ASK DR J – ISSUE 200 – MIND THE BOLLOCKS

I was toproping indoors, fell about three feet and felt a sharp pinch near where my penis meets my abdomen. The next morning my scrotum was severely swollen and bruised, and the left side of my groin still hurt. An ultrasound revealed a hydrocele, spermatocele and strained groin, and that I should be OK in two to three months. It has been 11 weeks and I no longer have pain during daily activities. However, I tried running last week and had swelling in my scrotum. Light climbing yesterday produced no swelling. Are a hydrocele and spermatocele typically associated with groin sprains? Are there any treatments or tricks in addition to rest that may help my condition (wear a jock strap? ice? heat?)? At what point should I either start climbing fully or go back to the doctor for more tests?

Crw5074 | Rock and Ice Forum

On that particular day, Diagnosis and Management class was always quite fun. Everyone spent the class loitering around in their undies examining man-tackle for anomalies such as hydroceles (swollen scrotum), varicoceles (dodgy veins), spermatoceles (a school of wayward swimmers) and tumors (badness).

Cameron, a relaxed and confident fella who generally wore silk boxers, was having a little pinch-n-roll time, as young men often do (old men stroke their beards). He says to me, kind of rhetorically, “Aren’t some lumps just normal?” Word spread the next day that, after a more thorough examination at home by his girlfriend (same class) and a trip to the local clinic, he did in fact have a spermatocele and not a testicular tumor. And the consequence of that diagnosis? Nothing. Spermatoceles are typically incidental and require no treatment.

A hydrocele, on the other hand, can be associated with trauma to the groin, like the time you fell with your nuts under your leg loop. Your injury smacks of damage to your inguinal region (maybe a hernia) or to your scrotum that is not resolving. This is not really my area, so get an ultrasound and a urologist’s opinion. More tests! It sounds like you may have also injured your groin, or more specifically the insertion point of your adductor muscles, a portion of which are right at the base of your massive shlong.

Groin strains really need time to heal before you can load them, and 11 weeks is well sufficient. I would try some harder routes and see how it goes. Climbing, as opposed to running, may not aggravate the hydrocele.

I have read some of your articles that say tape will not supplement the strength of a pulley. How about a hose clamp, or something like it?

Andy Richardson | Penrif, NSW

Genius, Andy, F*&$#ing GENIUS

I guess you would put the screw clamp on the top. You could adjust the tension with your Leatherman. It would be like a perfectly sized ring that you could put over a broken pulley to create a prosthetic fulcrum.

You could keep a couple in your bag so that whenever you blew a pulley, you could just slip it on, gulp another anti inflammatory and send your project like nuthin’ even happened. And if you got a medical engineer to design it, they could make it out of sexy surgical steel so that when it got caught in a crack and de-gloved your finger, it could be washed really easily, would hold its shape, and could be reused on your remaining fingers.

I had an accident eight weeks ago where I fell from my skateboard. My wrist hurt for three to four weeks. I went to a hand doctor and had an MRI (without dye) that showed a TFCC tear. I was placed in a splint for four weeks. Although it is feeling better, I haven’t done anything since it’s been in the splint. I recently went back to my hand doctor and he said I should be in the splint for four months! No climbing, lifting, even riding a bike. Is this normal treatment? What’s the natural progression for a TFCC tear? Do they heal? When does one decide to do surgery? Physical therapy? I’m getting weaker every day but don’t want to jeopardize my wrist.

JT | Rock and Ice Forum

Diddums! I haven’t had sex for months at a time. Imagine that! Dude, you’re only talking about climbing, get things into perspective. Still, I’ve never heard of immobilization for that length of time. Four to six weeks is more common for a conservative approach. The TFCC sits between the end of the ulna and the carpal bones on the little-finger side of the wrist, affording greater stability and functionality.

I tend to keep TFCC injuries quite mobile, making sure the patient avoids high-risk activities, like big-game hunting with Tasers. Although rehab therapy has shifted away from prolonged immobilization, even for many fractures, there is a “Tea Party” faction in every group. TFCC tears may or may not heal, but like most cartilage injuries, they tend to settle down and life goes on until your next impact injury. Depending on the severity, damage to the TFCC can lead to early arthritic degeneration. Becoming weaker is a natural consequence of injury. In the short term you will become a worse climber, grumpier and generally a bit of an ass. But in the long run it’s your choice as to whether you learn something from the horrid experience of not being able to climb.

Take the opportunity to strengthen your mind, talk to your partner, call your mama. On the up side, you can learn a lot by lurking around at the local gym—like who is hot and single. You may also learn something about why certain climbers fail and others succeed. Surgery really only becomes an option when the pain, even after conservative alternatives, persists. Surgery may also be an option when there is a precipitating issue, such as positive ulna variance (the ulna is longer than it should be) leading to TFCC damage.