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    Persistent Biceps Pain After Tenodesis/Tenotomy
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    TOPIC: Persistent Biceps Pain After Tenodesis/Tenotomy

    Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29436

    • ljansen
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    • 9 shoulder surgeries
    • Posts: 1351
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    For those of you who have had a biceps tenodesis or tenotomy and still have persistent pain, this is a good article to reference regarding revision and explanations for failure. It's a free access article, so you can read the full article as opposed to most, in which you can only read the abstract.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391784/

    Int J Shoulder Surg. 2012 Apr;6(2):45-50. doi: 10.4103/0973-6042.96993.

    Clinical outcomes of revision biceps tenodesis.

    Gregory JM, Harwood DP, Gochanour E, Sherman SL, Romeo AA.
    Source
    Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.


    Abstract

    PURPOSE:
    Biceps tenotomy and tenodesis are effective treatment options for biceps pathology, but outcomes of revision surgery are not known. This study examines the clinical outcomes of patients who have undergone a revision biceps tenodesis.

    MATERIALS AND METHODS:
    A retrospective review of all patients since 2004 (N = 21) who had undergone a revision biceps tenodesis with greater than 6-month follow-up was completed. A follow-up survey was carried out, and the visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and University of California - Los Angeles (UCLA) scores were obtained, along with SF-12 Mental (MCS-12) and Physical Component Summaries (PCS-12).

    RESULTS:
    Indications for revision surgery were continued pain (14) and ruptured biceps (7). Complete follow-up examinations were performed in 15 of 21 patients (71.4%). Average follow-up was 33.4 ± 23.5 months. The mean postoperative scores were 1.9 out of 10, VAS; 79 out of 100, SANE; 10.2 out of 12, SST; 83 out of 100, ASES; 29 out of 35, UCLA; 44, PCS- 12; and 47.1, MCS- 12. Five patients were considered failures with a UCLA score below 27. Seventeen of twenty-one patient underwent concomitant procedures. Complete preoperative and postoperative data were collected for 14 patients. All scores demonstrated highly significant improvement from preoperative levels (P < 0.005), except for the MCS-12. There was no statistically significant difference in the outcomes of revision due to rupture and revision due to persistent pain.

    CONCLUSIONS:
    The results suggest that revision subpectoral biceps tenodesis provides significant pain relief and improvement in functional outcomes at a mean follow-up of 33.4 months.

    LEVEL OF EVIDENCE:
    Case Series, Level 4.
    R. Shoulder Capsular Shift - Sept. 03
    L. Shoulder Bankart/SLAP/Capsular Shift/Rotator interval & SS repair - Jan. 05
    L. Shoulder MUA/adhesion release - Jan. 06
    L. Shoulder SAD/Bursectomy - Sept. 07
    L. Shoulder Biceps Tenodesis - Mar. 09
    L. Shoulder Open Latarjet & Arthroscopy - Nov. 24, 2011
    L. Shoulder Capsular Release/SAD - June 11, 2012
    L. Shoulder Capsular Release/Screw Removal/Biceps Tenotomy - Mar. 22, 2013
    L. Shoulder Arthroscopic Latarjet Screw Removal, Interval Repair, Axillary Neurolysis, Debridement

    Re: Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29438

    • riderk
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    And one cannot help but say, And? So what? When you still have pain!! They love to report success but not failures so much.

    Re: Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29447

    • ljansen
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    • 9 shoulder surgeries
    • Posts: 1351
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    Unfortunately that is the case, but regardless, I posted this because it's bound to help someone in some way, shape or form. Yes, surgeons love to report success rates more then failures and unfortunately the patient population has no control over that aside from making there decision in terms of how they will progress with treatment. Knowledge is power, I am sure it will aim to educate many people on this board who want more information on why they still have pain after tenodesis/tenotomy. What they take from it is up to them. I am one of those, and parts of this article were very informative for me and has provided me more background and knowledge that I can address with my surgeon. Yeah, it's a very small cohort but I posted this less for the statistical analysis and more for the explanations as to possible reasons people can still have biceps pain post tenodesis/tenotomy. Know one likes to report failures, for anything, not just medicine, so it's obvious to see the literature littered with articles, studies and reviews on success rates and satisfied patient cohorts. Again, take what you will, the article will be archived for the benefit of those who are will to appreciate it.
    R. Shoulder Capsular Shift - Sept. 03
    L. Shoulder Bankart/SLAP/Capsular Shift/Rotator interval & SS repair - Jan. 05
    L. Shoulder MUA/adhesion release - Jan. 06
    L. Shoulder SAD/Bursectomy - Sept. 07
    L. Shoulder Biceps Tenodesis - Mar. 09
    L. Shoulder Open Latarjet & Arthroscopy - Nov. 24, 2011
    L. Shoulder Capsular Release/SAD - June 11, 2012
    L. Shoulder Capsular Release/Screw Removal/Biceps Tenotomy - Mar. 22, 2013
    L. Shoulder Arthroscopic Latarjet Screw Removal, Interval Repair, Axillary Neurolysis, Debridement

