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      Bicep tenodesis - did I over do PT?
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      TOPIC: Bicep tenodesis - did I over do PT?

      Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18259

      I had a left bicep tenodesis on June 15th, so about 7 /8 weeks out now. At about week 4, I was trying to stretch my bicep out a little too forcefully (not with resistance or weights) because of a weird tight band that had developed (I know, stupid impatience - I have learned). I developed intense constant pain in the bicep at that point which resolved but has now become a sharp pain when I move my arm in certain directions. The pain almost feels like my bicep did when it had a tear in it. I am concerned that I screwed up the anchor or even partially re torn a part of my bicep again. Anyone else with bicep tenodesis issues that they thought they had re torn part of the bicep or screwed up the anchor? (Maybe all i need is time, but it is just concerning)

      Thanks.

      (I also had a microfracture of the humeral head done at the same time so doc is really most concerned about the microfracture healing correctly which meant a lot of early movement to encourage blood flow to shoulder).

      Re:Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18281

      • GirlGumby
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      Re:Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18282

      • sskylor
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      I don't believe anyone currently on these boards has had the issue you describe with a tenodesis. The type of tenodesis you had interferential screw or soft tissue pec attatchment may provide a clue but your OS is the one to go to for help and explanation. It does sound like you may have partially torn the biceps from the new anchor site. It is too bad that your OS did not use PRP during surgery to increase healing to the bone fracture as opposed to extensive ranging. The problem is trying to find out at this early stage post-op. MRI's generally cannot reveal anything at this time and even later. Sometimes an X-ray can show something if the attatchment was to the bone. I wonder whether a diagnostic ultrasound at the repair site would show anything. Because of the site of pain, I do not believe the issue has anything to do with the arthritis. What does your PT think?

      The biceps problems most frequently encountered on these boards have to do with SLAP repairs where the anterior anchor negatively affects the functioning of the biceps often causing
      tendonitis/tendonosis type problems. Let us know what the OS thinks and plans to do.

      Re:Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18286

      • ljansen
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      I had biceps tenodesis done in March '09 and have since fully recovered from it. It is a long process and one in which patience is required.

      Like Sharon said, it would be good to know how your bicep tendon was fixed, whether by interference screw, suture anchor or soft tissue. Mine was via suture anchor just lateral/distal to the biceps groove. I had a lot of anchor pain at first, it lasted for a few months and there were several times I thought I pulled the anchor, it's a very common concern regardless of the procedure done, so you aren't alone there.

      What other procedures did you have during the surgery? just tenodesis and microfracture? associated SLAP repair?

      also, what movements bother you the most? is it when you are trying to stretch and it feels like you are trying to stretch a strained muscle? do you feel it in the middle/belly of the muscle, up near the shoulder, or near the elbow?

      I can say that during my recovery, at first, especially within the first few weeks out of the sling, the muscle was very sore and almost felt like it had been strained/pulled. this was because I went 6 weeks without contracting/using that muscle at all, so the firing patterns were all off and I had to regain those. I had a lot of constant cramping and spasms at first, so I think by the sounds of it, that is what you are experiencing. Disuse atrophy can be quite painful, muscle relaxants might be good to try and heating the muscle.

      Also, what was your post op protocol? how long in the sling? how long til strengthening started? etc. all of this will help me in answering your post, to know whether its something related to the anchor, or more related to disuse atrophy.

