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Power Club 611. Nov 29 to Dec 5 2021 (Read 4233 times)

Wellsy

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#25 Re: Power Club 611. Nov 29 to Dec 5 2021
December 07, 2021, 11:48:01 am
Tricky decision to make that. Hope that however direction you go with it you get back in action sooner rather than later.

duncan

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#26 Re: Power Club 611. Nov 29 to Dec 5 2021
December 07, 2021, 01:26:54 pm

What a week! Up and down then up and then down... Coming to the conclusion that I'm going to at some point have to take the best part of a year off climbing/training is a pretty tough realisation. Going to explore all alternatives but from the sounds of it I'm just delaying the inveitible... There's a specialist called Val Jones in Sheff that was a great help and if she had any availability I'd be seeing her but she's fully booked up and doesn't know when she'll have space... Trying to stay positive but it's tough...

I’ve been thinking quite a bit about this one DD. I’ve sat on both sides of the desk and it's a difficult decision. TL/DR: go straight to the last sentence.

The crux is whether your current non-ideal anatomy will lead, in the long term, to arthritis and more pain and dysfunction. Your surgeon thinks so. You’ve had some expert physiotherapy opinion that it isn’t as clear-cut as that. There is probably a degree of “s/he would say that wouldn’t s/he” in both camps. Any chance of a second surgical opinion?

Personal experience: I had a right shoulder SLAP lesion, possibly less severe than yours, “tidied up” twenty years ago. Famous surgeon, consulted for Arsenal at the time. It took about a year before I felt like I was properly over the surgery. It didn’t help me in the short and medium term (at 5 years it felt much the same as before injury) but I didn't do as much rehab. as I could have done. In the long term that shoulder is now my stronger one but I can't be sure if this was due to the surgery. I’ve taken conditioning much more seriously over the last 10 years especially after dislocating my left (not the SLAP one) shoulder 4 years ago. I think the conditioning made the biggest difference. 

Professional opinion: the recent deterioration in your shoulder after getting this bad news is a good example of how pain and dysfunction is not simply down to the state of the joints, ligaments and tendons. Your shoulder hasn’t changed but your mood and anxiety probably have and you may even be doing less with that shoulder. What is the evidence that long-term lack of repair will give you arthritis? There are no very long-term studies (10+ years) that I’m aware of that track folk with unoperated SLAP lesions so any answer is going to be a bit speculative. The medium term (2-5 years) outcomes for non-surgical management are pretty good.

There is also this study, a rare example of a blinded clinical trial for surgery. Small numbers (n=118) so possibly underpowered and at risk of a false negative result and outcomes at two years only so far. Their conclusions are striking: “Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied”.


What would I do if I was in your shoes? Hammer the conditioning and wait and see.

Duncan Disorderly

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#27 Re: Power Club 611. Nov 29 to Dec 5 2021
December 07, 2021, 03:49:53 pm
Wow! Thanks for your input, really appreciate you running an expert eye over this... Making this decision is becoming my current day-job (people are just gonna have to wait to get their websites built!) so it's just the kind of info I'm looking for...

The crux is whether your current non-ideal anatomy will lead, in the long term, to arthritis and more pain and dysfunction. Your surgeon thinks so. You’ve had some expert physiotherapy opinion that it isn’t as clear-cut as that. There is probably a degree of “s/he would say that wouldn’t s/he” in both camps. Any chance of a second surgical opinion?

Yes and no... I've been in touch with Professor Funk (best-named surgeon on the planet!) who's done a fair few climbers and written about SLAP tears in climbers... I've had to hold off booking an appointment as his consultancy fees start at £260 (and follow-ups @ £210) and I'm not in possession of any private healthcare insurance or a spare £260/£470+ but it's not outside the realms of possibility if needs must... On the plus side, I've heard that if you do go see him and he thinks you need the surgery then there's a chance for an NHS referral but it's not certain... I'm not sure what my current surgeon would say about me asking for a second opinion, do they even do this on the NHS these days??

The medium term (2-5 years) outcomes for non-surgical management are pretty good.....

This, the study your cite and some anecdotal evidence I've acquired all seem to be pointing in the same direction... I contacted a guy on the other channel who had a very similar injury 13 years back and has managed it pretty well with non-surgical treatment (to the point he's still able to climb F8a+) which is a real eye-opener... I know we're all different but it's nice to hear some positives...

What would I do if I was in your shoes? Hammer the conditioning and wait and see.

This is generally what I'm erring towards right now... I think a good few sessions with someone like Val Jones or Jo Gibson to get what I need to do for my particular injury down and then just not deviate from the program... If it's not better/worse in say 6 months (??) then reassess...

Thanks again...

cheque

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#28 Re: Power Club 611. Nov 29 to Dec 5 2021
December 07, 2021, 04:29:22 pm
Professor Funk

If you’re going to consult anyone about SLAP it has to be this guy.

SA Chris

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#29 Re: Power Club 611. Nov 29 to Dec 5 2021
December 07, 2021, 04:39:47 pm
If Professor Funk can't play SLAP bass I'll be disappointed.

 

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