ASK DR J – ISSUE 199 – Arthritis, Inevitable?

I’m 28 and have sport climbed for 10 years. I push myself hard but have taken most of the last year off. Since April 2010 I have been experiencing degrees of pain in the base of my thumbs—mostly my right thumb. I’ve talked with two hand specialists and X-rays indicate that the joint spacing in my hand is good, but I was told that I am developing arthritis and should quit climbing. If it seems like it is arthritis, is there a way to be sure, and what is the next course of action?

Injuredclimber | Rock and Ice Forum

Our opposable thumbs rather than our intellect differentiate us from the mass of the animal kingdom. As a result the joint suffers considerably by way of wear and tear, and is typically the first joint to succumb to arthritis. That said, gee whiz, you’re a bit young for age-related dilapidation!

A few metabolic disorders, such as gout, can cause the formation of crystals inside the joint, resulting in arthritis. These, however, tend to involve more intense relapsing and remitting pain as well as considerable inflammation, none of which you have mentioned.

In all likelihood your doc is on the money with his or her estimate of the situation, at least from a conservative perspective, i.e. the likely worst-case scenario is early stage osteoarthritis (OA). It is more common to see signs of joint degeneration such as a narrowed joint space or bone spurs by the time you feel the symptoms, Rustam Gelmanov gives his all. No way around it, climbing takes its toll on joints and tendons, and can cause the onset of arthritis, especially if you overdo it or are injured while still relatively young. but that is not always the case.

An Australian climber, “John Doe,” who in retrospect was probably the first to onsight 5.14a (5.13d at the time of his ascent), has the thumb dimensions of a button mushroom. I have never seen him use his thumbs since they are of no functional length.

Solution: Don’t do pinches, drink fish oil like it’s the elixir of life, and traction your thumbs like you are milking a cow’s tits.


I’m an avid climber and have had chronic pain in both shoulders for six months. Since I don’t remember any injury event, the pain appears to be from repetitive abuse. Curiously, neither shoulder hurts when I climb except for the occasional jolt of pain when my arms are at the extreme limits of their range (up and back). Instead, they hurt late at night—often to such an extent that the pain wakes me. Holding my arm bent against my chest is the only thing that seems to lessen the pain. Once I’m up and around for the day, the pain goes away. The pain doesn’t seem to originate in the joint itself but instead seems centered in the muscle on the outside of the shoulder. It has been suggested that I have the classic symptoms of rotator-cuff tendonitis, but I have not been to a doctor for a proper diagnosis.

Andy B | Rock and Ice Forum

Stoic was what your granddaddy was because medicine was either overrated or unaffordable. The United States have somehow managed to make it still unaffordable, which is impressive given the more socially progressive models on display in many Western countries. Nonetheless, go and get some!

Pain on the outside of your shoulder, in or around the deltoid muscle, tells you about as much as a foreign correspondent inside China— that there’s a problem. The vast majority of shoulder injuries, from cartilage tearing to bursitis, refer pain to this area.

To say that it is classic rotator-cuff tendonopathy is a bit like saying since the bed is wet you must have pissed it. Eighty percent of shoulder injuries relate to rotator-cuff tendons.

Bilateral shoulder pain is concerning. One overloaded wing I can understand, two is a definitive step toward medical hellfire and has me considering autoimmune arthritis. Blood tests. MRI.

On the good side, however, your pain pattern is fairly similar to tendonosis in that it warms up and goes away, returning after you cool down. You will almost certainly have some internal joint issues such as synovitis given the nighttime pain and the protective position (which reduces pressure inside the glenohumeral joint).

Solution: None. Get a diagnosis. This will dictate how you handle the problem. Tendonopathy can be corrected with manual therapy and an eccentric exercise program. The other diagnostic options will be less fun.


I started climbing last Christmas and immediately took to it, doing pull-ups, curls and hand exercises. I flew up the ratings to 5.11+ but one day I noticed that my elbow was sore. It has hurt for about a month now. The pain, a dull ache, goes away when I start to work out or climb, and comes back soon after I stop. I don’t know if I pulled something doing a dyno (that’s when the pain began) or if I’m going to have an ongoing problem.

Stokedclimber | Rock and Ice Forum

You are suffering enthusiolisthesis, whereby your excitement to climb goes beyond tailwagging enthusiasm and leads you down the slippery path of injury.

You are almost certainly suffering elbow tendonosis. Medial epicondylosis (inside elbow) is the garden variety for climbers. Read the “Dodgy Elbows” article archived at www.drjuliansaunders. com for a rehab program.

With this level of enthusiasm, you will absolutely need a comprehensive climbing conditioning program if you are to avoid injury. The first couple of years in climbing are fraught with danger for your connective tissues. That is, muscle strength skyrockets while tendon and pulley strength lag well behind.

Solution: Purchase two bondage collars and two bullwhips. Put on one collar and tether yourself to the clothesline with the bullwhip every other day. To make the rest time more interesting, hang the spare set on the line next to you and “sext” naked pics to all your friends. Not only will this force you to rest, but it will be a formative period in your life. Rest at least 48 hours after a day on the rock or a hard training session.