I’m 26 and have been climbing for six years. The last three years I’ve had medial tendonosis in both elbows. For several months I’ve tried all the exercises in various rehab programs including [Dr. J’s] Dodgy Elbows. I got a cortisone shot in March that lasted until July. It’s frustrating because when I get into better climbing shape, I can’t push my limits at all—it gets too painful. Now I’m in pain again. Typing on the computer is very painful (and I just spent two months writing my dissertation). I wake up every night with pain in my elbows, particularly when I bend my arms. Should I keep getting cortisone shots three times a year? Is surgery an option?
—Vlasof | Rock And Ice Forum

You take pain with the valor of a freedom fighter! (Or are they peace keepers? Depends on which side you’re on, I suppose.) And I like your persistence.

There are variations on medial epicondylosis. The same muscles or biomechanics are not always involved. Hence the exercises and angles can be quite different. Are you doing both the pronator teres and flexor carpi ulnaris exercises? Have you tried changing the elbow angle to better target the painful area?

Cortisone may temporarily placate the condition (or not) and will certainly further feed the rapacious pharmaceutical industry. Long-term use is not recommended for many reasons, including that it is not a solution.

I have never actually referred someone for surgery for this condition (assuming the diagnosis is correct). I only know two people who have actually had surgery. Both regretted the decision—the first because he subsequently saw me for his other elbow and my program provided a safer and faster solution, and the second person because the surgeon inadvertently (and irreparably) sliced through the ulna nerve, causing more weakness than death itself. At least after dying you would have the benefit of rigor mortis.