Image by pine  watt
climbing-doc-n-cascades.jpg

Winston J. Warme, MD

Avid Climber, Orthopedic Surgeon

Professor and Attending Surgeon, University of Washington

Dr. Winston Warme is passionate about climbing and taking care of people as an orthopedic surgeon. He seeks to help others expeditiously return to top form and pursue the activities they enjoy. 

 

Climbing since 1973, Dr. Warme personally understands the passion and strains of this sport!  Sustaining a torn finger pulley led him on a journey to develop the S.P.Ort – a custom pulley splint – so he could keep climbing (and operating). The S.P.Ort now helps others with the same injury keep doing what they love to do.  

Developing the S.P.Ort

1994

1995

2000

2002

2016

2018

Dr. Warme sustains his first pulley injury as an orthopaedic surgery resident. This prompts his interest in "climber's finger" and other pulley injuries.

As a sports medicine fellow, Dr. Warme begins researching the effectiveness of circumferential taping.

Research study concludes that tape alone will not sufficiently support an injured pulley. The Climbing Doc begins prototype development of a rigid splint.

Warme WJ., Brooks D.; The Effect of Circumferential Taping on Flexor Pulley Failure in Rock Climbers. American Journal of Sports Medicine, 28(5): 674-678, Sep-Oct 2000. Link

Dr. Warme sustains his second pulley injury, prompting a refining of his splint prototypes.

The first generation S.P.Ort splint is born, after years of testing on his own fingers and helping other climbers with pulley injuries.

University of Washington research study on the effectiveness of the S.P.Ort splint begins.

S.P.Ort research published by the University of Washington. RocknSport launched and began selling the S.P.Ort online and in local Seattle-area gyms.

Bellevue, KD, Allan, CH, Warme, WJ. The Novel Semilunar Pulley Orthosis (SPOrt) Decreases Flexor Tendon-Phalanx Distance in Climbers with Chronic A2 Pulley Ruptures. University of Washington Department of Orthopaedics and Sports Medicine Research Report, Discoveries 2018. Read Research.

Evolution of the S.P.Ort

The S.P.Ort has been in the development process for over 20-years, dating back to my orthopaedic surgery residency when I became interested in “climber’s finger” or pulley injuries.  It is exciting to see it finally reach the place that the S.P.Ort is ready for the climbing community!
 
I began climbing at the Gunks at the age of 13 and was immediately hooked.  I later sustained a middle finger pulley injury in my mid-twenties climbing in Leavenworth, WA dynamically moving off a crimp.  At that time, I had no idea how to treat myself and attempted buddy taping the middle to the adjacent ring finger and returned to climbing as soon as the pain abated.
 
As a sports medicine fellow, I conducted a research project to see if circumferential taping of the base of fingers in cadavers would increase the force required to rupture the pulleys, and I could not detect a significant difference, (Warme WJ., Brooks D.; The Effect of Circumferential Taping on Flexor Pulley Failure in Rock Climbers. American Journal of Sports Medicine, 28(5): 674-678, Sep-Oct 2000. Link).  Subsequent investigators have found tape alone provides little benefit, (Schweitzer A. Biomechanical Effectiveness of Taping the A2 Pulley in Rock Climbers. Journal of Hand Surgery (British and European Volume, 2000) 25B: 1: 102±107).  While commonly done, even H-taping is minimally effective, (Schoffl A. et al. Impact of Taping After Finger Flexor Tendon Pulley Ruptures in Rock Climbers. Journal of Applied Biomechanics, 2007; 23:52-62). It stretches with use and needs to be re-applied after each route or boulder problem. Further biomechanical cadaveric testing by Dr. Deana Mercer and her research team at the University of New Mexico was not able to show a significant effect with H-taping. (Link)​

The reason tape alone will never work to support an internal ligamentous structure, or a pulley is that tape cannot hold its shape and will change from a ring to an oval immediately when stressed.  This was clear to me after my time in the lab, and after reading other investigators’ work, as noted above.  While a ton of tape is used to “support” wrist and ankle injuries in football, gymnastics and other sports, the ability to support the underlying biologic structures has not been shown biomechanically.  Much of the benefit is psychological which is OK but isn’t going to help pulleys heal when damaged or protect them from further injury!

prototype1.jpg
crimp edge.JPG

Early S.P.Ort Prototypes

My early prototypes came from the tops of plastic soda bottles cut with a Swiss Army knife saw blade and filed down on the rock.

