Hand injuries in rock climbers.

Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has grown in popularity in recent years. An estimated five million people participate in "rocking" at least three times a year. Climbing places unique demands on the upper extremity, especially the hands. The flexor tendons and flexor pulleys are prone to sprains and ruptures. Pulley injuries occur in up to 20% of climbers. The A2 pulley of the ring finger is the most frequently injured. Most pulley injuries can be successfully treated with a week of immobilization, followed by a range of motion (ROM) exercises for one week. Isometric training on a finger board can be started once ROM exercises are painless. A return to climbing can be initiated when the climber is able to avoid grip positions that produce pain; however, the closed crimp grip should be avoided at this time. Surgical reconstruction using the technique described by Widstrom is recommended for acute injuries with clinical evidence of bowstringing. Ultrasound and MRI are the current modalities best suited for confirming clinical findings.