Ask Dr J – Issue 183 – Boobie Trapped with a Titanium Spear


I broke my leg bouldering and had a titanium rod installed. I have heard mixed reports about leaving the rod in, one problem being irritation by the screws. Can the rod increase the chance of the leg breaking in the same place under similar circumstances, since the bone cannot “weld” itself together on the inside? Also, can I go to Hueco in 12 weeks?

Peter Allison | Christchurch, New Zealand


I would say thanks for the video (and I have posted it on my web page, www.drjuliansaunders. com) but it reminds me too much of when I had my own highball epiphany—hey, bones really break!

Prosthetic titanium fixtures have been a gargantuan step forward in fracture management. Alignment is virtually guaranteed, and weight bearing and healing resume much more quickly. The fracture should be healed in a year or so. Though removing the rod is routine, this decision will rest with your orthopedic surgeon. And then you could get the titanium coldforged into a funky necklace or genital piercing.

Although strength will be pretty good by the time Hueco comes around, you would be a brave soul coming off anything but the lowest of lowballs. My advice would be to go on the trip, but if your scrotum can’t drag on the gravel you’re too high. Literally, you cannot land on that leg until the rod is removed, and then some. You have been booby trapped with an in situ spear. In the event of a bad fall and landing you can shear the locking screws and drive the rod either through your ankle or up into your knee. Badness, cabron!

The biggest problem, short term, will not be the fracture site but rather the temporary lack of ankle mobility due to swelling and recent immobility. Simple things like heat and stretching will do wonders. For more detail check out the ankle stretching video on my web page.




I’m 26 and for the past two years I have been unable to bend my fingers into a complete fist. I’ve started doing the finger stretches that you suggested [No. 173 or] as well as ice baths, but nothing seems to improve the range of motion. Outside of tenderness and mild soreness when I bend/straighten my fingers it doesn’t affect my climbing. Is this something to worry about? What is causing it?

dgflr7 | Forum


Any loss of Range of motion is a tad concerning. In the absence of pain, it is likely to be one of a few scenarios. First, you may have some fluid accumulation in your fingers due to ongoing stress. Second, the connective tissues have, in the process of strengthening, thickened and now act like a cumulative wedge. Last, thickening around the joint capsule and collateral ligaments that stabilize the finger joints will lead to stiffening and produce the same effect.

It is certainly common for climbers to experience swelling and stiffness in their fingers much like a sumo wrestler gets sore knees … because they get hammered.

End-range pain usually suggests that the joint is simply under chronic strain. That it does not affect your climbing is awesome! Just keep in mind that loss of ROM is the first sign that the joint is undergoing changes as a result of the stress. The next station on your express train to world domination may be an unscheduled stop at Destruct-o-ville.

I would not be too worried— though I would do the stretches diligently and try to increase the ROM. Once you lose the accessory motions such as rotation and multiplanar sheering of the PIP and DIP joints, the pulley system will be under relatively greater loads at certain points and the chance of damage is on the upswing.

If the joints become any more painful or swollen, see your physician. I doubt very much that it is an inflammatory arthritis, but I can’t see your fingers!




I have numbness and pins-and-needles in my left forearm. The first time it happened was last March while climbing in the Red, and it happened again this past June at Smith Rock. Both times I didn’t notice anything until I was finished with the route. When I got down, it felt like a big rubber band was being tightened from the tips of my fingers through to the top of my elbow. My belayer squeezed my arm for about 15 minutes and the pain subsided, but the numbness and prickling won’t go away. If I run my thumb down my forearm I feel tingling on the underside and in my thumb. Any ideas?

Rachel | Bend, OR


That you are suffering a compromised radial nerve requires fewer brain cells than picking boogers.

There are a few variations on this genre. Damage in your upper arm from a humeral fracture is the most common, but I suspect a broken wing would prohibit climbing in the Motherlode! Next in line is entrapment of a branch of the radial nerve called the posterior interosseus nerve. You haven’t mentioned loss of grip strength so this is also unlikely, albeit in the right area—your elbow.

Though it sounds like something you would catch at the Berlin Love Parade, Wartenberg Syndrome is far less titillating. Named after an astute German neurologist, this nerve-compression syndrome involves a small superficial sensory branch of the radial nerve as it passes between two muscles near your elbow (brachioradialis and extensor carpi radialis longus).

Nerves carrying sensory fibers can be compressed around the elbow in other sites, but all will usually be accompanied by weakness when there is a sensory loss. Although there are other purely sensory nerves, their entrapment and your description don’t correlate well. Keep in mind that the nerve supply through the forearm and hand is a complete Charlie Foxtrot and, like hair distribution, tends to vary a little.

It sounds like the nerve, at least while you are really pumped, is being squeezed harder than Fannie Mae. The “rubber band” tightness should be worse if you grip your thumb in a fist, turn your palm toward the ground and bend your wrist toward your little finger (De Quervain’s test).

Your best bet is to have a therapist brutalize your forearm (especially from above the elbow on the outside and down toward your thumb) to the point that plucking your bikini line with forceps would be a more enjoyable pastime. Within reason, you can’t really do more damage than the nerve has already been subjected to.

Try the brachioradialis stretch that is described in “Dodgy Elbows” [No. 156 or drjuliansaunders. com], but with your thumb tucked into your palm. It will hurt and, like so many others, you will curse me.

Though it does not sound like a blood supply issue, it could be. Though it does not sound like a tumor … it could be. So if it does not settle reasonably quickly, go and see zee doktor. A nerve conduction study, blood flow ultrasound and MRI might be the order of the day. Along with a nice vino tinto.