Elbow and Wrist Pain in Climbers: Inside, Outside, Pinky Side, and When to See a Doctor

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You bouldered all evening, went home, scrolled your phone for half an hour, and now the inside of your elbow aches and your little finger feels a bit numb. Or you've been practising mantles (pressing down on a hold with your palms to push your body up over it), and the pinky side of your wrist stings every time you push. A friend says: "Golfer's elbow. Just rest it."

This post covers the most common kinds of elbow and wrist pain: the inside of the elbow, the outside, the elbow after a fall, and the wrist, both the pinky side and the wrist that hurts "everywhere and nowhere". The aim is to help you adjust your training and know when to see a doctor, not to diagnose yourself. Finger problems are covered in the two earlier posts, Finger Pulley Injuries and Other Finger Injuries.

A word on evidence first. There isn't much climbing-specific research on elbows and wrists. Below, each claim is labelled by source type: research, case series (only patients who came to a clinic, no control group), general population (not climbers), or physical therapist experience.

Where elbows and wrists sit among climbing injuries

Grønhaug (2018) surveyed 667 climbers about chronic injuries in the past six months. The elbow came third, after fingers and shoulders. Among women, the wrist came third, ahead of the elbow.

This is a self-report survey (research), not doctors' diagnoses. It tells you elbows and wrists aren't rare problems, but not which kind of pain you have.

Something you can do tonight: on a sheet of paper, sketch your elbow and wrist and mark every spot that has hurt in the past month, noting which movement hurts. At a doctor's appointment this sheet is far more useful than "my elbow feels weird".

Inside of the elbow: tendon or nerve?

The bony bump on the inside of the elbow is where the wrist and finger flexors start. Pain here is usually called golfer's elbow, medically medial epicondylitis. Taiwanese physical therapist Li Bin of Anjian Weikang PT (in Chinese) attributes it to prolonged gripping, pull-ups, or over-flexing the wrist while gripping.

But physical therapist Jason Hooper, in Hooper's Beta Ep. 162, warns that medial elbow pain has two common causes, tendons and nerve compression, and the second one is the one people miss. Nerve compression doesn't only cause numbness; it can also feel like a dull ache or a stabbing pain, which makes it hard to tell apart yourself. His clues (physical therapist experience):

• Numbness or tingling: only nerves cause these. If numbness is the main symptom, it's a nerve.
• Pain when the elbow stays bent, for example holding your phone for a long time: a nerve is likely involved.
• Symptoms change after chest and shoulder stretches: a nerve is involved.

When the ulnar nerve is compressed at the inside of the elbow, Taiwanese hand surgeons call it cubital tunnel syndrome (in Chinese): numbness, tingling and weakness in the palm and fingers.

This isn't just theory. Meller et al.'s 2024 case series (Hooper is a co-author) reported 3 climbers whose problem was first treated as elbow tendinopathy and later turned out to be ulnar nerve compression. After switching to nerve-glide exercises, all three returned to their pre-injury climbing performance. Three cases show that misdiagnosis happens, not how often.

On recovery time, Hooper's experience is that a pure nerve problem improves within a few days to a few weeks, while a tendon problem takes 2–4 months. These are his clinical estimates, not study results.

Something you can do tonight: this week, note when the medial elbow pain shows up. Is it on small crimps and pull-ups, or also while scrolling your phone or when you wake up? Does numbness reach your ring and little fingers? If the last two happen, make a point of telling the doctor.

Outside of the elbow: tennis elbow

The bony bump on the outside of the elbow is where the wrist extensors start. Pain here is tennis elbow, medically lateral epicondylitis. Li Bin's article links it to repeatedly gripping and releasing with the wrist extended.

Climbing-specific evidence is thin. González-Iglesias's 2011 case series, for example, has only 9 climbers and describes improvement after manual therapy and dry needling, with no control group. So most of what is said about the causes and management of tennis elbow is borrowed from research on non-climbers (general population).

Two views worth knowing (both expert opinion):

• The UIAA Medical Commission's sport climbing factsheet says many overuse injuries come from muscle imbalances, for example neglecting the rotator cuff or forearm extensors.
• Physical therapist Esther Smith, writing for Black Diamond, describes the elbow as the link "caught in the middle". In her observation, the triceps, trapezius and posterior rotator cuff, which connect to the forearm extensors, tend to be some of climbers' weakest muscles. Her approach trains the shoulder and core too, not just the elbow.

Something you can do tonight: make fists with the backs of your hands up and slowly lift your wrists. Compare sides: which tires first? If you barely train your extensors, add the reverse curls from Antagonist and Core Training to your weekly routine.

The elbow after a fall: dislocation

The first two are slow-building pain. The next one happens in an instant: you fall backwards off a boulder, put a hand down, and the elbow dislocates.

Müller et al. (2024) followed 30 patients at a Munich level I trauma centre, all with elbow dislocations from bouldering falls. The most common mechanism was a low backward fall onto crash pads. About half had surgery. Most returned to bouldering, but only about two-thirds regained their previous level. The authors warn that "only a short fall onto a mat" may create a false sense of security.

