Q:

I’ve been climbing 40 years. My elbow issues started in the 1980s while I was abusing a Bachar Ladder and used a poorly planned pull-up training regime. Although healthier at 54 than I was in my 20s, I am experiencing a flare-up of medial epicondylosus on my right elbow. Six months ago I got a new, aggressive Dupuytrens adhesion on my right hand, and it definitely seems to be pulling on said tendon. What do you think about the Dupuytrens connection, and is there anything to do about it? I have it on both hands (ring finger tendon), but the left is a different type of adhesion and does not hurt. Both are causing only minor palm deformation.
Should I cease all climbing while pursuing your therapy? Spend more time in the weights gym? Thanks for all you do! You are a tremendous resource for the climbing community, and I recommend you to tons of my clients. Love your column in R/I.

—Tom Davis

A:

The Bachar Ladder was visionary, but no matter how you abused your elbows back in the day, those sins are not indelibly etched into your tendons. That period is not causative in terms of your current situation; rather, it just highlighted a propensity to develop tendonosis given the right (or wrong!) training environment. There are many reasons why people generate tendonosis, but the condition is typically underpinned by excessive gains in muscle strength.

I am 90 percent sure I agree with your medial epicondylosis diagnosis, but I am 99.9 percent sure that the Dupuytrens has nothing to do with it. Dupuytrens is a fibrosing disorder of the palmar fascia, which does not have any tendon investment that loads the common flexor tendon at the elbow. Some of the palmar muscles do invest onto the palmar fascia, but these are not thought to affect medial epicondylosis in any detrimental way.

Unless you have significant nodule formation in the palm and associated finger contraction, there is nothing to be done other than appreciate the rich Celtic gene pool from which you inherited the problem. If contractures cause the fingers to become a bit gimpy and annoying, then I would find a specialist who does needle aponeurotomy, as it’s far less invasive than surgery and can at least be repeated if the contracture occurs again. Surgery is a one-way slippery slide of ever-increasing damage control. The internet will provide you with a vast array of “proven” solutions— all will cost you money, and none will work.

Though rest is typically the fallback position for most injuries, especially when taking a conservative approach, it is not an effective solution for medial epicondylosis.

Be careful in the weights gym. Using free weights or body-weight exercises with too much wrist flexion is a common cause of medial epicondylosis.

 

Feature image by Jan Novak


This article appeared in Rock and Ice 239


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