberty. Reconstr Surg Traumatol. 1968;10:3–104.

    CAS  PubMed  Google Scholar 

  74. Bailey DA, Wedge JH, McCulloch RG, Martin AD, Bernhardson SC. Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg. 1989;71(8):1225–31.

    Article  CAS  PubMed  Google Scholar 

  75. Alexander CJ. Effect of growth rate on the strength of the growth plate-shaft junction. Skelet Radiol. 1976;1:67–76.

    Article  Google Scholar 

  76. Feldman D, Shrier I, Rossignol M, Abenhaim L. Adolescent growth is not associated with changes in flexibility. Clin J Sport Med. 1999;9(1):24–9.

    Article  CAS  PubMed  Google Scholar 

  77. Connolly SA, Connolly LP, Jaramillo D. Imaging of sports injuries in children and adolescents. Radiol Clin N Am. 2001;39(4):773–90.

    Article  CAS  PubMed  Google Scholar 

  78. Hochholzer T, Schöffl VR. Epiphyseal fractures of the finger middle joints in young sport climbers. Wilderness Environ Med. 2005;16(3):139–42.

    Google Scholar 

  79. Schöffl VR, Hoffmann PM, Imhoff A, Küpper T, Schöffl I, Hochholzer T, et al. Long-term radiographic adaptations to stress of high-level and recreational rock climbing in former adolescent athletes: an 11-year prospective longitudinal study. Orthop J Sports Med. 2018;6(9):2325967118792847.

    Google Scholar 

  80. Schöffl VR, Hochholzer T, Imhoff AB, Schöffl I. Radiographic adaptations to the stress of high-level rock climbing in junior athletes: a 5-year longitudinal study of the German Junior National Team and a group of recreational climbers. Am J Sports Med. 2007;35(1):86–92.

    Google Scholar 

  81. Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217–23.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Center of Sportsmedicine, Klinikum Bamberg, Bamberg, Germany

    Volker Schöffl

  2. School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK

    Volker Schöffl

  3. Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA

    Volker Schöffl

  4. Department of Orthopedic and Trauma Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany

    Volker Schöffl

  5. Department of Pediatric Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany

    Isabelle Schöffl

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  1. Volker Schöffl
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Editors and Affiliations

  1. Center of Sports Medicine, Department of Orthopedic and Trauma Surgery, Sozialstiftung Bamberg, Bamberg, Bayern, Germany

    Volker Schöffl

  2. Department Of Pediatric Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany

    Isabelle Schöffl

  3. Department of Orthopedic Surgery, University of Rostock, Rostock, Germany

    Christoph Lutter

  4. Orthopädie und orthopädische Chirurgie, Privatklinik Hochrum, Innsbruck, Tirol, Austria

    Thomas Hochholzer

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Schöffl, V., Schöffl, I. (2022). Anatomy and Biomechanics of the Hand. In: Schöffl, V., Schöffl, I., Lutter, C., Hochholzer, T. (eds) Climbing Medicine . Springer, Cham. https://doi.org/10.1007/978-3-030-72184-8_3

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