Any Doctors out there? Help?

Visited my doc about a week ago and was diagnosed with bicep tendonitis. He did a couple of tests by having me push in different directions against his arms and did a couple of mobility tests. When he told me what i had it kind of felt, well, half-assed.
As a climber... I'm worried. . .
I usually heal like Jesus and this injury doesn't seem to be recovering at all. It's been three weeks now and i still feel weak. Ive iced 3-4 times daily and have been taking prescription Naproxen but still feel pain when:

-i hold a weight palm-down and lift it straight up.
-i lean on it, like against the arm of a chair or sleep on it.
-and i get a random throb and a crack here and there.

Other than that i have full range of mobility without a weight.

Now let me explain why i think its something else and i really hope someone can help me.

Before my injury, any time my hand was above my head and not resting on a hold or anything my arms would fall asleep. I'm guessing pinched nerve?
After some research i discovered that when the acromion bone gets a spur it can lead to a pinched nerve and possibly impingement syndrome. Impingement syndrome is the number one cause of supraspinatus tendonitis aka rotator cuff tendonitis.
Now, a sign of rotator cuff tendonitis is a bump on the tip of a shoulder. . .
I have a pretty large bump on the tip of my shoulder.

The other big fear i worry it might be is a (degenerative) partial supraspinatus tear which could be that large bump on my shoulder.

If it is not that, could it be a swollen bursa or a calcific deposit?

Is this too general? And if so, could you tell me what info you would need to make a better diagnosis?

So, please, if anyone can help me out id be really appreciative. Im real nervous about this.

Chase,

See a good physical therapist. There are many things this could be, including subacromial impingement, nerve 'irritation', tendonitis/tendonosis, or a few other things.

From your subjective information, it doesn't really sound like bursitis. If you have been taking scheduled anti-inflammatories (Naproxen) and have not seen results, I also seriously question if there is really inflammation in there, too. Other possibilities off the top of my head could include thoracic outlet syndrome or radiculopathy.

Go see a good PT if you really are concerned about this and please don't rely on the internet, ESPECIALLY because you have already tried self-managment for 3 weeks without results. You should also know that there are many people out there who have significant tissue changes (rotator cuff irritation or tears, meniscus tears, bulging spinal discs) who don't even have any symptoms, and there are many more who are fully functional after some initial problems.

Go see a good PT!

Erik Pohlman, PT, DPT

Thanks a lot Erik. That's the first thing i'll do. Ill repost here with results soon. Thanks again!

Erik Pohlman wrote:Chase, See a good physical therapist. There are many things this could be, including subacromial impingement, nerve 'irritation', tendonitis/tendonosis, or a few other things. From your subjective information, it doesn't really sound like bursitis. If you have been taking scheduled anti-inflammatories (Naproxen) and have not seen results, I also seriously question if there is really inflammation in there, too. Other possibilities off the top of my head could include thoracic outlet syndrome or radiculopathy. Go see a good PT if you really are concerned about this and please don't rely on the internet, ESPECIALLY because you have already tried self-managment for 3 weeks without results. You should also know that there are many people out there who have significant tissue changes (rotator cuff irritation or tears, meniscus tears, bulging spinal discs) who don't even have any symptoms, and there are many more who are fully functional after some initial problems. Go see a good PT! Erik Pohlman, PT, DPT

I usually don't mess with internet/medical advice threads, but I have a type III acromion, (re: Erik's post) and have the exact same issues. Not saying this is what it is, but maybe consider asking about getting a simple x-ray.

Thats exactly what i thought it was, type 3. Read about that yesterday. Ill get an x-ray as well. If all fails ill probably get an mri. Thanks for the reply Mike. Ill post when i get results.

youre need snake oil!

Hey Chase,

Sorry you're struggling with this. Something you'll find as a climber is that as you advance in grades (or just get older) you'll have many of these types of injuries to deal with. Just par for the course. Some things you can do to stay healthy is to climb outdoors (not in the gym), climb <= 3 days/week, continue to stretch, and continue to do non-climbing related strengthening to stay balanced.

I agree with the idea to find a good sports medicine PT. Diagnosing a bicep tendonitis/osis should be really straight forward and the Dr. probably got it right. You probably just need to do some rehab for it to resolve. It continues to amaze me how many shoulder issues will resolve with simple rotator cuff training. Concerning the hand falling asleep....that could very well be associated with the tendonitis or it could be a separate problem. Your PT will be able to tell you more. Many climbers develop a kyphotic posture due to overly strong/tight pec minor and lats and this will often cause the pinched nerve scenario. MRI's aren't always helpful in diagnosing the true pain generator with any of these conditions. If you do a search on pubmed you'll find many studies that show pain-free shoulders with multiple findings and extremely painful shoulders with absolutely no findings. The sad truth is that many docs seem to overly rely on MRI when in most scenarios they should attempt 6-12 weeks of supervised rehab first. Heal fast and be sure and PM me if I can be of any help. -Jon

Thanks Jon. Hopefully you are right and it is just bicep tendonitis. As soon as this injury is healed i am definitely going to climb no more than three times a week, and twice if i hit the gym both times. When i injured it i climbed outdoor 4 times in a row and was pushing my limits which is 10.d+. My real fear is that i wont reach 11's (definitley not 12's for that matter) and ill begin to decline in skill. I don't care how much it costs i just really wanna be out climbin again at my current level.
Also, i am definitely going to do more cross training or enjoy other sports to strengthen my body instead of more arm workouts. I scuba but for me thats not much of a workout so ill probably take up running.
Anyway, thanks for helpin me out and ill definitely send you a PM let you know how this all worked out.

