Shoulder Surgery or Not Shoulder Surgery?

[kfennell]

So I went to see the doctor today about a torn sub scapular tendon and partially torn long biceps tendon. The sub scap is torn where the long biceps tendon "pully" is (from a jump crash) and it allows the bicep to move around and pop causing tearing when I take slack hits...

 

He gave me three options. His opinion was that the bicep and sub scap would not repair themselves, but that there was about a 40% chance that it never gets and worse. Pain and popping would never go away.

 

1. I can do PT and keep skiing, 60% chance I rupture my bicep and get Popeye bicep, probably wont get any better as stated above, but PT will help stabilize shoulder to reduce pain and popping,.

 

2. I can cut the bicep long tendon, heals in a month and back to no pain likely and 75% strength, but still popeye bicep. When he is in there he looks at the subscap and repairs it if nessecary, however if we do that then the recovery is bad again.

 

3.. Tenodosis + repair the sub scap. Back to near 100% after 6 months or so. 1 month in a sling, 1 month range of motion exercises, 2 months pt 2 months light exercise.

 

 

 

Not super excited about popeye bicep, or 6 month recovery so I am pretty torn. Has anyone else had this surgery here or had to choose?

 

Thanks

 

 

[gregy]

If you want another opinion? This Dr is in west Houston he operated on my dads and uncle shoulders. Also did my knee last spring.

 

Mark Provenzano M.D

http://www.orthopedicsports.com/

[skihard]

To me it's a no brainer. Even if it costs me 6 months I'd want it fixed. It sucks to have to go through the pain and recovery time but just the simple fact that it's FIXED and right would give me piece of mind.

[Skoot1123]

No brainer to me. Bite the pill now and do option 3. 100% recovery even if it means a longer ski layoff means you'll be able to get back to where you are (or were) today. Heal quick!!

[Razorskier1]

Fix it. I've missed plenty of skiing due to surgery, mainly shoulders. Why do it? If you are like me you want to keep skiing many more years. If you don't fix it you put that at risk. If you do fix it, you add years to your ski career. Easy choice (said from a guy who has had 4 shoulder surgeries).

[9400]

3 for me. Like the sound of 100% a whole more than the other options.

[LagoLydia]

I had acute long head bicep rupture on July 2 going to the one ball. At the end of the pass could see bicep balled up above my elbow. Next day MRI revealed at least a partial tear of supraspinatus tendon which definitely tipped the scale toward surgery. The bicep would be anchored to the humerus and a look at the rotator cuff to see if repair was possible on July 15. Arthroscopic inspection revealed a full thickness or complete tear; he was able to make an excellent reattachment and reasoned it was the probable culprit for the stress that caused bicep disruption.

 

Sling and passive range of motion for six weeks followed by six weeks of active range of motion and stretches which went well. Started light bicep resistance several weeks ago and high rep shoulder strengthening (and lifting over 5 lbs) as of yesterday. No weight restrictions in another month and ski date possible 12/15 or 1/15 at the latest, which will be 6 months.

[kfennell]

Man you guys are all about getting cut up eh? :)

 

Good stuff to think about.

 

@LagoLydia‌ Since that is about the same surgery, how long were you hurt bad enough that you had to be on pain killers after wards? I am a sales engineer and I only get paid when i am selling things so I would like to be back in action after say a week, is that possible?

[LagoLydia]

Had nerve block put in prior to surgery and stayed on Vicodin for 2 to 3 days then only at night to sleep. My postop instructions showed return to work on the third day after surgery possible. Being in the sling was the biggest problem and had to sleep in a recliner for eight weeks.

[Razorskier1]

Plan surgery for Thursday. After the weekend go back to work.

[davemac]

Ugh. I'd prefer to spare you my story, but I'm 47 and had a bicep tenodesis procedure 12 months ago (my shoulder had "frozen" the summer before, and I couldn't get rid of chronic bicep tendonitis).

The Shoulder specialist in Boston found long head to be pathological and torn longitudinally.

Unfortunately other findings (while in there) included compression problems, bursitis, superior & posterior labrum tears, full thickness cartilage loss, arthritis, etc.

The joint was "cleaned up"...but I wish it weren't... far worse now. First follow up, Doc told me I'm "a cardio guy from now on" and too young for the full shldr replacement I need. Now sucking it up (cortisone and lots of "Vitamin i") in hopes of improved medical technology.

While I believe that the tenodesis procedure statistically is highly successfuly, I still have pain around the bicipital groove...as well as a whole bunch of new pain in the joint. In hindsight, I wish my

bicep had severed. As you probably know, you can easily get by and ski without the long head. While I would have had the "popeye" thing, at least I wouldn't have been made aware of my toasted shoulder.

Fortunately, skiing is one of the things I can still do (really helps to keep the handle low, and let the boat pull/traction the handle up on my offside.)

 

Should mention, post-op pain wasn't too bad. I wasn't a candidate for nerve block. I only did a day and a half of oxy, then Ibuprofen. Ice, sling, light PT

 

I wish you the best of luck and relief.

