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Injuries and Medical Advice

Shoulder: Torn Labrum, SLAP Lesion

Two months ago I was working an overhanging crack on toprope. My left hand was jammed in a bottleneck constriction, and as I was reaching up with my right hand for another hold, my feet came off. I fell with full force onto my left arm, but my left hand did not come out of crack.

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I have been climbing for seven years. Two months ago I was working an overhanging crack on toprope. My left hand was jammed in a bottleneck constriction, and as I was reaching up with my right hand for another hold, my feet came off. I fell with full force onto my left arm, but my left hand did not come out of crack. I felt a pop followed by intense burning pain in my shoulder. I saw an orthopedic surgeon (OS), and had an MRI that indicated probable cartilage (labrum) damage. The OS prescribed two months of physical therapy and no climbing. I did my two months of PT, working very hard on my own as well. The physical therapist and OS cleared me to try climbing again. I warmed up on a 5.9 crack, then a 5.10c sport climb and felt good. I woke up the next day unable to lift my left arm past the height of my shoulder due to pain. I was in a lot of pain for several days and finally went and saw another OS for a second opinion. He feels that I need surgery. What do you think?

Crimp7 | rockandice.com Forum

Just the thought of swinging around no feet with one hand jammed is enough to put me off crack climbing for life. If there is one mechanism for cartilage damage, that would have to be it.

The course you have taken is quite a good one. As far as climbers are concerned, you have done well.

It is difficult to know whether the aggravation is related to a SLAP lesion or a climbing-related load on a joint that had forgotten what climbing is. In the absence of overt locking, I would be disinclined to have surgery. The pain you describe smacks of bursitis.

Not being able to lift your arm above your shoulder, though acute, is not a great sign that surgery is required. It is possible that the climbing has annoyed a tendon or bursa, both of which are exceedingly capable of rendering you a blubbering mess. I would be inclined to do some fairly vigorous stretching and try to climb again. One easy and very effective stretch involves putting your hand palm out in the small of your back, and lever your elbow forward. Hold it for 30 seconds and repeat a few times. Surgery is not urgent in this case, though may help your mental state—not to underestimate that!

Orthopedic testing in the shoulder is notoriously unreliable. The “empty can test,” mentioned in a Rock and Ice forum post, is positive for supraspinatus tears, impingement, infraspinatus tears, SLAP lesions, bursitis, AC joint strain, brain tumors, ingrown toenails and whether your stocks will bounce back this week. The only thing this test can reliably say is that there is something wrong with your shoulder.

Cartilage damage is the pink T-Rex in the doctor’s office. Notoriously difficult to evaluate using orthopedic tests, it is also often under-diagnosed in MRIs. Additionally, a labral pathology is rarely a stand-alone injury. Rotator-cuff tears often ride shotgun and discharge more than their quota of ammo.

A brief word on other stuff: Look out! Despite a committed effort by The Skeptics Society the planet remains polluted with new-age voodoo. Cancer is controlled by the mind—didn’t you know? Asbestos is just a gargantuan red herring. And injecting salt water into your labrum (that’s in your shoulder, not your vagina) will render it new again. Bullshit. Call me an unenlightened heathen and log complaints at www.nudierudie-emperors.com. The idea that Cortisone is a treatment option needs to be largely deleted from medicine’s collective conscience. Dr. Phil is also proving as hard to remove as a skid mark on sheer silk.

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