<p>Rock climbing has seen rapid growth in participation worldwide, resulting in an increasing frequency of sport-related injuries encountered in routine clinical practice. Many of these injuries arise from biomechanical demands unique to climbing and demonstrate characteristic imaging features. This review highlights the spectrum of acute and chronic rock-climbing injuries with emphasis on anatomy, injury patterns, and key imaging findings. Upper-extremity injuries predominate, particularly involving the fingers, where annular pulley injuries represent the most common and sport-specific pathology. Additional frequently encountered entities include flexor tendon tenosynovitis, lumbrical muscle tears, wrist synovitis and ligamentous injuries, and stress-related osseous changes of the hand and wrist. Shoulder and elbow abnormalities, often related to repetitive loading or falls, as well as lower-extremity injuries associated with bouldering and specialized maneuvers such as heel hooks, are also reviewed. Ultrasound and MRI each have advantages and disadvantages but ultimately play complementary roles in evaluation. Awareness of climbing-specific injury patterns permits recognition of subtle but important diagnostic findings, guiding management and facilitating safe return to sport.</p>