The NHS page on sprains and strains lists when to go straight to A&E: you heard a crack, the body part has changed shape or points at an odd angle, it's numb or tingling, or the skin looks blue or grey or feels cold. The NHS also says not to drive yourself. Don't try to put a dislocated elbow back yourself.

Something you can do tonight: next time you top out a problem, try climbing all the way down instead of jumping. The German Alpine Club (DAV) bouldering handbook (in German) says climbing down is always safer than jumping; if you must jump, keep your arms bent close to your body with your hands in fists. Full landing technique is in Bouldering Falls and Ankles.

Wrist pain: mostly on the pinky side

Schöffl et al. (2023) analysed 69 climbers at a German sports medicine centre, with 78 wrist injuries in total (case series). Their conclusions:

• Ulnar-sided (pinky-side) injuries were the most common, and many patients had more than one diagnosis.
• The most frequent included synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains and ganglion cysts.
• Both surgery and conservative care mostly went well, but about a third still had discomfort after treatment. The authors therefore stress accurate diagnosis and expert care.

What is the TFCC?

On the pinky side of the wrist sits a group of structures called the TFCC (triangular fibrocartilage complex): a fibrocartilage disc plus several ligaments that stabilise the wrist. Climbers' pinky-side wrist pain is often attributed to it.

On evidence first: what's said about the TFCC in climbers comes mainly from physical therapists' experience, not research. The mechanisms and timelines below come from two such write-ups (The Climbing Doctor, Hooper's Beta Ep. 157):

• Compression: landing on a hand after a bouldering fall, repeated mantles, cross-through moves that squeeze the space between the wrist and the ulna.
• Overstretching: the wrist is forced towards the thumb side, as with an overhead gaston or a hold far from your body; slopers and underclings can also do it.
• Symptoms: pinky-side wrist pain, worse when rotating the forearm (turning a doorknob) or tilting the wrist towards the pinky; possibly clicking, weakness or a sense of instability. Hooper notes that healthy wrists click too; it only matters if the clicking hurts or clearly changes.
• Timeline: in Hooper's experience most cases take 2–4 months; a tear near the centre of the disc may take about 6 months.

Both sources give the same line for seeing a professional: if you've rested and rehabbed as planned for 4 weeks without improvement, see a specialist. If you suspect a fracture after a fall, don't wait.

Something you can do tonight: check your hangboard and bar-hanging position. The Climbing Doctor recommends keeping the wrist as neutral as possible rather than hanging at the end of its range for long. On mantles, load your weight gradually instead of dropping it onto your wrist with momentum.

The wrist that hurts everywhere: get imaging

Some wrist pain is diffuse; you can't point to one spot. Here the researchers are consistent: get imaging.

• Hamate fracture: the hamate is a wrist bone on the pinky side with a "hook". Lutter et al. (2016) reported 12 climbers with hamate hook fractures, all presenting with diffuse wrist pain. The authors explain that flexor tendons, tightened under a hard pull, transmit the stress onto the hook. Their conclusion: diffuse wrist pain needs an X-ray, then CT or MRI if the X-ray is unclear, to avoid severe complications.
• Bone marrow edema: Lutter et al. (2018) found overload-related bone marrow edema on MRI in 28 of 31 high-level climbers, mostly in the distal radius, distal ulna or carpal bones. Even with consistent load reduction, the edema took 3–4 months to disappear completely.

Both are case series from the same German group, in high-level climbers.

Numb fingers: the carpal tunnel

The best-known nerve compression at the wrist is carpal tunnel syndrome. The climbing data are old. Rooks (1995) examined 39 recreational climbers and found signs of carpal tunnel syndrome in 4. Among Peters's (2001) 83 climbers who came in with symptoms, about a quarter had a nerve compression syndrome, and most responded to conservative care.

There's one rare red flag worth knowing. Zbeda et al. (2021) reported a case: four days after climbing at an indoor gym, a climber had numb fingers, marked tenderness in the hand, and pain when someone else moved his fingers. It was acute carpal tunnel syndrome caused by a deep infection, and he needed urgent surgery. The authors think a scrape on a finger or palm let the pathogen in. It's a single case, but "numbness plus swelling and severe pain that keeps getting worse" should not be written off as overuse.

Something you can do tonight: when you wash your hands after climbing, check your palms and fingers for broken skin. Clean any wounds. If over the next few days your palm swells and hurts, your fingers go numb, and you can't bear it being touched, see a doctor that day.

When to see a doctor, and which department

See a doctor rather than relying on an online routine if:

• Your fingers or palm go numb or tingle, especially more and more often.
• After a fall, your elbow or wrist is deformed, swells quickly, can't move, or you suspect a fracture: go to the emergency department.
• Your wrist pain is diffuse and you can't locate it.
• You've reduced load and rehabbed as planned for 4 weeks and your wrist hasn't improved.
• Your elbow pain hasn't responded to load management, strength work or nerve exercises (Hooper's advice).
• You're under 18 and have chronic finger or wrist pain: growth plates are covered in Youth Growth Plates. Kwon et al. (2018) reported a wrist growth-plate stress injury in an 11-year-old girl who climbed.

