These authors sought to analyze the prevalence of pain and degenerative changes in the shoulder joints after highlevel rock climbing over at least 25 years in 31 adult male high-level rock climbers in comparison to controls.
On MRI examination, the rock climbers had significantly more abnormalities in the labrum (82% vs. 52%), long biceps tendon (53% vs. 23%), and cartilage (28% vs. 3%). There were no significant differences between the 2 groups with respect to rotator cuff tendon pathology (68% vs. 58%) and acromioclavicular joint degeneration (88% vs. 90%).
Despite the increased degenerative changes in the rock climbers, their Constant scores were still better than that of the nonclimbers.
The authors concluded that prolonged high-level rock climbing leads to a high prevalence of shoulder pain and increased degenerative changes to the labrum, long biceps tendon, and cartilage on shoulder imaging, but that these changes were not related to any restriction in shoulder function.
Comment: Serious rock climbers are very committed to their sport - a sport that requires both range of motion and strength. As a result, abnormalities on shoulder imaging may be less symptomatic in climbers than in a control group because the former continue to optimize their rehabilitation.
Serious climbers can develop advanced glenohumeral arthritis and are often concerned about the risks and limitations associated with the polyethylene glenoid component used in total shoulder arthroplasty. As a result, they may consider the ream and run arthroplasty which avoids a glenoid prosthesis.
Here is an example:
An active technical climber presented with a painful stiff left shoulder than was limiting his ability to pursue challenging international routes. Here is a photo of him climbing in Laos.
Below are his x-rays at presentation showing osteoarthritis and a biconcave glenoid with posterior decentering.
He had a left ream and run using an anteriorly eccentric humeral component. At one year after surgery is postoperative films show good alignment of his humeral head with his reamed glenoid in both views.
Note the anteriorly eccentric humeral head.
Here is a video of him climbing at 12 months after his left ream and run. Note the stretches!
He returned for a ream and run on the right shoulder.
His postoperative films are shown here.
Note the anteriorly eccentric humeral head.
Three months after his right shoulder arthroplasty, he sent this video of him "dry tooling" in his gym, stating that his shoulders are getting stronger everyday.
Here's a second example
A man in his late 50s from a couple of states South of here presented able to perform only half of the functions of the Simple Shoulder Test and with these radiographs of his arthritic left shoulder.
Here's his standardized axillary view. No CT scan or 3-D reconstruction was necessary.
His goal was to return to rock climbing after shoulder arthroplasty without having to worry about wearing out a plastic glenoid component. He elected to have a ream and run procedure. Here are his immediate postoperative x-rays showing prosthesis fixation with impaction grafting and the use of an anteriorly eccentric humeral head component that helped center his head on the glenoid. He also had a rotator interval plication.
In our experience, rock climbers and swimmers tend to be excellent candidates for ream and run arthroplasty because of their commitment to flexibility.
