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Discussion
Prevention of primary periphyseal stress injuries in skeletally immature climbers
  1. Paulo Miro1,
  2. Volker Rainer Schöffl2,3,4
  1. 1 Diagnostic Radiology, University of Utah Hospital, Salt Lake City, Utah, USA
  2. 2 Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Bayern, Germany
  3. 3 School of Health, Leeds Becket University, Leeds, UK
  4. 4 Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Paulo Miro; paulohmiro{at}gmail.com

https://doi.org/10.1136/bjsports-2023-107774

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    Background

    Primary periphyseal stress injuries (PPSIs) are the most common overuse injuries affecting adolescent climbers.1 PPSIs are stress-related injuries affecting the intricate epiphysial–physeal–metaphyseal (EPM) complex.2 Climbers’ periphyseal injuries resemble those in other youth sports, such as proximal humeral physeal injuries in baseball pitchers. Finger PPSIs are frequently overlooked by skeletally immature climbers who mistakenly identify second annular pulley (A2) ruptures as the most prevalent paediatric climbing injury, remaining unaware of PPSIs.3 This commentary will explore the pathophysiology, clinical presentation, diagnosis, consequences, current preventive strategies and treatment of PPSIs.

    Pathophysiology, clinical features and long-term sequelae

    PPSIs are categorised as bone stress injuries and result from repetitive microtrauma due to the demanding mechanical stresses on the EPM in climbers, with a predilection for the middle and ring fingers.2 This results in disruption of the metaphyseal blood supply, impacting the perfusion and mineralisation of hypertrophied chondrocytes.4 PPSIs most commonly present between the ages of 13 and 15 years, occurring more frequently in males; however, the exact incidence and prevalence remain unclear due to limited evidence on this topic.4 Classically, an adolescent climber presents with a gradual onset of single or multiple proximal interphalangeal (PIP) joint pain and swelling, usually located dorsally near the insertion of the central slip of the extensor tendon.4 Diagnostic imaging is the mainstay of diagnosis, including radiography, ultrasound and MRI, …

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    Footnotes

    • Contributors Literature search, draft of discussion report: PM; review and editing of discussion report: VRS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.