In Taiwan, elbows and wrists can be seen in orthopaedics (many hospitals have hand surgery), rehabilitation medicine (PM&R), or a sports medicine clinic. The Taiwan Society for Surgery of the Hand (in Chinese) explains that hand surgery covers "all conditions of the upper limb, from the shoulder to the fingertips", performed by orthopaedic and plastic surgeons, and that many conditions don't need surgery. For differences between departments and NHI referrals, see the series overview.

Something you can do tonight: on the pain map from the first section, add three lines, "when it started", "after doing what", and "any numbness", and keep it on your phone.

Adjusting training while it hurts

This post doesn't give treatment plans, but many physical therapists use a reference line that helps you decide whether to cut back. Hooper gives the same one in both his medial elbow and TFCC episodes (physical therapist experience):

If an activity stays at or below 2/10 pain while you do it and for 24 hours afterwards, it's probably fine; if not, reduce the intensity or volume, or change the movement.

He stresses that reducing aggravating factors doesn't mean stopping all activity; a complete absence of stimulus doesn't make recovery faster. On prevention, Quarmby et al.'s 2023 systematic review found that a strength-training intervention prevented shoulder and elbow overuse injuries. The evidence is narrow; see Antagonist and Core Training for details. The same review linked higher climbing intensity, bouldering, the crimp grip and previous injury to overuse injuries.

Something you can do tonight: after your next session, rate your elbow and wrist pain from 0 to 10, and again the next morning. If it's above 2 twice in a row, drop the movement that hurts next time.

Practice: four scenarios

Answers are below each question. Think first, then look.

1. The inside of your elbow has hurt for two months. A friend says it's golfer's elbow and tells you to do eccentrics. You've also noticed your little finger is numb when you wake up.

2. You've been working mantle problems, and the pinky side of your wrist stings when you press down. It's been three weeks.

3. You fall backwards off a boulder, put a hand down, and your elbow is visibly deformed and your fingers are numb.

4. Your wrist has hurt for over a month. You can't say exactly where. A few days' rest helps, then climbing brings it back.

Next

Elbow problems often lead back to the shoulder: Esther Smith's approach starts with the shoulder and core, and the UIAA names the rotator cuff. The next post, The Shoulder, covers common causes of shoulder pain in climbers, why a finding on MRI isn't the same as an injury, and a shoulder self-check.

References

• Grønhaug G. Self-reported chronic injuries in climbing: who gets injured when? BMJ Open Sport Exerc Med 2018
• Holtzhausen LM, Noakes TD. Elbow, forearm, wrist, and hand injuries among sport rock climbers. Clin J Sport Med 1996
• Meller LLT et al. More Than Just Another Elbow Tendinopathy: misdiagnosed ulnar nerve compression in climbing. Curr Sports Med Rep 2024
• González-Iglesias J et al. Multimodal management of lateral epicondylalgia in rock climbers: a prospective case series. J Manipulative Physiol Ther 2011
• Müller M et al. Mid- to long-term functional outcome and return to sport after elbow dislocation in bouldering. Arch Orthop Trauma Surg 2024
• Schöffl V et al. Wrist Injuries in Climbers. Am J Sports Med 2023
• Lutter C et al. Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering. Wilderness Environ Med 2016
• Lutter C et al. Rock Climbing-Related Bone Marrow Edema of the Hand: A Follow-up Study. Clin J Sport Med 2018
• Rooks MD et al. Injury patterns in recreational rock climbers. Am J Sports Med 1995
• Peters P. Nerve compression syndromes in sport climbers. Int J Sports Med 2001
• Zbeda RM et al. Acute Septic Carpal Tunnel Syndrome in a Rock Climber. J Orthop Case Rep 2021
• Kwon SW et al. Physeal fracture in the wrist and hand due to stress injury in a child climber. Medicine 2018
• Indoor Boulder-Check: Schulungsheft zum DAV-Boulderschein (German Alpine Club, PDF, in German)
• Sprains and strains (NHS)
• Quarmby A et al. Risk factors and injury prevention strategies for overuse injuries in adult climbers: a systematic review. Front Sports Act Living 2023
• How to Fix Stubborn Medial Elbow Pain (Jason Hooper, Hooper's Beta Ep. 162, 2025)
• How to Fix Ulnar Wrist Pain: TFCC Injury Recovery Guide (Jason Hooper, Hooper's Beta Ep. 157, 2025)
• I Was Rock Climbing and Now My Wrist Hurts: TFCC Injuries (Hooper's Beta, 2020)
• TFCC injury – A common source of wrist pain in climbers (Kimmy Wiley, The Climbing Doctor, 2022)
• Hang Right Part 2: Elbow Pain in Climbers (Esther Smith, Black Diamond)
• UIAA Medical Commission: Factsheet on Sport Climbing (PDF)
• Injury prevention for climbers' fingers, elbows and shoulders (Li Bin, PT, Anjian Weikang Physical Therapy) (in Chinese)
• Ulnar nerve compression / cubital tunnel syndrome (orthopaedic hand surgery team) (in Chinese)
• Taiwan Society for Surgery of the Hand: About (in Chinese)