Ask Dr J – Issue 167 – Peace, love and a happy world

Peace, love and a happy world

My hands, especially my little fingers, go numb (they tingle), whenever I climb a lot. A few pulls here or there cause no problem, but all-day climbing sure does. It seems related to my shoulders or even neck, as it’s worse when I carry a heavy pack or gear sling.

Duane Raleigh Redstone, Colorado


Homie, you have thoracic outlet syndrome. There are other ways of attaining the lofty medical heights of numb appendages, but this is the most likely explanation. The nerves that arise from your neck and feed into your arm are getting pinched, most likely in the side of your neck, or between your collar bone and first rib. Any therapist worth a grain of salt will know what to do. That said, salt can be an amazingly rare commodity in the medical field.

You need a solid massage and a jolly good cracking in your upper thoracic and lower cervical spine (upper back and lower neck). A physical therapist will do the soft tissue only, unless you can find one that does manipulations as well. A chiro will do manipulations but is highly unlikely to spend any time doing the soft-tissue component. If either of these therapists does both, sweet. An osteopath of the musculo-skeletal variety will almost certainly do both, but you will pay more. Most doctors of osteopathy in the States operate a bit like holistic family doctors.

You will need to call and ask if the person’s practice is more about manual therapy than general medicine. Any practitioner consulting for less than 10 minutes is massaging your wallet. Twenty to 30 minutes is worth paying for. A good therapist will give you a bunch of stretches to do. Yoga is your friend! Stress is your enemy. Peace and love and a happy world—problem solved. May you meditate full throttle, no parachute. Lovely.

P.S. I am not too sure what meditation is, as my nose always gets itchy, and apparently, you are supposed to ignore it, which I can’t.


Pesky DNA

I’ve been climbing for 30 years and just noticed a lump forming in the palm of each hand between the bones that extend down from my ring fingers and pinkies. The lump doesn’t hurt but it looks like somebody slipped a peanut into my hand. WTF?

Jeff Jackson Basalt, Colorado


In the mid 9th century, the Vikings got around, albeit in a less than gentlemanly manner. Visiting the neighboring shores across the North Sea, Scotland, Ireland, England, yada yada, they raped, pillaged and plundered to their hearts’ content. Wreaking havoc on your neighbors was apparently a great tonic.

Though the genes for blue eyes and blond hair has its advantages, the full Viking genome does not come with a lifetime warranty. It carries a pesky piece of DNA that causes Dupuytren’s disease (DD), defined by the formation of scar tissue in the palm of the hand— more specifically, in the fascia underlying the skin.

DD is purportedly associated with many other diseases: alcoholism, epilepsy, AIDS, diabetes, hepatic disease, fibromatosis, peptic ulcers, myocardial disease, carpeltunnel syndrome, trigger finger, one ear lower than the other, or your mother predominantly calls on a Tuesday. Because DD has an onset in the middle to later ages, for many it is more likely a coincidental association only. Fact: most of the afflicted are males aged over 35, of Anglo descent.

Splints, heat, cortisone, electro gizmos, vitamin E, etc., are all uniformly and categorically unsuccessful.

Needle aponevrotomy is the most significant advance in DD management in recent decades. The Dupuytrens cord is weakened and cut with a #25 gauge needle. Relax! It is quite small. Simple, quick and comparatively cheap, the procedure will cost you about 650 bingo bets per finger. Like surgery, recurrence is as high as 50 percent. Unlike surgery, it can be repeated and has very little rehab. One physician, regarding recovery, says, “Close to 100 percent could return to climbing within two weeks after the procedure.” SOLD. That is, if you can get to one of the handful of physicians in the USA who are qualified to do it.


Party Tricks

Is it possible to climb all the time and not get injured?

Andrew Bisharat Carbondale, Colorado


Nope, I don’t believe so! The fact that climbers have arms resembling sculpted titanium rods is a good indication of the stresses they endure. Hanging onto a cliff—not infrequently risking a perfectly good set of ankles—is a great way to generate strength. It is also a great way to self-combust. Eyepopping, tendon-ripping and, at times, bone-fracturing feats of power are for some climbers just party tricks. Fear is the catalyst of physiologic mayhem.
The flip side of the coin is where pain becomes background noise only, and every contractile tissue available moves you upward an inch at a time. Tap into this dark well of strength often enough, and you learn to do it without the adrenalin. You naively reset the many cerebral and physiological emergency brakes until they are barely a hindrance. The strange thing is that climbers are always surprised when something snaps.


The Wishbone

Five weeks ago I went climbing and injured my left knee. It happened just as I stood up from a drop knee. The doctor said that I ruptured my ACL. 1. What is it this ACL exactly? 2. The doctor told me to wear a support. What kind of knee support should I wear? 3. The doctor also told me only to swim for exercise, but I am currently in the desert and there is no swimming pool here. What about cycling? 4. Finally, will I be able to recover completely or not?

Albert Boenardi Bandung, Indonesia


The knee has four major ligaments: one on each side (medial and lateral collateral ligaments) and two that cross in the middle, called your anterior and posterior cruciate ligaments (ACL and PCL, respectively). Together these hold the knee joint together, and in a position that allows the muscles to articulate the bones smoothly. The two menisci are kidney-shaped cartilage discs that do several things, but primarily act as shock absorbers between the ends of the femur and tibia.

I looked at your MRI report and you have a partially torn, not fully ruptured, ACL. It sounds like your knee is recovering well. If you can run and exercise without much pain, then I would say you are free to do most anything you like. I would avoid strenuous drop knees for another couple of months as they turn your knee into a wishbone. I wouldn’t bother with a brace, given your current state. That said, there are many brands of ACL braces. They are all bulky and pains in the proverbial. It takes a lot of plastic to replace a one-inch piece of ligament!

Doctors are fans of swimming. Chasing a black line up and down a pool is akin to watching paint dry. I sink like a stone and am consequently less than fond of it. It is, however, low impact and good for knee rehab (and the badly broken, in general), where sudden loading is not advisable. Road cycling is also good, as long as you have eyes in the back of your head to avoid the geriatrics, road ragers and the distracted.

Scar tissue is weaker than the sublimely pure cells you were born with, but you can make that puppy functionally stronger by strengthening the muscles that give control and stability to the knee. Google “ACL Rehab Program” and you will find plenty of info.