Ask Dr J – Issue 191 – Snap, Crackle, Wrist

Snap, Crackle, Wrist

Two weeks ago I tweaked my wrist doing a funky mantel, but it didn’t hurt until the next day. Doorknobs, slopers and sidepulls bring the most discomfort on the pinky-finger-side of my wrist. I have experienced clicking in my wrist. Sometimes something suddenly pops and everything seems to move a bit easier. What’s up?

Thomas | via e-mail

Mantels are more dangerous than shagging Medusa. Even if you survive manteling, you will carry the scars. The wrist has more tendons, nerves, bones and ligaments per square inch than any other part of the body and it’s all manacled tighter than Lindsay Lohan. Frankly, you could have injured yourself in several different ways. Without looking at it, I would rather try and solve a Rubik’s Cube over the phone. That said, a good therapist should be able to figure it out and save you the expense of an MRI.

Although you could have torn a ligament in isolation, the most likely injury is to the triangular fibro-cartilage complex (TFCC), a small disc-like piece of cartilage with multiple ligamentus anchors that sits between the end of the ulna and the carpal bones that articulate with it.

Carpal instability on that side can be a chicken or egg situation with either a ligament or TFCC injury, and can lead to the bones continually drifting out of their proper position. And then the sudden relocation click.

This is different than the click you might notice as you move your hand in a circle where the wrist clicks as you go through the range over the little finger side. This click is more likely to be a torn free edge of the TFCC that is getting in the way. That said, it could be a bone that is not articulating properly with its neighbors because of a snapped ligament. See someone if it doesn’t settle.




I was climbing Rainier two weeks ago and took a hit from grapefruit-sized rock. Plunked me in the muscle just above the kneecap. I gutted it out and summited, but it was 18 hours before I was home to ice and elevate it. Gradually, the swelling (which was only moderate) has gone down and I have my mobility back. But here I am, two weeks later, still with a small knot above my knee and lingering pain. Should I see a doctor? Physical therapist?

TyneRock | Rock and Ice Forum

Somebody get this guy a sponsorship deal! Hell, a book deal! OMG, call Hollywood! Two weeks is not long when you have just taken a haymaker from a midget Mike Tyson … and summited! A rock that size traveling somewhere between really fast and holy-shit fast is tremendously powerful. That it did not break your leg is a minor miracle. Had it smashed your patella to smithereens you could have crawled your way to a major screenplay and maybe even a nude scene with Penelope Cruz.

Oddly, it does not sound like it caused a hematoma, but rather has crushed/fused some of the muscle fibers to the point of annihilation. They say if you could compress coal you would make a diamond. But when you compress muscle tissue with a sudden force, and undoubtedly some hematoma formation, you just make a fibrous lump. The lump will probably remain, and may well cause you some patella tracking issues in the future. Your best bet is some remedial massage to try and free up what you can.




In mid June, I fell bouldering. It was a bad landing and moderately compressed my second and third lumbar. On my foot, my navicular was broken, my cuboid crushed, and my talus resembled gravel. After two surgeries, three plates and tons of screws, my foot is on the mend. The doctor said that I could backpack, but I can’t ever run or put any kind of impact on my foot due to lots of cartilage damage; my foot has a limited amount of steps before arthritis sets in. Can I ever climb again?

Max | via e-mail

In the late 20th century, before I became a medical sage, I bouldered with a guy who went by the handle Gatito, meaning kitten. In a double entendre euphemistic kind of way, he was just that—a 6’3″ wroughtiron sculpture, he went about the world wide-eyed and playful.

A minor fall on scree a couple of years before had resulted in multiple fractures in his ankle followed by several operations. His foot was fused in every direction with virtually no motion at the ankle itself, and resembled a prosthetic limb that a dog had chewed on.

We met in Refugio Frey, Patagonia, both partner-less. Gatito’s diamondbit fingertips pulled harder than a tractor on nitrous. He out-bouldered, outclimbed and out-socialized me at every turn. He took whippers, walked for hours up exfoliating Patagonian slopes, had no bouldering pad and drank his body weight in maté every morning at 30 different camps.

Not to say his ankle was without issues. From joint stiffness and cartilage damage is born a multitude of pathologies, namely tendonitis and early joint degeneration. But he adapted and made things workable.

Your injury is a mild swerve to the left, not the end of the road. It doesn’t sound like your doc has advised against climbing, and neither would I. I saw a guy today who was stopped on a 100-footer by a loop of static line that snagged around his ankle. Two plates and 12 screws. His surgeon was smart: Climbing
is great for it. Go climbing. It will develop strength and range of motion.” Knighthood!

Impact, however, is bad. Avoid slabs (like you needed an excuse!), buy a phat pad. Lowballs are the new black. Arthritis has started already—you have a limited amount of steps before you notice it!