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loud pop on inside of elbow (medial epicondyle)


Original Post
lisa.r · · davis, CA · Joined Oct 2014 · Points: 10

I hate posting in the injury forum, but I'm curious to see if anyone else has done this and I'll also just be another data point for the future. I was climbing Butterballs in Yosemite this weekend and had a left finger lock with my elbow pretty far out. As I stepped up high with my left foot, I heard/felt a loud pop in my left elbow. There was NO pain or tingling in the arm, so I shook it out and finished the climb without any arm problems through the hard sections. When I got to the top about 4-5 min later, I started to feel very sore and weak in the elbow and forearm likely due to a delayed inflammation response. There was a bruise at the joint, but then again my whole body is pretty bruised from doing waverly wafer right before. It hurts to touch the tendons on the medial side of my elbow and I can't do any twisting motions, like steering a car without sharp pain. It seems the pain is the same site of golfer's elbow, except this was a sudden and acute injury rather than due to overuse.

I went to the doctor today (2 days after injury) and x-rays show no avulsion on the bone, which means no tendon ripped off the bone. They've ruled out a bicep tendon tear and unlikely that it's a ligament tear (UCL) based on laxity tests. The suspicion was that there was a partial tear in the medial epicondyle, but the doctor couldn't even detect that via ultrasound after comparing it with my right arm. I'll visit the doc next week to reassess if a MRI is worth the cost. The visit today was certainly good news even if my elbow feels weak and sore.

Has this happened to anyone else? I'm really hoping the pop was insignificant and the ability to finish a 11c finger crack means the tendons are still functioning well.

King Tut · · Citrus Heights · Joined Aug 2012 · Points: 420

As you have pain and focal tenderness you likely have a soft tissue injury.

Ice for pain/inflammation when it hurts, heat for healing when it stops hurting.

The only cure is tincture of time (rest). Most climbers fail this test at least the first time around and make the injury far more chronic than it needs to be.

Rest. Rest. Rest.

Sorry, that is the way it is. Very frustrating at the start of a season.

Your ability to keep cranking is immaterial. Your body produces lots of "natural" pain killers when you are on the sharp end. All it means is that the tendon didn't completely tear.

lisa.r · · davis, CA · Joined Oct 2014 · Points: 10

Thanks for the response and I agree rest and ice are the current treatment. I just hope I'm solid by the fall, which I've been looking forward to for a while too. I'll try to update this with any significant news as I usually like to see the progress of injuries. Here's to spending my free time on things other than rocks!

Ernest W · · Camarillo, CA · Joined Aug 2009 · Points: 0

Boy, that sounds familiar!  I had a similar issue several years ago with my left elbow. I finished the pitch but by the time I topped out the arm was pretty useless. Did the PT routine for a few months without resolution. Finally got the MRI which showed a tendon tear at the medial epicondyle significant enough to require surgery to correct. It was a long, painful recovery but I had a great surgeon who got me back climbing. As for the MRI, they're likely to try non-surgical treatment (PT, ultrasound, e-stim) first anyway so many docs/patients hold off on the MRI & do it if the non-surgical treatment doesn't work. In either event, that tendon takes a long time to heal. 

lisa.r · · davis, CA · Joined Oct 2014 · Points: 10

So, good news (or at least as good as you can get given an injury)! It seems I have a partial tear to either my ulnar collateral ligament or the something in the capsule. Either way, it's not the tendon because I have full strength and none of the pronation tests bother me. This explains why I had full strength after the injury, as the tendon was still in tact and why the doctor didn't see anything fishy in the ultrasound. Provided it's the ligament, my stability might be compromised but the doctor said partial tears in this ligament can scar over. As far as I can tell right now, it doesn't feel unstable at all, but there might be some laxity that I can't detect. Luckily, the elbow seems like a relatively stable joint compared to the knee or shoulder, both of which I've torn in the past and had to get surgery for. So, Ernest, I don't think I have what you had, but crazy that the onset and symptoms can be so similar for different injuries. 

Regarding progress, the first 7 days were awful and my arm was so swollen that unless I was laying down with it elevated, my left hand would swell up like a balloon. After the inflammation started dying down, I hardly have any pain except for motions that move my forearm back. Ex/reaching back to grab seatbelt with my left arm in the driver seat = BAD. I can now do pretty much all my shoulder theraband exercises, which was unfathomable 1 week ago. Given the rapid progress in the last week, the doctor thinks I'll be fine to start easing back to light climbing in 2-4 weeks. I have an MRI scheduled for a couple of weeks from now, but if things keep recovering I'll cancel it and save money.

King Tut · · Citrus Heights · Joined Aug 2012 · Points: 420
lisa.r wrote:

So, good news (or at least as good as you can get given an injury)! It seems I have a partial tear to either my ulnar collateral ligament or the something in the capsule. Either way, it's not the tendon because I have full strength and none of the pronation tests bother me. This explains why I had full strength after the injury, as the tendon was still in tact and why the doctor didn't see anything fishy in the ultrasound. Provided it's the ligament, my stability might be compromised but the doctor said partial tears in this ligament can scar over. As far as I can tell right now, it doesn't feel unstable at all, but there might be some laxity that I can't detect. Luckily, the elbow seems like a relatively stable joint compared to the knee or shoulder, both of which I've torn in the past and had to get surgery for. So, Ernest, I don't think I have what you had, but crazy that the onset and symptoms can be so similar for different injuries. 

Regarding progress, the first 7 days were awful and my arm was so swollen that unless I was laying down with it elevated, my left hand would swell up like a balloon. After the inflammation started dying down, I hardly have any pain except for motions that move my forearm back. Ex/reaching back to grab seatbelt with my left arm in the driver seat = BAD. I can now do pretty much all my shoulder theraband exercises, which was unfathomable 1 week ago. Given the rapid progress in the last week, the doctor thinks I'll be fine to start easing back to light climbing in 2-4 weeks. I have an MRI scheduled for a couple of weeks from now, but if things keep recovering I'll cancel it and save money.

Just be cautious easing back into climbing even though it is so hard to not try and push.

Nearly all of this sort of injury are overuse injuries where the muscles overpower the connective tissue. This is because there is a mismatch in the recovery after exercise that induces micro-tears in all of the tissues. The muscles recover faster and become stronger than the connective tissue. The muscles then cause the tear when you crank.

All exercise that increases strength introduces micro tears in the tissues, full rest before the next session is essential to prevent injury. 

The longer you rest the less chance you will have of re-injury, returning to climbing too soon is the quickest path to a chronic or more serious re-injury.

The struggle to rest is real! Virtually every climber I have ever known, including myself, struggled with their first connective tissue injury giving it enough time to heal. We all try and come back to soon so as not to lose too much strength and endurance that we had gained.

When you feel perfectly normal and ready to start cranking, rest another 2 weeks+ before pushing it is my advice.

Also, when you are again feeling your strongest, that is precisely when you need to take a bit of a break to let the connective tissue catch up with the muscle gains or you are in danger of repeating this episode.

The Struggle is Real! :)

Good Luck!

Guideline #1: Don't be a jerk.

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