Alphane Moon 8A in Chironico,
pic by Aldo Tonazzi

Tuesday, April 9, 2013

The Diagnosis

O.k. then... looks not too bad my finger. But also not good.

I was now at two different specialists. One of them is close to my hone town and usually my first choice for troubles with my fingers. Dr. Lacher is a hand specialist and -surgeon. The other one was a proposal from Martin Keller. Thanks again! His name is Dr. Andreas Schweizer. He is chief physician of the "hand department" at Balgrist University Hospital in Zürich. Probably one of the or THE ONE specialist for climbing injuries on the hand in Swizzy. He's pulling very hard too (up to 8c climbing) and also makes research on the biomechanics of the hand while climbing.

Anyway... in the end I got two different diagnoses.

Diagnosis of Dr. Schweizer (on 3. April):
Arthrosis at my age would be very atypical. Also atypical would be a strong degeneration of cartillage. In general climbers usually get rather a thicker layer of cartilage, as also stronger bones at their fingers. He just knows two or three examples (climbers) with arthrosis. If their arthosis is coming from climbing is still unsure (is usually genetic).
Arthrosis usually starts in the older age of 40 or 45. This nodules on my joint have nothing to do with arthosis... but with an adaption of the bone to the climbing.

In this picture you can see a usual joint (blue). Special at many climbers is the adaption of the bone in red. In the beginning this is still cartilage. After many years it hardens and becomes bone.

The following picture shows, why the bone adapts. The contact surface is getting larger with this additional bone mass, if you bend the finger.
The "problem" is that if you unbend it the cartilage can be pushed back (black). If this happens often, you can get an inflammation.

In the radiograph nothing was visible. I have still enought cartilage (still big enough joint space). But some additional bone is already visible (first picture).


We also made an ultrasound scan of the finger. The additional cartilage (red part above) was even better visible. But because of the fact that most of this adaption is still cartilage, it is just visible in the ultrasound scan. 

The conclusion of Dr. Schweizer:
I can climb! No Arthrosis! Usual for climbers. Just some inflammation because of the reason mentioned above. It may be that the pain goes away soon, but it also may be that I have to climb the rest of my life with some pain. 

The reason for my huge pain some weeks ago was the fact that a part of this additional bone (still cartilage / red part in the drawing) was broken off (visible in the ultrasound scan). This is no problem and it will grow back.

The second doctor, Dr. Lacher (on 4. April), just told me that it is arthrosis in the initial stage. He just had a look to the radiograph and didn't made any further inspection (ultrasound etc.). As I told him the outcome of my visit at Balgrist he just told me that this could be... but in the end it is still arthrosis in the initial stage.

The conclusion is the same in the end. It's not possible to do anything. I can climb and should enjoy it as long as possible. If the arthrosis is getting worse (in a few... or many years, who knows), I just can stiffen the finger.  

Funny... two doctors - two different diagnoses...!!!
To be honest, I would rather believe Dr. Schweizer. His diagnosis sounds better and is understandable, he also did better research (ultrasound) and has a lot of experience from his own climbing, as also other climbers and their problems.

Since some days the pain is back on a similar level as before my last entry (the huge pain). I can climb and crimp... but I should be careful. Extremely overhanging routes with ultrasmall crimps are "passé" I think. The pain then is too big and it makes no sense to take some additional risks... !!

BUT the most important outcome is definitely that I can go on with climbing... AND that I can go for my revival-trip (after 2005) to the Rocklands in July this year. YESSS.... ;)))))



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