Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are described. A survey was completed by 46 climbers. Three fourths of the climbers reported a climbing-related injury; of these injured climbers, almost one half reported a hand or wrist injury. More than half of the injured climbers had been treated by a physician for their injury. More than half of all climbers reported distal interphalangeal or proximal interphalangeal joint pain while climbing. Case reports of three climbers with acute hand injuries are presented to illustrate the minimal effects of their residual deficits on their climbing abilities. A wider understanding of the manual aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport will facilitate prevention, treatment, and rehabilitation.