This type of improvisation can still work in a pinch if you are on a trip and need a temporary splint - until you can make a custom S.P.Ort for your finger – which is more comfortable and designed to be worn when climbing.

 

I started playing around with Kevlar rings, all sorts of plastic materials with a plethora of fastening devices including Velcro and trialed them on my injured finger at the cliff and on my climbing wall, like this second prototype.

Most were too bulky, uncomfortable, too thick, interfered with climbing, slipped, or hurt.  The Velcro wore out and got stinky. Fasteners were clunky and not sturdy enough or too big.  Though a LOT of trial and error, the S.P.Ort was born.

How the S.P.Ort Helps My Fingers

When customized and applied as directed in the kit instructions and video tutorials, the S.P.Ort works amazingly well.  I have been treating local climbers for years for a variety of finger injuries including chronic and acute partial pulley tears, complete pulley tears, even tendonitis from overuse and the reports are very enthusiastic.  (See the testimonial section.)  Personally, with my middle finger pulley injury, which has a chronic complete A2 rupture, the S.P.Ort holds my tendons closer to the bone, where they should be, and decreases the discomfort I experience after climbing/training.

Ultrasound Evidence of S.P.Ort Effectiveness

In researching pulley injuries, and the ways to treat them, we measure the Tendon Phalanx Distance, (TPD) with ultrasound. Normal TPD is up to one millimeter, as you see below on my relatively normal right middle finger below.  The pulley is thickened, (a finding commonly seen in climbers’ fingers and certainly in this finger), but it is functioning well.

ultrasound1.jpg

{This long axis ultrasound image shows a thickened but functional A2 pulley in my uninjured right middle finger, with a normal TPD of 0.92 mm, (the distance +---+).}

pre

{Long axis image of my injured left middle finger and with stress the TPD is 4.19 mm; (the length from +--+); a measurement that is consistent with a chronic complete A2 pulley tear.}

Ultrasound Results - Taped SPOrt

{With the  S.P.Ort  taped in placed, even when stressed, the TPD is reduced to 2.69 millimeters, (+---+); it holds the tendons 36% closer to the bone, or 47% closer to the normal location.}

Summary of S.P.Ort Effectiveness

I was one of the research subjects and the principal investigator in a study looking at the effectiveness of the S.P.Ort on ~ 20 rock climbers with A2 pulley injuries. As the ultrasound pictures above show, the S.P.Ort holds the tendons closer to the bone. An uninjured tendon should be within 1 mm of the bone, but mine is 4.19 mm. With the S.P.Ort taped in place, the distance reduces to 2.69 mm. This is not back to normal, but 47% better than without it. But most importantly, when I wear it for training (hangboarding, campus boarding, bouldering/gym climbing), my finger doesn’t hurt later! That matters to me and most climbers.  
 
The theoretical benefit is that an A2 S.P.Ort may protect the other more distal pulleys, that will be seeing greater forces and are at increased risk of injury once the most important and strongest A2 pulley is injured.  Similarly with an A4 injury, an A4 S.P.Ort may protect the more proximal pulleys, as it helps keep the tendon in a more anatomic (normal) location.

I hope it will help you recover from your injuries, and stay in the game for a long, long time!

Try it Out

Our custom S.P.Ort (Semilunar Pulley Orthosis) supports A2 and A4 pulleys after injury and aids the healing process.