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Slap lesions and surgeons and bollocks 20-May-2012 At 4:13:47 PM Elaine Stevenson

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Hello Wendy,

I am sorry to hear that.

On surgery - don't go with someone just because they'll see soon. As a climber, you want the best. The person I generally suggest people go to is Greg Hoy at Melbourne Orthopaedic Group in Windsor.

A good friend of mine used to do his shoulder rehabs (physio) and recommended him highly. I saw him a while ago when I needed an opinion and happy to say he lived up to reputation. I managed to avoid surgery, thanks to some great physio and soft-tissue work, but if I hadn't been so lucky, he's the only one I would have trusted to work on me. He's a lovely person AND a great surgeon too. His client group includes a number of Australia's top athletes and is someone I'd be happy to send you to.

I'd also recommend you go see Wendy Braybon first, either Wendy or else get in touch with Julian (Saunders, osteo, now in the Blue Mountains).

Julian won't be able to examine you directly (unless you want to drive up there) but he will be able to review the scans and via skype I'm sure he'll be able to give you a good sense of the relationship between what the imaging shows and where you want to go as a climber. He'll also be able to look at your range of motion etc remotely via webcam and should be able to give you a pretty good assessment based on that plus history etc. It'll cost you, but surgery is a pretty high price to pay for injury and with surgery you'll pay in terms of scaring, pain, down-time etc etc, as well as financially.

One thing to consider is that surgery may not be your only option. Again, this is where you need to get advice from a range of people, including osteopaths and physios. The idea is to get you fully functional and pain free again, physically cutting you open and repairing the lesion **may** not be the only way to achieve that outcome. The lesion itself won't heal without surgery, but, depending on the situation you may be able to strengthen / retrain other structures in the rotator cuff to support the joint capsule sufficiently without going under the knife. Again, that's a Julian question. As well as being an Osteo who specialises in climbing injuries, he's also an exercise scientist, and has seen a truckload of slap lesions in climbers of all grades.

In terms of the other person I mentioned, Wendy is in Melbourne, and you'll have to wait a few weeks to see her but she'll also be able to give good information re whether surgery is your only option and what you pre-hab / re-hab processes would be. She works closely with Greg Hoy and would be the person I'd be wanting you to hook with if you did decide to get Grey to operate.

Re Ultrasound - don't be too hard on the Horsham ultrasonographers - ultrasound won't pick up a slap lesion, you need an MRI for that, and you probably do have bicipital tendonosis. These conditions tend to cluster together such that when there's an RC tear and/or slap lesion, bicipital tendonosis is often an associated finding.

Re John Salmon, who did you speak to? Was it John himself, or someone in his office? He's a lovely man and he has a reputation for being very compassionate. It's not that irregular for people to get elective procedures done privately - ie without insurance. It's possible that the person you spoke to in his office was new and didn't understand that you wanted to pay up-front, ie not via Medicare. Some private health insurance companies are a real hassle to deal with in terms of administrative requirements and it doesn't make sense that he wouldn't operate privately, unless of course he's had issue with bad debts from previous private clients.

Hope that helps. If you need contact details for any of the people I've mentioned, EMAIL or CALL ME and I'll pass them along. Good luck with all and keep us posted on how you do.

Cheers!

Elaine.