Chase, try your best to take a long term approach here. Don't sweat it too much. You're young and you've got decades of climbing ahead of you. I've been at it on and off for over 10 years and I've seen many friends burn out, often due to injuries, but also changing priorities. I used to train hard in the gym and I felt like I was constantly dealing with nagging injuries similar to yours. Now that I'm older and free time is such a precious commodity, I just climb for fun and you know what, I'm climbing harder now at 38 then I ever was in my 20's. I understand your wanting to get back at it and push for improvement; anyone who is competitive would think the same, but that mindset can be very counterproductive in the long run.

Why not use this time to climb some easier stuff at Tahquitz or in the Sierra, which will make you a better all-around climber? That way you can allow your body to heal and improve at the same time.

Thanks for the reply Jason. I'm definitely going to take it a bit slower after this is over with. Youre right ive got plenty of time to climb and shouldn't be too worried about this. I'd definitely be down to climb some easier stuff at Tahquitz because:
1: Ive never been there.
2: Havent done multi pitch trad yet, only sport
3: Theres a couple 5.5-5.6's ive heard are amazing
4: Never climbed anything higher than 500 feet
So it helps to hear that.

The only issue i have is im afraid that wearing a backpack may take this injury to heal longer and i have a pretty sharp sting from lifting a 3 pound weight with a straight arm (palm down) above my head. Maybe ill need to pull up rope that way?

I juss want to get back out there. Not so much from the competitive aspect, but more from the oh-dear-God-im-f*****-tired-of-this-video-game aspect.

If your down to drag a cripple up an easy trad multi you kno who to call. ha

Thanks again.

Welp... got a cortisone shot everyone.
I was hesitant about it but got one anyway.
The doc i went to was an orthopedic surgeon. He x rayed me and did a physical exam of my shoulder and diagnosed me with bicep tendonitis, rotator cuff tendonitis and slight impingement syndrome. He said the naproxen i was taking probably wouldnt have helped much and that one cortisone shot would not hurt me in any way as he has given thousands of them and had no serious side effects in anyone. I asked him how bad my impingement was and he said that surgery would not likely be necessary as it is not that bad.
Also, he gave me 3 weeks of physical therapy and advised no climbing for a month. At the end of the month, he said, i should have 80%-90% strength back. He also said to remain on Naproxen and ice twice daily until swelling and pain has gone.

As for lessons learned, i am definitely going to include the physical therapy workouts i do into my weekly workout an i would strongly advise that any new climbers out there do the following. You dont want to end up like me.

Im going to:
take it slow
climb no more than 3 times a week and twice if i go gym both times
workout my shoulders more
crosstrain with other sports, i.e run or scuba
and never push my limit too hard.

Thanks everyone for all your advice, information, time and kindness in helping me with my shoulder, it is SO appreciated. Best of luck to all of you and i pray none of you have any injuries.

PS: Doc said diving should be okay in a week or so but to be careful with lifting. Ive almost got my divemasters, anyone want to dive the yukon? point loma kelp bed? or other boat dive? Id be down for a beach dive but id need help getting into the water and out of the water (serious hassle id rather not burden anyone with)

Hope you are doing alright. I've been there!~

Cortisone is not a permanent fix and can cause further damage while you think you are doing fine due to the relief.

If you go back to climbing hard while the effects of the cortisone are in play...

I went through three orthos with my own shoulder problem, two of which ordered PT which I endured for 9 months without results, and one who gave me cortisone. The third ortho said he wished I had come to see him from the get go and he would have fixed it straight away. He did the surgery and after a bitch of rehab, the shoulder is doing well.

Part of the solution perhaps related to you was the involvement of the bicep tendon which was cut off an reattached to the humerus (bicep tendonesis)

Also went through three Pt groups in the process until finding one that really made a difference.

Good luck, be careful and choose your docs and PTs wisely

Thanks Ben.
Im back to climbing 5.6 but still feel pain/soreness in the supraspinatus tendon. The infraspinatus doesnt really hurt much anymore. I'm in PT now and they are focusing on strengthening the tendon. I have full range of motion with no pain so i dont think its a tear, but the pain is still there. Fridays my last day, im gonna request an MRI. Hopefully, i wont need surgery or anything major. Hope youre climbing as good as you were!