I was bouldering and I suddenly weighted a two-finger hold with my left hand. I felt something in my ring finger and heard a pop, like a knuckle cracking, and had mild pain but no swelling thereafter. I tried a V0 with big holds to see how my finger felt and I had no trouble and no pain. It seems that I have a pulley injury. What should I do about this?

Hambone Rock and Ice Forum

A “mild strain” is incongruent with any sense of popping. By all appearances it sounds like you ruptured a pulley, except that there is little to no swelling. That’s odd. Though a pulley that fully snaps can (ironically) be less painful than a partially torn variety, it typically inflates faster than a porn star and stays that way for several weeks.

You haven’t mentioned exactly where the mild pain is, so it’s difficult to give you a definite diagnosis. If you were torqueing the finger you may have torn a collateral ligament, an injury that usually exhibits minimal swelling and only mild pain.

You may have simply cavitated the joint (cavitation is the popping noise that you hear when you crack your fingers or spine, among other freely movable joints). Still, I would have to qualify that 99.9 percent of the time, when a person thinks he has cracked a knuckle under load he has actually snapped some form of connective tissue, most often a pulley. The pulleys hold the tendon close to the bone and are essentially a ligament that rejoins to the same bone rather than cross a joint to neighboring bone.

I would give it an acid test at the gym or outside, where you can control how much force you are using. Start on something easy and build the difficulty, albeit cautiously. Stop at roughly 75 percent of your max (for example, if your best is V8, warm up and try a V6) and take a rest day to assess any delayed soreness. Next time around, go to 90 percent, after which, if you still have no pain, release the hounds.

Experimenting on your project is a no-no, unless you have had zero trouble on every grade leading up to it. You may well have made an unsanctioned pass under the Sword of Damocles, lucky you, but I would be cautious wielding your power again until you are sure there is more than a hair between you and bisection.

 

I partially tore my meniscus on a drop knee. Surgery or not?

Daniel Ferguson Minneapolis, Minnesota

I was at Arapiles about 15 years ago on London Calling, a route named after the iconic and lyrically apocalyptic song by The Clash. And so it proved to be. Upon reflecting that my knee was torqued into a position that had biomechanical carnage written all over it, I drove upward to the next hold, assuming my educated concern was unwarranted. I mean, I had just graduated, was in love with everything, climbing pretty well, Hottie on belay. What could go wrong?

After a couple of weeks on crutches, completely unable to weight bear with that leg, I concluded that I was young and stupid and that intuition has a rightful place in injury prevention. It should have been an epiphany, really, that I sat at the citadel of my training philosophy. That realization, however, took many more injuries.

Suffice it to say that my medial meniscus was reamed, squashed and torn like a pigeon that forgot to watch the traffic in Times Square. I discussed the pros and cons of surgery with a sports physician at the time and, given that I was not a runner, there was no evidence that debriding the torn segment was better than leaving it. There are now some studies that suggest that the flap can chafe or roughen the articular surface, causing degeneration—maybe, maybe not.

Fifteen years later—no surgery—and I’m experiencing mechanical locking every time I shag. The knee snags and I have to say, “Hang on, honey,” and then twist it around like an aging gymnast to unlock it. At first it was infrequent and rather amusing. Now it’s impossible to avoid and I feel like a geriatric. And then there are the highsteps and rock-overs that lock the knee mid send. More than once I have had to grunt my way up a climb using one leg, the other unable to straighten.

Times have changed since I tore my cartilage. Meniscus tears are being stitched back together with some great results. Whether you have surgery depends on the severity and location of the tear, and not least of all how much it is affecting your life. Your knee doesn’t need to exhibit locking for surgery to be an option. A decade and a half later, I am looking down the barrel of surgery anyway. Would it have been better to do it at the time? Time and research will probably provide an answer that is redundant for me but highly valuable for those injured in the near future.

Get a surgical opinion, and then get another and buy a pack of tarot cards.