[rwskier]

@kfennell‌ I had that same surgery a year ago January. Tear in the sub scap that allowed the bicep tendon to be displaced. As they repaired the sub scap they also did the biceps tenodesis. I have to say that for me the first week was a bitch, I made it about 5 weeks with the sling then couldn't take it anymore. Pretty sore for the first 3 months but with PT things started coming around. 6 months and I was back on the water. This whole season it has felt better and stronger than ever. No pain at all now and always keep my elbows in peripheral view during any lifting or exercises (no more crab walks).

[Edbrazil]

Got a bit of a shoulder story myself. This one from snow skiing, where I took a splat at the

local ski area right near the finish line. Hard-hard hit on my right shoulder Ugly-looking

Grade 3 separation, but not a dislocation. My orthopedic doc recommended just leaving it

alone. He was an older guy, quite older, and I followed his advice. Turned out to be a good

idea. He said that at my age, something that just looks ugly should be no big deal.

Said he could operate on it and turn it into a Grade 1, but maybe an annoying and painful

Grade 1.

[kfennell]

@rwskier‌ were you given the option of doing the surgery vs not? What made you go with doing the surgery? My doctor friend recommended that I try PT and not skiing for 6 months before I commit to surgery, did you try anything like that?

[cragginshred]

@kfennell if you came to my PT clinic I would say based on all the successful Tenodesis surgeries I have have been a part of rehabbing once you ensure the ortho doc has a great track record (not all do) I would go for the surgery. With a second opinion and making certain you have the ortho of choice you will be better than before.

[Ed_Obermeier]

@kfennell FWIW I'm missing the upper (long) biceps tendon in both arms. AFAIC it's really not a big deal. The "popeye biceps" thing is overblown, not a big deal at all. The ortho who did my last surgery does the KC Chiefs fix ups too so he knows his stuff. Told me that the upper bicep tendon can be lived without no problem. His example - told me that John Elway won his last Superbowl for Denver missing his upper bicep tendon in his throwing arm. If memory serves he threw for a bunch of yards in that game.

 

I've had both shoulders pretty much completely rebuilt once each. Right side was a slalom crash nearly 20 years ago, dislocated the shoulder and tore the upper 2/3rds of the rotor cuff away from the bone. Had it all reattached, spent 9 months in PT, lots of stretching, strengthening exercises etc, happened in early June was skiing again the following late April. Upper bicep tendon was originally reattached but didn't stay that way. Shoulder was actually less sore after it tore lose again (once I healed up from it a bit of course) and I elected to just leave it be.

 

Left side was basically a birth defect - where the scapula and collar bone meet there is supposed to be a bit of a gap but my scapula was elongated and eventually over a lot of years wore through the supraspinatus and long bicep tendon (if this isn't a correct description of the anatomy someone correct me please). Had the repair done and had the joint shaved out (or whatever it is they do for that). Elected to not have the tendon reattached, wasn't much left to work with anyway I was told.

 

Because of my shoulder issues I can't press much overhead, I suck at bench presses etc but pullups, pulldowns etc are not an issue. Like @davemac said as long as I keep the handle low etc, pretty much anything I can do below shoulder height isn't an issue whatsoever. I've lived a lot of years now without upper biceps tendons and to me it's a non issue.

[rwskier]

@kfennell‌ I was given the option and told that I could go thru years with out any problems but my surgeon also said that I should limit the the use of the bicep or it could get worse. Well for obvious reasons (like skiing) that didn't seem like a smart way to go so I just bit the bullet and did the surgery. I do not regret it now but I will say it was a tough couple of months after the surgery. Good thing was that most of the recovery was during the winter.

[Shortenit]

@kfennell I'm scheduled for surgery 12/3. Shoulder started going bad last August 2013.Tried to avoid surgery with extensive PT for almost a year, had significant improvement but not good enough for me. Now will repair an almost completely torn superspinatus, clean up capsule, bone spur, some bursa sac work maybe. Depends on what he sees while in there. Long bicep tore off in my sleep with little pain and coiled up about 5 months ago. Saw the doc and left it alone with no issues and continued to ski all summer. Told by my surgeon it is not needed and if I don't care about the bulge don't mess with it. Hospital For Special Surgery in NY. Saw two world class orthos, NY Giants and NY Mets/NBA. Both concur that surgery is the way to go for me. Most pertinent part of my story for you perhaps is that PT did not improve it enough even after a great amount of time and money. Yes, it got better and I could live with it the way it is, but why? I'm in my 50's, will only get worse and be a tougher surgery later. Key is the surgeon. Needs to have done a lot of shoulders. Get more than one opinion.

[skiinxs]

Try a round or two of PRP first. If it isn't torn too bad there could be a chance of healing without surgery. I have had 11 PRP's and all but two have worked great. Shoulders, elbows, heels (Plantar tendons). No downside other than a couple weeks without skiing each time.

[mwetskier]

ed hickey who is a great great skier just had a shoulder ' replaced '. i didnt even know they did that but he might be a good case to keep an eye on or even seek out for his opinion.