Ask Dr J – Issue 194 – Love The Sloper

Learn to Love Slopers

Recently I strained my wrist quite badly while climbing. Slopers and pinches are painful. I’m concerned about pushing it too hard to the point of tearing cartilage. I just feel that most doctors, no matter how you explain it to them, don’t understand climbing at all.

Ryland | See the entire post at Dr. J Forum on


Julian Ass ange would have a better chance of perusing CIA documents in the national archive than doctors have of finding any research about climbing injuries. In this instance, however, knowledge of climbing injuries is not especially necessary, and both the chiro and PT have given you sound advice.

Based on your description, it sounds like you ruptured the radio-ulna ligament and have developed radial-ulna joint instability.

The lump you describe is the now-unrestrained ulna sticking out the side. Don’t worry too much about injuring the triangular fibrocartilage complex (TFC) that sits between the ulna and the carpal bones on that side—you already have!

Taping the wrist will work reasonably well. However, increasing stability by way of compression is about as rudimentary as the wellknown prosthesis of Captain James Hook.

The ulna-side carpal bones will tend to drift forward, primarily because you will have instability resulting from damaged ligaments and the probable disruption to the TFC complex. This disc contributes significantly to stability on the little-finger side of your wrist.

Slopers will hurt because the mechanics of your wrist now operate much like a bunch of coins in a tumble dryer. Pinches will hurt because your wrist is typically flexed to the little-finger side, exerting direct stress on the injured structures, especially the TFC complex.

Surgery is still an option, but most surgeons are loath to do it because it is both difficult and prone to failure. My concern with taping is that it may not provide sufficient stability to prevent further degeneration of the TFC complex and carpal joints, resulting in significant arthritic degeneration down the line.

Hand specialist. MRI. Many factors will determine the best course of action, not least of all the extent of damage.




A year ago I injured my middle finger on my left hand, rupturing my flexor digitorum superficialis. Now I can’t make the crimp position with that finger. The specialist said any surgery would be a shot in the dark and involve a tendon graft and months of rehab, which my insurance would not cover. The therapist told me I could begin climbing again as long as I took it slowly. After much work, I can now boulder V4/5 again. Outside of climbing and trying to play guitar, it doesn’t affect my life much. I finally have decent insurance so I’m wondering if there is something I should try.

Andrew | Rock and Ice Forum


Wow. You are what we doctors call interesting—that special blend of amazing and unfortunate. At least you can recalibrate to be a left-handed guitarist. Did you know that 60 percent of dominant-hand dexterity is automatically transferred to your other hand without any training? Halfway there! Well done.

I am not surprised you got kicked around the medical stables like an unrideable brumby. I have never seen your injury either. But it is difficult to argue with an MRI and that you can’t assume the crimp position.

Flexor digitorum profundis is the prime mover for finger flexion, not superficialis. Although you will lose some functional coordination of the finger (which will mess more with your plucking than your pulling), strength will be much less affected.

The advice you have received thus far is very good. Surgery is a poor option, albeit the only one if you want to regain capacity with this finger. With regard to climbing, the surgical outcome is a gamble for which I would not be so brazen to give odds.

Much of injury rehab, however, is dependent on the patient. The medical establishment can be more apocalyptic than the Mayan calendar. Likely outcomes, or even what might be possible given good conditions, are at times discussed in much less detail.

The likely worst possible outcome for your finger is that the operation fails and you have some additional scar tissue. The likely best-case scenario is that you get an almost fully functional finger. I wouldn’t steer you toward surgery, but I would recommend discussing it with a few different surgeons.

Otherwise, become an open-hand aficionado. Forget Hueco. Go to Horsepens, Font and Castle Hill. Become a sloper snob!


Breaking Tendons

Studies show that when you pull on the tendons of a cadaver’s hand, the A2 pulley is the first to rupture, followed by the A3 (which tends to be more stretchy than A2), then A4 and rarely A1. The superficialis tendon (held in place by A1, A2 and A3 pulleys) almost never ruptures before the pulleys snap. Surgery is an extremely overrated option for pulley repair given that almost all climbers will return to their previous level of climbing within 12 months, even with multiple pulley ruptures.