Clay-shoveler's fracture during indoor rock climbing

Indoor rock climbing is becoming more popular for people of all ages. Despite the tremendous interest in this competitive sport, participants are made aware of the dangers associated with participating. The authors present the first reported case of a clay-shoveler's fracture at the T1 spinous process during indoor rock climbing. They describe the management and natural history of this fracture and discuss management strategies for this increasingly popular recreational sport.A 14-year-old competitive indoor rock climber presented with acute-onset midline thoracic pain at T1 while indoor rock climbing. He reported no recent falls or trauma but stated that the pain came on abruptly while rock climbing. On examination, he was neurologically intact except for significant tenderness to palpation at the T1 spinous process. Magnetic resonance imaging demonstrated a minimally displaced T1 spinous process fracture with evidence of significant surrounding muscular edema, suggesting an acute fracture. He was treated conservatively with anti-inflammatory drugs, complete climbing restriction, and rest. He continued to have focal upper back pain at the level of the fracture over the next 4 months. He was unable to climb for 4 months until his pain resolved after conservative treatment of climbing restriction, pain control, and rest.This is the first documented case of a clay-shoveler's fracture sustained in a pediatric patient directly attributable to indoor rock climbing.