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Upper extremity injuries are common among the growing population of climbers. Although conditions affecting musculoskeletal structures are the most common causes of symptoms, a comprehensive differential diagnosis is necessary to avoid the misdiagnosis of high-morbidity conditions in this patient population. We present a case of a climber with acute edema, erythema, and pain of the entire right upper extremity. After confirmation of an upper extremity deep vein thrombosis by ultrasound, and in the absence of secondary causes for his thrombotic process, he was diagnosed with effort thrombosis. The patient was treated acutely with anticoagulation, catheter thrombectomy, direct thrombolysis, and balloon angioplasty followed by surgical decompression of the subclavian vein. Owing to the importance of early diagnosis and initiation of treatment, it is critical to keep disorders affecting the upper thoracic vascular structures in consideration.

Objective To assess the medical knowledge and preparedness of mountain climbers on Colorado's 14,000-foot peaks and to compare differences in knowledge and preparedness based on demographics, training, and difficulty of the climb. Methods Mountain climbers from 11 14,000-foot peaks in Colorado were surveyed at the time of summiting. These peaks represented every major mountain range and class of difficulty in Colorado. Marijuana use and demographic information including age, gender, state of residence, and income level was collected in the survey. In addition, participants were scored on medical knowledge and preparedness using a novel assessment tool. Scores were then compared and statistically analyzed. Results Mountain climbers scored 2.84 ± 1.25 and 3.92 ± 1.20 out of 6.00 on medical knowledge and preparedness, respectively. Medical training was shown to be the only significant predictor of medical knowledge, whereas age, race, income, and group status were all shown to be significant predictors of preparedness. It was shown that 9.4% of participants were using marijuana. Only 25% of individuals climbing class 3 mountains elected to wear helmets. Conclusions Most mountain climbers had no formal wilderness medicine training and did worse on the medical knowledge assessment than those who did have training. Consistent with previous studies, participants performed poorly on the medical knowledge assessment. As such, ways to improve wilderness medical knowledge among outdoor recreationalists should be sought. The low rate of helmet use on Colorado's technical peaks represents an important area for education and injury prevention.

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.

Objective The purpose of this study was to measure support for a mandated helmet policy among resort employees along with the impact of such a policy on job satisfaction, and additionally, to measure the prevalence of barriers to helmet use among this population. Methods In all, 728 Vail Resort employees were surveyed regarding their opinions on the helmet policy and on general helmet use. Results The majority of the 728 employees surveyed (66.5%; 95% CI: 63% to 70%) agreed with the helmet policy. Only 18% (95% CI: 16% to 21%) reported a negative effect on job satisfaction. Older employees (>25 years old) were more likely to disagree with the policy (odds ratio [OR] 3.1; 95% CI: 2.2 to 4.3) and report a negative effect on job satisfaction (OR 4.8; 95% CI: 3.0 to 7.6). Skiers were much more likely than snowboarders to report a negative effect on job satisfaction (OR 9.8; 95% CI: 5.2 to 18.1). Among resort employees, ski patrollers were more likely to disagree with the mandate (OR 9.8; 95% CI: 6.8 to 13.9) and report a negative effect on job satisfaction (OR 13.2; 95% CI: 8.3 to 21.). Forty-three percent of participants (95% CI: 39% to 46%) agreed with the statement that wearing a helmet encourages reckless behavior whereas 51.0% (95% CI: 47% to 54%) believed that wearing a helmet limits sensory perception. Conclusions A mandatory helmet use policy was supported by most resort employees. However, ski patrollers and older, more experienced employees were more likely to report a negative effect on job satisfaction. Barriers to helmet use continue to persist in the ski industry and represent a target for further educational efforts.