1: The Injuries

The largest bone in your arm, the humerus, has a ball at the top that articulates against a shallow cup in your shoulder blade. That shallow cup is deepened into something like a socket by a ring of cartilage at its edge called the ‘glenoid ligament’, ‘glenoid labrum’, or just labrum. In both my left and right shoulder, the labrum is damaged. This injury is common in climbers, and it usually starts at the top of the labrum, where one of the tendons of the biceps muscle attaches. Pulling hard on the biceps muscle, combined with shoulder weakness or instability, can rip the labrum off of the shoulder blade and fray it, and this tear can progress around the ring of cartilage over months or years of climbing. This injury is called a SLAP tear, standing for “Superior Labrum, Anterior to Posterior”. I’ll try not to use more jargon.

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Edge-on view of a shoulder blade. The labrum (here labeled the glenoid ligament) is the cup of cartilage that once helped hold my arm bone. The biceps tendon attaches to the top, where it can tear the cartilage off the bone. (image Wikipedia)

Cartilage heals badly on its own, or not at all. In endoscopic pictures of joint surgeries, everything is white, because there are no blood vessels providing nutrients to the tissue. For the most part, cartilage injuries only get worse, unless you get surgery.

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Endoscope image of (someone else’s) joint surgery.

Sometimes bad labral tears happen very suddenly, such as with a fall on an outstretched arm, but they might happen just as often by adding up many small events that aren’t serious on their own. I suspect a lot of labral damage of the second type is undiagnosed, because the changes accumulate slowly.

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Red and yellow tuff on the Northwest Corner of the Monkey Face, Oregon (photo Moos Van Caspel)

I injured my left shoulder in a sudden moment in 2010. I made a bad decision while bouldering, jumping to a hold with one arm and not letting go when I swung out. My hand held on on, but my shoulder didn’t, and the swing ripped part of my labrum off the bone of the shoulder blade.

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Cutting feet on a beautiful day in New Mexico. This is not when I hurt my shoulder. (photo Owen Summerscales)

After the accident, I had the option to have surgery. I knew very little about shoulder injuries. My doctors and physiotherapists knew little about climbing. Physiotherapy was helping a bit; should I just do physio? Would surgery be better, or worse? Maybe I’m just not training as well as I used to? Should I train more? Or less? I could still sort of climb. I didn’t know what surgery to get or what questions to ask. I was worried that the surgery might go badly; between 6% and 25% of patients regret surgical intervention, depending on the study. A low probability, but high consequence.

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The Needles (photo Matt Pech)

I did a lot of physio and did not get the surgery. My shoulder recovered from the initial trauma to a new version of healthy. I’m not sure how much weaker my shoulder was a year after that first injury than it had been before it. I made big achievements, for me, in climbing: I climbed long routes in Squamish and Yosemite that I’d once considered lifetime goals. I traveled the world and made new friends. I bouldered and climbed gear routes harder than I ever had before. I matched my previous sport climbing limit. All after the injury.

I was aware that my climbing style had changed. I wouldn’t think of jumping to a left hand or hanging one-handed, for example, but I got better at other aspects of climbing and picked my battles. I rarely even thought about the option of surgery.

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Hueco Tanks four years after my left labrum tore. (photo Jason Halladay)

It’s been eight years since that injury. In the last five, my left shoulder has given me more trouble every year. What’s worse, my right shoulder, which never had a bad fall, has started to give me as much trouble as the left.

I went to the doctor, and I went to get an MRI. Even though the two shoulders felt similar, I was surprised to be told the two MRIs looked similar, too. Large SLAP tears with a lot of frayed cartilage. Chronic inflammation and shoulder impingement. Calcified and cracked biceps tendons. I now realize that both my shoulders have been consistently wearing down, and I’m not sure if the trauma of any particular fall was that important. Instead, I blame a lack of discipline with antagonist training, poor posture, intense use spaced by periods of sedentary desk work, and maybe a little bit of genetic predisposition (my dad has bad shoulders, too).

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Paso Superior, Fitz Roy (photo Matt Pech)

I do think that some activities have been much worse for my shoulders than others, but it’s embarrassing and frustrating that the damage I’ve done to my body wasn’t during the big days that I look back to as my best times in the mountains. In my case, the common thread is pulling a little too hard while bouldering indoors, where I tend not to rest enough between climbs. I think that the meteoric rise of indoor bouldering will make these kinds of injuries more and more common.

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The Incredible Hulk, High Sierra (photo Matt Pech)

What started as occasional impingement in overhead movements is now constant, and the associated pain is normal and expected. I can’t really do yoga, which I once did daily, because I can’t get into downward dog pose. My ability to hang from one arm, on either side, is almost gone, especially with the arm extended. On a recent trip to the High Sierra I had trouble stemming, because of pain from pushing with a straight left arm, almost 8 years after that first injury. It’s possible that that initial injury started a process of wear that left me in this state, or it’s possible it would have been just as bad if I had never had that first tear. I’m not sure. But I stopped looking at my injuries as one-time events that I could leave behind me, and more as ongoing problems that I wanted to put an end to.

I decided to have the surgery. Two surgeries.

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