ASK DR J – ISSUE 217 – EXPLODED SHOULDERS AND FINGER CYSTS

I dislocated my shoulder over the summer and was forced to take a hiatus from climbing. After three months of physical therapy, my shoulder still hurts in certain positions on the wall. The pain is quickly followed by my arm giving out, and discomfort for a couple of days after. Will my shoulder ever go back to normal? Are there specific exercises I should do to build strength and are there movements I shouldn’t do?
LOOSEHOLD Rock and Ice Forum

For a climber, having a dislocated shoulder is akin to being a porn star with a fractured penis.

You need some damn fine professionals watching your rehab every step of the way, if for no other reason than to avoid the speed traps. If you have not had an MRI—and it doesn’t sound like you have—sack your current treatment team en masse.

A shoulder dislocation is like a bomb going off in a mall—until you have a look inside, you won’t have a damage report to base your next move on. If you have significant cartilage damage that has not stabilized, any rehab now is like repairing the Titanic with papier mâché.

I appreciate that the United States medical system doesn’t routinely allow an early MRI for such an injury, but an athlete who is going to re-enter the sporting arena at the earliest possible time (and probably too early if not managed closely) needs an accurate assessment. A shoulder that dislocates for a second time due to damage inflicted to the joint in the first injury is significantly more likely to dislocate multiple times thereafter, at which point you might as well take up croquet and dating older women. As long as your rehab is thorough, and by that I mean involves massive amounts of stability and strength-based exercises, you should be able to climb again, and even improve on your previous best.

The discretionary qualifier here is that I don’t know how much internal derangement there is. A nasty dislocation is virtually impossible to rehabilitate fully without surgery, let alone in three months. I have seen patients with massive amounts of damage who didn’t even realize they’d temporarily dislocated their shoulders. I’ve also seen many a person whose dislocation was forever forgotten two moments and a glass of wine after it was relocated.

If you have had an MRI and are cleared of major structural injury then I suspect you need more time and more (or better) rehab until your shoulder is ready for the stresses of climbing. If you have a reasonable range of motion, you should be OK to try any particular movement as long as the loading is graduated. My advice: Get a shoulder rehab specialist.

 

I fell bouldering and the little-finger side of my ring finger has gone numb from the first joint to the tip. I can move something around on the bottom part of the knuckle that makes it tingle even more. That area also seems a bit larger (lumpy) than the right ring finger. I’m guessing it’s a compression of the ulnar nerve, but what exactly can I do to get the numbness to go away? Is it OK to climb? I’ve stopped for two weeks.
PTHOMAS119 Rock and Ice Forum

Shabam! You must have given it a proper whack. A direct hit to the nerve is possible, but it sounds more like a traumatic ganglion cyst has formed and that it is pressuring the nerve, causing the numbness.

The digital nerve that runs down that side of the ring finger is a branch of the ulna nerve. (The median nerve supplies the other side of the ring finger).

You have a couple of options:
1) Wait and see how it goes. I am impatient by nature when it comes to medicine and recreational drugs in that I like results, the faster the better, but give it at least another week to settle.
2) If you can isolate that lump (it will feel like a pea), give it a good press and see if it pops like a water balloon. That will solve the problem with a level of immediacy that would satisfy even the rich and famous. OMG! You call yourself a climber? There is not even any blood! Get back on the horse and ride it like you’re the Pony Express. The numbness will be mildly irritating but that’s about it.

If anything, the cyst may enlarge, but I would argue that that just makes it easier to isolate and burst. If the numbness is due to damage done by direct impact, it will probably subside over the next month. Permanent numbness is pretty unlikely.