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Injuries and Medical Advice

Wrist: Klienbock’s Disease

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.”

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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. “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.

KEINBOCK’S DISEASE
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.