What Finger Imaging Reveals About Injuries and Adaptations in Youth Climbers

Finger Adaptations and Injuries in Adolescent Climbers

Climbing is a sport built on loading small surface areas with high force—especially the fingertips. But what happens when that loading is consistent through adolescence, before skeletal maturity? This study used ultrasound (and some MRI) to explore just that.

Researchers evaluated 20 youth climbers (ages 10–17) and 6 non-climbers as controls. Climbers were grouped by training volume and bouldering grade:

  • Category 1: V0–V5

  • Category 2: V6–V8

  • Category 3: V9–V13

Physiological Adaptations

 As training intensity increased, so did these measurable adaptations:

  • Flexor tendon thickness increased with each tier (from 3.6 mm in Cat. 1 to 4.5 mm in Cat. 3).

  • Volar plate thickness followed a similar trend, especially at the DIP joint (3.4 mm in Cat. 3 vs. 2.3 mm in the non-climbing control).

  • Soft tissue hypertrophy was also significant.

These are likely examples of normal physiologic remodeling to chronic load: tendon hypertrophy and thickening of passive stabilizers like the volar plate. Nothing new if you're familiar with adult climbers, but it’s notable that these adaptations are happening pre-epiphyseal closure.

Pathological Changes

Where things get concerning is the prevalence of stress-related changes:

  • 68% had joint effusions.

  • 58% showed phalangeal subluxation.

  • 20% had physeal misalignment.

  • MRI confirmed Salter–Harris fractures, early physeal bridging, and capsular ruptures in some of the most intensely trained climbers.

These aren’t benign changes. Epiphyseal injuries risk permanent growth plate damage if not caught early. The fact that a subset of these kids continued to train through pain underscores the mismatch between youth coaching norms and the physiology of growth plates.

Takeaways 

  • Finger flexor hypertrophy and volar plate thickening are expected with training. These alone don’t indicate pathology.

  • Joint effusions and subluxations may be early warning signs of overload, even in the absence of pain.

  • MRI adds diagnostic value where US is limited, particularly for central physeal pathology and marrow edema.

  • Supplemental training (hangboarding, etc.) was more common in injured climbers. That doesn’t confirm causality but raises red flags for high-intensity protocols during skeletal immaturity.

Why It Matters

This study reinforces that adolescent fingers are not just small adult fingers. The growth plate is a weak link, and load tolerance needs to be managed accordingly. Imaging—particularly ultrasound—is a valuable tool for identifying normal adaptations and early signs of overuse injuries.

Research:

Garcia, K., Jaramillo, D., & Rubesova, E. (2017). Ultrasound evaluation of stress injuries and physiological adaptations in the fingers of adolescent competitive rock climbers. Pediatric Radiology. https://doi.org/10.1007/s00247-017-4033-4

Tyler Nelson