    Re: Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29448

    • jo4121
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    • Posts: 196
    • Karma: 2
    Leanne,
    Thanks for the article...this is me. After my 3 surgeries, tenotomy and tenodesis included, I am in the 'failure to heal' and 'persistent pain' category. I have been diligent in all my after-surgery care, followed all the guidelines, and still....well, it just hurts!! My surgeon has done his part, but my body isn't....for whatever reason. He wants me to get a second opinion, but have been rejected 5 times already. I am now heading to the University Hospitals in Iowa City or The Mayo Clinic in Minneapolis. Since this is a WC claim....it's really out of my hands who my next OS will be. I have suggested pain management, but WC is holding out on that route right now....seeing if there is any other option. You know you are in the extra special category in WC when you get a nurse case manager...this happened last week. She is personally taking my file to a OS and sitting with him to review my case...as well as offering Oreo cookies (had to laugh when she told me that one). If he takes my case, I will see him either December 17 or January 7. If not....???

    Oh well...personally, I have had several close friends pass away in the past few weeks from cancer and a sudden heart attack...so, in retrospect....my life doesn't suck that much!!!

    Keep warm and take care from the frozen tundra in the Midwest,

    Jo
    6/10 Left SLAP
    2/11 Left Bicep Tenotomy and debridement
    2/12 Left Rotator Cuff repair, bicep tenodesis, SAD
    5/13 Right Rotator Cuff repair, SAD, removal of bone spur
    3/14 Left reverse tenodesis to tenotomy and removal of screw

    Re: Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29449

    • riderk
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    • Posts: 2043
    • Karma: 24
    I was not being critical in the least, just frustrated with the position many of us are left in. Sure there are tons of stats, but they are totally meaningless for the few who do not do well. I have been able to be privy to information that is not published publicly. Believe me, the docs are just as frustrated as we are that sometimes there are no solutions.

    Being retired, unable to use my arm for any length of time, but still having the benefits of faculty, I have read so many journals on all shoulder maladies that it would make one's head spin. Every month i go through the new ones. The fact is for people like you and I, they just do not know. They don't. I will never presume to understand the details, but I get the conclusions. Why did my rotator cuff just die away? The whole darn thing? It looked torn on xray, looked fine under open surgery examination, and dead three months later.

    I am angry, in pain, disabled,... I guess that is enough to apologize for my sarcasm. I see people hurt when it did not have to be that way. That makes me mad, especially when the docs say so what? To the patient. Too bad for you, get out of here, and by the way, none of my friends will see you either after I screwed up. Yes, bad things happen and good docs help, but every person is in a class of their own and not everyone can be healed. I should have listened to the one who said, do not have any more surgery. I might have believed him if he had continued to tell me why, including that he had made a grievous error. But he failed to mention that fact and off I went.

    Anyway, if you get your hands on that other article, please let us know. I am not so much interested in successes but how they deal with failures.

    Re: Persistent Biceps Pain After Tenodesis/Tenotomy 11 months, 3 weeks ago #29455

    • ljansen
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    • Platinum Boarder
    • 9 shoulder surgeries
    • Posts: 1351
    • Karma: 17
    I am no way offended by any comments on this forum board or by any sarcasm that may be misconstrued, I am being very honest about that. My career involves a very large contingent of males where I am one of a few females and deal with all kinds of criticisms on a daily basis, to me, it's part of life, I choose to take it constructively and for personal growth. I may be unlucky in the shoulder dept, but in general I do not consider myself unlucky or unfortunate at all. I lost my mom to brain cancer when I was 26 years old and seen my dad fight cancer twice and has since had a recurrence now. There are much bigger things in life that make my shoulder just a speck of nothing. I've gained a lot of strength and things happen for a reason and I believe that reason was to help others and make me a stronger, more well rounded person. But everyone is different and deals with things in there own way, it's like you say, while a procedure may be the same across individuals the results will always be different because no two shoulders and individuals are the same.

    So to close off, I mean no offence to anyone, if it is ever taken that way, it certainly was not the intent and I am not offended. Everyone is entitled to their own opinion and it's up to the receiving end to take what they will from that. This is what the forum is for, because people understand here and I don't think anyone should be faulted for that...so vent away, I think everyone will agree with me on that.

    Jo, I'm glad you got some answers from the article. When I get into campus over the next week or so and can login there I will be sure to post the article. Until then, just keep keeping on and don't worry about it, really.
    R. Shoulder Capsular Shift - Sept. 03
    L. Shoulder Bankart/SLAP/Capsular Shift/Rotator interval & SS repair - Jan. 05
    L. Shoulder MUA/adhesion release - Jan. 06
    L. Shoulder SAD/Bursectomy - Sept. 07
    L. Shoulder Biceps Tenodesis - Mar. 09
    L. Shoulder Open Latarjet & Arthroscopy - Nov. 24, 2011
    L. Shoulder Capsular Release/SAD - June 11, 2012
    L. Shoulder Capsular Release/Screw Removal/Biceps Tenotomy - Mar. 22, 2013
    L. Shoulder Arthroscopic Latarjet Screw Removal, Interval Repair, Axillary Neurolysis, Debridement
    Last Edit: 11 months, 3 weeks ago by ljansen.
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