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Dr 8a

Unidentified elbow/bicep injury

Mathew Rowe
hi all I've been climbing since beginning of 2005.started out sport climbing for a few months and then in April of 2005 i started to boulder and only sport climbed a few times since. In about June of 2005 I started to get this intense pain in my left elbow area.The pain is on the anterior side of my elbow(palm up),next to the bicep tendon in the groove more towards the lateral part.It is a very debilitating pain and feels like its deep inside.I only get it if I climb 2 days in a row and it starts up almost immediatly.I can climb really hard the first day and dont really get any symptoms,maybe towards the end of the day but nothing serious but on the second day if i climb something that is really easy it will start to build up straight away and eventually get to a point where it is impossible to climb because of the pain which will persist for about 45 minutes and upwards.still happens if i have a easy first day.My arm will fell very weak and REALLY sore(to the point of feeling like throwing up) and it is even a struggle to change gears in my car(right hand drive in South Africa).There is no obvious swelling and i didnt really know what injuries were when i first started climbing so i never took a break but have taken 2month breaks now,a few times and it hasnt gone away.I thought it could be a nerve getting pinched but i dont get any tingling or numbness.Been to doctors,physios,specialists and no one can figure out what it is.Tennis elbow and medial epicondylitis have been ruled out but its not in that area anyway.Have also had a nerve conduction test and he said all was fine(but thats when im not climbing).The elbow specialist i went to said i should aggrivate it and come in to get an MRI so think that s the way to go at the moment.The climbing scene in South africa is very small and every climber i have spoken to hasnt experienced this or heard of anyone that has.It started happening in my right arm so i had a 2 month break and its never bothered me there again.It feels like its under the bicep tendon at the elbow but its deep inside so hard to pinpoint.Sorry for the essay but wanted to get as much info out as possible.Could have gone on for much longer.Going to get a MRI but unable to at the moment because i got a finger injury which no one can figure out either and hasnt gone away since December.would be interesting to hear your thoughts and opinion.Thanks Mat

Bjoern Alber
Hi Mat This is likely to be an overuse injury to your biceps tendon, The tendon insertion is divided between the Ulna (arm bone connecting to the hand at the side of the little finger) and about 30% of the tendon connecting to the other forarmbone (Radius). When twisting the arm at the same time as flexing the elbow there is a lot of stress on the tendon. I think the MRI will show a swelling at the radialportion of the tendon. In this case try intensive stretching o the tendon and try to get a sport medicine specialist to give a mixed cortisone/lidocain shot next to the tendon insertion (not in the tendon) otherwise supplement with a strong antiinflammatory drug for 3-5 weeks. Please write some feedback when you: Best of luck Björn
Mathew Rowe
Thanks for the quick response. That makes alot of sense.will be awhile before I get the MRI done because healing a finger injury at the moment but will definatly let you know how it goes. Mat
Adrián López
Hi! I think I have the same problem of Mat, always I climb two consecutve days appears that kind of pain in the elbow. Usually I had the pain in the left elbow, but few times in the right elbow too. I have been climbing for 3 years, but, more or less, 6 years ago, I used to play tennis, and I remeber that pain in the right elbow when I made very hard shots. I haven't understant something in your response, Björn. You said that Mat needs cortisone/lidocain, but that will solve the problem? Some people had told me that could be a unbalanced strength between antagonistic muscles. In my case I think I could have a big strength difference between biceps and triceps. Thanks Sorry for my crappy english. Adrián
Noah Kaufman