      Leanne
      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:Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18387

      Thanks for the reply. The tenodesis was by interferential screw. I had very "aggressive" early protocols because the doctors were so worried that my arm move due to circulation for the microfracture to heal. I was out of my sling part time by the end of the first week...(my PA saw me in the clinic that day and was shocked to see that the dr had me out of the sling so soon) I was moving my arm at the elbow (just passive straightening and flexing) by day three after the surgery. I was doing some passive range of motion by the end of the first week and into active range of motion by the second week. My arm was moving way too much I think. My PT had me doing stretching exercises for bicep by week two...I think I was stretching something that had not healed. I was totally out of the sling by the end of week 2-3. I was doing behind the back exercises by week three and four. I think the grade 4 chondral lesion on the humeral head and the grade 3 chondral lesion on the glenoid had the doctors so worried (cuz if microfracture does not heal I am looking at bone implant or hemi arthroplasty), that an over aggressive approach was taken. This approach back fired because I end up in pain and injured and now ended up having way less motion then they wanted. I even stopped taking anti inflammatories by week 2 because anti inflammatories reduce clotting and the microfracture needs to clot in order to heal. Unfortunately the over aggressive PT protocols got me back on anti inflammatories because I was in so much pain constantly. This was really not well thought out it appears.

      SInce the procedure at this point was "only a little over 2 months" ago, right now it is a wait and see situation. I started to have this weird sharp pain after doing my PT exercises at about week 3 and 4 and that is only now getting a little better at week 8. I think by now I am supposed to be doing some light bicep work, but we are staying away in order to try to get everything to heal. I looked at my OP report and realized that I forgot to mention the SLAP repair. This was a 2 1/2 hour operation in all. Unfortunately, the micro fracture really put a twist in things and lead to a really aggressive protocol. I cannot have any arthroscopic surgery to repair a near cartilage tear/catch point until 4-6 months from the original surgery date. I get to live in this limited range of motion and pain for many more months arrrgh. They cannot go in again soon because they must let the micro fracture clot heal/scar first and this apparently takes 4-6 months.

      The doctors said that they really were not worried about the tenodesis because the procedure with the screw is very, very difficult to tear out. Their main concern is the microfracture, but in being so concerned about movement this lead to a new cartilage repair. Yikes. I did a search for protcols in other institutions/clinics that do shoulder microfracture with tenodesis, SLAP repair etc and the protocols I saw were much more conservative. The "movement" is often gained early by having the patient just do a ridiculous amount of pendulums every day. The pendulums are mostly passive if done correctly and really keep the humeral head in the socket (eg not rotating out across labrum). My PT had me doing behind the back active exercises that probably are the reason that my humeral head cartilage (with cartilage defect now made bigger in surgery due to "cleaning"} caught on the labrum and tore more. My doctor said that active ROM alone could tear my cartilage more just because it was so loose on the humeral head--so why did he prescribe these exercises?

      I was doing pullups- 25-50 3x a week as of last december before bicep tendon tear with no bad osteoarthritis symptoms, so I think that the "cleaning out" and enlargement of the chondral defect in order to do the microfracture all has lead to a sort of nightmarish result. The doc said that he had to do the microfracture because soon I would be bone on bone and then really feel the symptoms..but the point is i had not really started to feel them yet. Arrrgh. My adventure in shoulder repair.... I have to admit that this whole thing has really spun me a bit. My upper body has really been important to me in regards to swimming, lifting, general athletics...I keep telling myself that this is about acceptance and things could be so much worse. I have to keep telling myself that am lucky for what I do have.

      Re:Bicep tenodesis - did I over do PT? 6 years, 7 months ago #18396

      • sskylor
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      Thanks for the explanation. It is good you had the interferential
      screw tenodesis as this is the strongest at week 3-4 As you elluded there was misguidance about how best to go thru early rehab to protect the SLAP repair while achieving good blood flow.

      It is a wait and see for sure, but it seems getting a simple x-ray would give information as to whether the SLAP repair anchors have moved or are in place.

      I am sorry that this has happened, but going forward be sure everyone is on the same page. Bear down for a long year and possibly another surgery. Hopefully the chondral defects will properly heal in the next few months. Keep us posted.

      A few questions, did you have any other trauma to the shoulder?
      I am trying to figure out why the extensive defects(usually caused by impact loading/twisting shearing forces). You refer to the doctors, is there more than one? Is it a teaching institution?
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