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azwa
May 11, 2009, 5:47 PM
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I've been trying to get a bad case of lateral epicondylitis/tendinosis to quiet down for over a year now. Two cortisone shots, acupuncture, phys. therapy, and occupational therapy have not been able to quiet it down. It's consistently inflamed, and has significant calcium deposit growth in the area.
My orthopaedic doctor recommends surgery---first, arthroscopic surgery to do an indirect tendon release. if that doesn't work, open surgery to remove dead tissue, scrape off the extensive calcification that has developed, etc. He says he's had a 90% success rate with both these surgeries, and he's highly regarded here in Tucson.
However, he's never done the surgery on a climber before. Anyone have experience with either of these surgeries? Were you able to go back to pulling down hard? I haven't climbed in over a year--haven't even been able to go to yoga---and am severely bummed about it.
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pseudolith
May 14, 2009, 1:51 PM
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Has your doc had any experience with PRP? (platelet rich plasma). The way it works is that the doc draws about 26cc of your blood mixed with an anticoagulent, and then spins it down in a centrifuge. This concentrates the platelets, which contain the growth factors that you want at the injury site. You can get up to 10x concentration.
This concentrated "buffycoat" is then injected driectly into the tendon sheath, promoting healing. It's not painless, but clinical results are very promising.
Ask him about PRP, otherwise known as "platelet gel."
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Mastertater
May 19, 2009, 3:42 AM
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I know your pain...literally. My elbows were wrecked. I've had numerous shots and PT in the past, but it did not help. I basically had to do a number of things.
I took Ibuprofren daily
Drank tons of water
I rested my arms as much as possible. For example, my arm would hurt from the way I drove, the way I would position my arms at work, and especially after I slept. (I sleep with one arm under a pillow and then I put another pillow under the wrist of the arm that is under the pillow to elevate it and it stops the soreness)
I did a ton of ice including the ice massage.
I stopped climbing for 5+ years and the years before I stopped, I was limited due to pain. About a year and a half ago I decided to start climbing again. I got into shape by doing push-ups and sit-ups. I ran (shake your arms out while running or that can flare it up), I stretched, and took vitamins. Then started climbing in a friggin' gym but I only grabbed slopers and I was really aware of the way I gripped holds. I have had some flare-ups but they are different than in the past. I can usually ice down and they are less frequent.
I climb in an inherently overhanging area and although I push myself, I am still being cautious.
Anyways, I have never heard any climber have a positive experience with the surgery. Most the people I have talked to have gotten little relief from the surgery and have independently found what works for them.
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jt512
May 19, 2009, 5:47 AM
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Mastertater wrote: I know your pain...literally. My elbows were wrecked. I've had numerous shots and PT in the past, but it did not help. I basically had to do a number of things. I took Ibuprofren daily
Well, that was a monumental mistake.* NSAIDs, including ibuprofen, inhibit healing of connective tissues.
Jay
*which I have also made.
(This post was edited by jt512 on May 19, 2009, 5:49 AM)
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Mastertater
May 19, 2009, 1:08 PM
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Well, that was a monumental mistake.* NSAIDs, including ibuprofen, inhibit healing of connective tissues.
Jay
*which I have also made.
I thought that the anti-inflammatory meds helped to prevent swelling which in turn would prevent more damage to the injured area.
Do you suggest just ice for the inflammation?
Regardless, I am relatively pain free and enjoying climbing again.
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onceahardman
May 19, 2009, 6:24 PM
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In reply to: I thought that the anti-inflammatory meds helped to prevent swelling which in turn would prevent more damage to the injured area.
That's true. But it's a non-sequitur. Preventing swelling and damage is one thing. Healing, i.e. formation of scar tissue via fibroblast activity is something else.
In reply to: Do you suggest just ice for the inflammation?
I suggest ice and rest. Then (in ascending order) passive ROM, actve ROM, and resistive exercise, each performed to the extent possible without increasing inflammation.
Manual therapy can be very helpful in some cases, including friction massage, and joint mobilization.
In reply to: Regardless, I am relatively pain free and enjoying climbing again.
I am happy for you! 
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