Hey guys, I am an ER doc and have been climbing for 16 years.  I agree with Bjorn, mostly.  There has been an increased incidence of tendon rupture with steroid injection.  It's a short term "bandaid."  The lidocaine wears off in about 45 minutes.  Marcaine would last ~8 hours, but still short lived. The MRI is useless as there are no good surgical options.  Orthopods and Sports specialists will have you do a ton of rehab stretches and exercises that are useful, but you will heal the same on your own if you are disciplined about your recovery. The problem is likely tendonitis.  Imagine tiny cuticles at the tendon-bone junction.  The key to healing these things and preventing Tendonosis (a more recalcitrant chronic form of tendonitis) is EASY rehab climbing, stretching and rest.  get the blood moving.  climb V0- jugs (5.5 to5.7)  ...Not easy to do, but key to healing.  No overhang climbing.  Just commit to super easy climbing (it will feel like "too easy") for 2 to 3 weeks.  You will heal. Absolutely don't smoke, stay well hydrated and eat 600 mg ibuprofen 3x/day for 4-5 days to kick start your anti-inflammatory healing process. Best of luck and heal well! Noah T. Kaufman, MD
Adrián López
 Thanks a lot for the response! To keep the blood moving can I do anothers sports? For me it's easy go out for swimming or running, that find some places with very easy routes. And, after 3 weeks of "blood moving", I suppose is better to getting contact with climbing proportionally, climbing first days easy grades and getting harder the next days. Thanks Adrián
Noah Kaufman
Yes!  Just don't do other sports that make it hurt (at all.)  Pain = not healing (for tendonitis, not tendonosis.) You are also correct about the slow re-introduction to climbing (hard.) Noah
Mathew Rowe
hey thanks for your input noah.sorry to hear about your injury nocker,i know how it feels to be in your sucks big time! i never managed to get an MRI because shortly after writing the initial thread i injured my finger badly so wasnt able to climb for FOUR months.i have started bouldering again and so far i havnt had any elbow problem so the time off did it good.i also consentrated on working the antagonistic muscles(tricept mainly) by doing push ups(3 sets 15 evey 2nd day or so) so it seams to be paying off.i not 100% sure what the injury was but tried a few things to try and isolate the area of pain and i found that if i did hammer curls with weights (research them on the internet) it would cause the "area of pain" to be stiff and very tender to movement/pressure for 2-3days.did them with both arms and it only felt like this in the injured arm!! im not saying you must do this but maybe it will be worthwhile just to see if the same happens to you.i have started doing the hammer curl motion with a "therma band"(stretchy rubber bands from physio) and it hasnt produced pain(i do it very gently though) to try strengthen this muscle slowly.the muscle im talking about is the brachialis muscle.i have no medical experience only lots and lots of research from the internet so all of this is just what i have tried and tested on myself.if it requires you to be climbing really easy stuff for a while like noah said then do it and just be grateful that you can at least climb least you are still outdoors enjoying whats left of the environment. good luck and let me know if you do hammer curls and it stiffens your injured area. mat 
Mathew Rowe
Hi Just an update and a few more questions. I finally managed to go for an MRI of my left anterior elbow.I wasnt able to aggrivate the injury before(due to time constraints) but thought that seems as though its been injured for 4 years something would deffinatly show up.The results came back saying no signs of anything being wrong,only that my humeral head at the elbow joint looked like it had a dent?? at the bottom(a small piece missing).The specilaist gave me a cortisone injection into the joint and said i must climb 2 days in a row and see if there is a difference.There was no relief at all from the injection so he reffered me to a guy that specialises in complex elbow injuries which i have not been to see yet!My specialist went through the MRI with me and said that if anything was wrong it would show up as a bright white area??From what I've seen on the internet this is not true.So my nightmare continues and the most frustrating thing is not knowing what is causing the problem.I personally dont think its tendonits or tear or anything like that because previous injuries I have had would hurt anytime I stressed them,not only the second day of stressing them and its a totally different sort of pain!I think it could be some sort of nerve entrapment(radial or musculocutaneous) as when reading about there path of travel etc it seems to fit perfectly and the weakness my arm experiences when the pain starts. Hope this all makes sense and hopefully you can point me in the right direction of what sort of specialist I should try see or what I should try and do.If you have any specific questions just let me know. Thanks and appreciate what you doing for us unfortunate climbers. Mat ps i ad image of areas of pain
Allan Taylor
Just thought Id add that when I had an MRI done on my arm (tendonosis) I had no signs of anything wrong either but was in pain.
