gms | German Medical Science

Objectives: Bone marrow edema due to sports usually represents a chronic overload or repetitive non-physiological motion sequences. The diagnosis of this affection is currently more frequent with the increased implementation of MRI. The most frequently affected regions for stress related BMEs are statically strained regions of the lower extremities. Pre-released literature rarely describes this type of BME on the upper extremities, especially the hand. We investigated 31 high-level rock climbers complaining of unspecific pain in the hand, fingers and distal part of the forearm. (Figure 1)

Methods: MRI was performed subsequently using standard technique. Only patients suffering under load-dependent pain, unable to practice rock climbing and with discomfort during simple daily tasks were included in the study and none of the patients suffered under pain in rest. In 29 of the 31 investigated athletes, a BME was found in the distal radius, the distal ulna or in the carpal bones which wasn't based on any other incidents such as trauma, inflammatory factors or tumor. BME in combination with, or even caused by other underlying conditions was detected in ten patients (stress induced fracture, nonunion, osteoarthritis, negative ulna variance, fractured cyst). All patients were either fully disadvised from training or from extensive training under continuation of light compensation sports until full recovery.

Results and Conclusion: Bone marrow edema of the wrist and the carpal bones was the most frequently occurring group of injuries in our patient collective. Compared to the other groups of injuries, climbing experience and climbing level were higher in this group. Patients with injuries of the hamate or the capitate showed a significantly higher climbing level compared to other injuries (p=0.001).

MRI showed an edema of the metacarpal bone in only 10 percent of our athletes suffering under diffuse pain in the hand and wrist joint. The group of patients with affections of their wrist and MRI proof of edema in the forearm was of a significantly lower average age as compared to the athletes with other injuries (p=0.018).

Conservative therapy led to an absence of affliction with full regain of strength in 27 of 31 patients, three patients had to be treated surgically. Both, conservative and surgical treatment, led to the disappearance of symptoms and all of our athletes finally became free of symptoms and regained full strength and their pre-injury climbing level.

Climbing related injuries of the hand seem to be climbing level dependent. BME must no longer be detectable in MRI and symptoms must have disappeared before resuming training. A duration of up to six months seems to be normal. We recommend a break in training for at least four months in cases of documented BME. In nearly all cases, high training frequency with high exercise load is the reason for the described conditions. The athletes who increase their training intensity dramatically within a short time span seem to be especially predisposed.