Ask Dr J – Issue 197 – “I hate rock climbers”. Cripes!

Why It Hurts

I got an MRI because my doctor suspected a TFCC tear in my wrist. The imaging showed a perforation in the TFCC and avascular necrosis of the lunate bone (possibly Kienbock’s Disease). Three months later, the necrosis still showed on the MRI but I had no symptoms. When I asked my doc about getting back into climbing, he said “I hate climbers.” Backtracking, he then said, “I just hate climbing. We aren’t made for climbing. You should feel lucky you were able to climb for four years without injury. If you continue to climb, you will always have pain.” I started climbing a few weeks ago and get an achy feeling in the ulna side of my wrist, which lasts a day or two. Crack climbing the last two weekends at Index seems to p-off my wrist the most.

Christy Galitsky | Rock and Ice Forum


“Uncommon things are uncommon.” That’s what they told us in school. Repeatedly. That is, headaches are rarely brain tumors. If you have Keinbocks, I will be surprised. Why? Because it’s uncommon. But if you do have it, your bone is dying and you’re not yet done with it. Pooh! Climbing is going to be less fun, if any at all. That said, the diagnosis is not confirmed so let’s just keep that in the wings.

“You’re lucky you lasted that long”—I couldn’t agree more. I wish I had some ninja skills like yours. Four years injury-free would be a record for me and virtually every climber I know. Consider this injury a rite of passage, and not least of all a celebration that you have been trying hard!

“If you continue to climb, you will always have pain”—definitely true, though it may or may not be in your wrist. Crack climbers have the pain tolerance of those who operate in a world of fear and jammed flesh. Scare tactics? Your doctor might as well try to bluff a professional poker player with a pair of UNO cards.

The pain you have on the pinky side of your wrist is most likely related to the TFCC. That the MRI only demonstrated a perforation a) does not dictate the amount of pain you should have, and b) is not necessarily true—there could be more damage than the MRI suggests.

That it’s painful after crack climbing is predictable. I would try some gently overhanging face climbing and see how that goes. Crimping will probably be better than open handing.

Regarding your lunate, it’s a wait-and-see game. If there is further necrosis of the bone you will have a real problem. I assume Captain Tactless has said you need to come back at some point in the near future. I would certainly follow up with him, but keep in mind that not all specialists understand or have compassion for sports people. If it worsens get a second opinion.




I’ve had pain on the outside of my elbow for four or five years. I climb, rest, do tons of PT, fish, find a new PT, rest, climb, quit fishing forever, climb, quit climbing forever, climb, rest, and so on. Right now I’m talking with an orthopedic surgeon who’s experimenting with PRP therapy. I was obviously interested in magic-potion injections and made an appointment. He was not able to diagnose my injury. We did some x-rays and ruled out joint stuff, arthritis and some other stuff I think he was making up. Point is he does not think (based on the location of my pain) that it’s lateral epicondylitis. Now he wants to do an MRI. The pain has moved around a bit in recent years but the marked spot on the attached photos has been the most persistent. Should I have an MRI?

Anonymous | Rock and Ice Forum


Clearly you are a guy of extreme responses, but quitting fishing is going a little far.

PRP therapy is a variation on autologus blood injections, whereby instead of blood being injected into the naughty tendon, it is refined into a solution that is higher in platelets. There are no studies to suggest one method is more effective than the other, or in fact that either is particularly effective by itself. Currently there are some fairly low-quality studies and a bunch of anecdotal evidence that suggest improvement rather than resolution of tendonosis. If you have a predilection for needle-stick medicine, I would try voodoo first.

Keep in mind that you are attempting a lazy solution. Or someone doesn’t know their exercise rehab. Or both. I agree with said doctor that lateral epicondylosis in its more common incarnation is unlikely; i.e., tendonosis of extensor carpi radialis longus (ECRL)—the long muscle that extends your wrist on the thumb side—is not the culprit. The position you have marked on the image is over the supinator. Does it hurt to supinate your hand against resistance when the elbow is straight or slightly bent? Take someone’s hand as though you are going to shake it. Now try to twist the person’s hand such that it is on the top while he resists at about 80 percent (i.e. you will win against the resistance).

If the condition is a tendonosis you will get pain doing specific movements of your hand or forearm that tend to diminish as the tendon warms up, but return soon after you finish exercising. The trick is to isolate that movement and tailor an eccentric exercise program to strengthen the tendon. Everything else is a trick that will end in a trail of tears. You can read about more common versions of elbow tendonosis and how to cure them at

Without a definitive diagnosis (and your pain may not even be tendonosis, let alone the type I have suggested), moving forward is akin to revving your engine in neutral—not likely to end in disaster but, not going to get you anywhere, either.

If your guy can’t diagnose the issue, an MRI may be a convenient, albeit pricey, shortcut. Certainly, this doesn’t sound anything like what a practitioner would routinely see in practice.



In 1910 the observant Dr. Robert Kienbock, sans x-ray machine, told his charismatic assistant that he had discovered a new disease. She was enthralled, or at least pretended to be. Encouraged, Bob described the collapse and fragmentation of the lunate, one of the carpal bones in the wrist, due to what he believed was avascular necrosis (bone death resulting from disrupted blood supply). They married and had four children, all Oompa Loompas. It is thought that an injury to the wrist, which can be as minor as a sprain, pinches or severs the blood supply, but in a significant portion of cases no injury event can be identified. Progression of the disease is virtually always treated with surgery unless you are an Oompa Loompa, in which case it is microsurgery.