Daniel Fernandes
Hi everyone, I know it's been 6 years since this topic was discussed, but it somehow fits my problem and I might have found the source of the problem. I started to feel pain and weakness, mostly weakness, in both my biceps. At the time I had been doing lots of one arm deadhangs, for very long periods . No muscle engagement at all. All tension was stupidly on the elbow. Probably that started this whole process. It might have weakened my elbows, and then the computer at work finished the process and destroyed the right one only. In my case, I went to 4 different physios, one MD specialist in bone injuries and one acupuncturist. They all seemed to agree my problem was tennis elbow. Indeed I had some of those symptoms, but my main pain was not apparently a normal symptom of tennis elbow. An MRI did show very slight tennis elbow inflammation and calcification. The acupuncturist was the first to tell me that indeed that is not looking like tennis elbow pain. I had searched the web for everything possibly related to elbow pain... Not one problem was giving my symptoms. The closest description was from distal biceps tendinitis: pain at the elbow-biceps junction when stretching and when flexing the arm. My issue was definitely pain when flexing the arm . Online exercises (kind of hammer curls with theraband) to cure that condition actually made it worse... Probably not that one too... I would feel some pinching on the outside of the elbow, right on the lateral epicondyle , That's why everyone was thinking about tennis elbow. I've had tendinitis before and the pain felt different. Even after telling that to the physios, my main problem according to them was tennis elbow. My suppinator muscle was indeed with problems, so some flexbar exercises for a month, with rest, and it got absolutely fine. It can still come back, though, it happened before. I haven't been using the right arm for virtually anything for about 3 months already, to give it a rest for the tennis elbow. It did not seem to work, as the pain would appear at its pleasure. Used flexbar, stretches, more eccentric exercises, magnesium pills, ibuprofen, fish oil... Nothing was curing it. The pain would get softer or get back in full force at its own pleasure. I felt despair plenty of times. 900€ spent, no one was giving me a solution, I could not climb, or do exercise rather than running, it was affecting my job... Being a ultra-rational and scientific person I even started to think about trying "alternative" stuff... Now this week... The physio that was helping me with the tennis elbow (who also is a climber) confirmed that that condition was a lot better than 4 weeks ago, almost cured. So I took the chance and told her to focus on the other pain. I had discovered 2 weeks ago that when pressing the inner side of the elbow I was able to flex it with no pain. And that area was very sore and hard. A few tries and she found another way for me to flex it with no pain. She massaged my shoulder muscles, including pecs and neck. The pain, in 30 minutes, was gone. It seemed it was radial nerve entrapment . Not the entrapment you usually see when searching online, no, therefore the trouble in finding the problem... She gave me shoulder/neck/pec stretching exercises and for 3 days the pain has not appeared. My happiness is never ending, but careful still, as I had days of no pain in this adventure before. Never for 3 days in a row though! The day after I went to another physio for a second opinion. A sports specialist. I got there with almost no pain, so I told him what I just said here. He did some tests and agreed the problem could be nerve entrapment. He then suggested me some nerve flossing exercises . I have already used my mouse with the injured arm. I've cycled twice. I can wash my hair with no pain... Taking off a shirt... In the end, although I'm not totally cured yet, if this is confirmed, the tennis elbow masked my nerve entrapment (or even caused yet). An entrapment that this last physio said is often seen in climbers (although he is not one, and my climber physio never told me that) and in martial arts due to sudden stretches of the arm (my deadhangs). Carrying heavy bags was giving me loads of pain also, which makes sense, as it is the same as a deadhang. And it then seems to be an entrapment originating in my neck or shoulder area. Apologies for the long text, but I sincerely hope I can help someone else. These were the worst 7 months in my memory, completely changing my daily life. Therefore, I hope no one else has to go through this :)  Feel free to ask anything, and I can even photograph the problematic areas of pain, like mat did.