There are 26 large climbing centres and 44 smaller indoor or outdoor climbing walls in The Netherlands at this time. Hand and finger injuries are the most common types of sport climbing injuries. Most injuries are caused by overstraining. Injuries include avulsion fractures, arthrosis, pulley rupture, damage to joint capsule and collateral ligaments, 'gamekeeper's thumb', 'climber's finger', lumbrical shift syndrome, 'climber's elbow', shoulder injuries and nerve compression syndromes. Treatment is usually conservative. Depending on the extent of damage surgical intervention may be indicated.