Symptomatology and associated risk factors

Athletes generally present themselves in an advanced stage of the disease with debilitating symptoms of digital ischemia in the spiking hand, like coldness, discoloration and paresthesia. These symptoms result in an inability to play volleyball and reduced daily quality of life. In an early stage of the disease, symptoms might only manifest after overhead movements in volleyball as a result of embolization into the digital circulation of the spiking hand. This can lead to a wide range of symptoms during or directly after volleyball. Similar symptoms will often be caused by, and attributed to, musculoskeletal injuries, and might therefore initially be perceived as minor, and thus ignored by the athlete. However, since there is a risk of necrosis and amputation, awareness of these symptoms, with a timely detection, is warranted.


Conclusions of the SPIKE study

Among surveyed elite indoor- and beach volleyball players, symptoms of cold and discoloured digits in the spiking hand during or directly after practice or competition were prevalent in respectively 31% and 38% of the players. The duration of the volleyball career, the intensity of performing strength-increasing weight training, and the female sex were identified as associated risk factors (Table 1). These symptoms and risk factors for digital ischemia, which are associated with PCHA pathology, can be assessed adequately in an international arena using the Shoulder PCHA pathology and digital Ischemia – Questionnaire (SPI-Q): a reliable instrument for identifying elite volleyball players with symptoms of digital ischemia, and for grading the severity of these symptoms.


Related articles:

– Van de Pol D, Kuijer PPFM, Langenhorst T, Maas M. High prevalence of self-reported symptoms of digital ischemia in elite male volleyball players in the Netherlands: a cross-sectional national survey. American Journal of Sports Medicine 2012;40:2296-2302. doi:10.1177/0363546512456973.  – link

– Van de Pol D, Kuijer PPFM, Langenhorst T, Maas M. Risk factors associated with self-reported symptoms of digital ischemia in elite male volleyball players in the Netherlands. Scandinavian Journal of Medicine & Science in Sports 2014;24:e230-e237. doi:10.1111/sms.12145. – link

– Van de Pol D, Alaeikhanehshir S, Maas M, Kuijer PPFM. Self-reported symptoms and risk factors for digital ischaemia among international world-class beach volleyball players. Journal of Sports Sciences 2015;5:1-7. doi:10.1080/02640414.2015.1093649. – link

– Van de Pol D, Kuijer PPFM, Terpstra A, Pannekoek-Hekman MJC, Alaeikhanehshir S, Bouwmeester O, Planken RN, Maas M. The international SPIKE study on Posterior Circumflex Humeral Artery pathology among elite volleyball players: four profiles for clinical management (4P4M). Submitted. – link expected