Proximal Bicep Tendon rupture (novel ahead)(not as good as guyjin though)

[litljay]

So, I'll start from the beginning (warning...novel ahead, cliffs below)

Last Monday night at the gym I was doing lateral raises and felt a huge 'POP' in my right shoulder. It felt like a really hard knuckle pop, but in my shoulder. It buckled me at the time and I remember looking down and wondering what the hell just happened. Not really a lot of pain, but more of a tingling sensation. I walked over to the DB rack and racked the weights and then went and sat down. About 5 minutes pass and I start to move my shoulder around...and no pain. Now I'm really confused. So, I finish my workout, with was just some tricep pushdowns.
I get home and tell my wife about this weird knuckle pop in my shoulder. The next day, there is more localized pain in the upper bicep/lower delt area and when I bend my elbow in a flex position, there's this indentation. So, I start googling things and run across "bicep tendon rupture at the shoulder" and start reading. Sure sounds like what happened to me, so I head to urgent care.
Urgent care tells me the only thing they can do is order an xray and that won't tell them anything. So, I make a Primary Care Doc appointment. They take a look and refer me to an Orthopedic group.

Here's a pic:



So....today was my Ortho appointment. I see a Dr. Johnson and he takes a look at my arm and says, "the best course of action is to do nothing." Huh? I'm thinking WTF? So, I say, "really?" I get a little run down that strength will not be effected other than supination strength, I'll still be able to play baseball and golf without limitation, and will still be able to lift weights all I want. He then reminds me that Brett Favre, John Elway, and Curt Schilling all had this tendon either cut or ruptured and still performed at a very high level without repair.
So, I'm pretty sure I still have a "WTF?" look on my face, so he says, I can get you a second opinion from one of my Colleagues if you'd like. So, I say sure.
He whips out his phone and makes a call right in front of me. I hear, "hey Eric, I have a new patient that would like a second set of eyes on his arm." Some silence, and then, "ok, we'll be up there shortly, thanks."
So, we go upstairs and Dr. Johnson hands the girls at the front desk my paperwork and tells them that he had just talked to Dr. Hansen and he'd squeeze me in. So, they hand me more paperwork to fill out since it's technically a different doctor's office.
They send me to have Xrays done before I see the doc, then get called back to a room. So, this doctor comes in and I get a similar rundown and he mentions the same thing with a caveat. Due to my age, and that cosmetics are probably still important we could do the surgery.

So, now I have 2 surgeons telling me that the best course of action is to do nothing, but if I want we can do the repair...

I've got to be honest, the picture above is the best angle to show the rupture. Also, the pain and function of the arm has increased 10 fold since last week. I'm also just about a week away from the busiest 3 months of the year for me (harvest time).

I'm leaning towards leaving it alone...convince me otherwise.

Cliffs:
Ruptured Bicep tendon at Shoulder
2 surgeons tell me to do nothing
have option for repair
what do?

[ectodad]

Hi litljay.

As far as I can remember, the window of opportunity for a quick fix is about 4 weeks. Anything beyond that is still operable but the procedure is a bit more demanding as it is usually no longer possible to manually extend the bicep to it's original length due to atrophy. As per your question I am not event going to attempt to make you change your mind. It's your body and your god-given freedom to decide what to do with it.

Good luck and all the best whatever you decide to do.

[GuyJin]

You have called and I have answered!

In all seriousness, I googled the injury and most of the sites say to leave it alone for the most part and that surgical intervention is rarely done. The sites also say that it will resolve itself in time with NSAID's, ice, and rest. In your case, since it's harvest time, rest is not necessarily an option.

If it's swelling up and your range of motion is becoming increasingly limited then surgery may be an option...or hire someone to take over the harvesting chores for this year. I'm not a doctor at all, but every single site I've looked at says it usually resolves itself over time for the most part. I realize that you want to look symmetrical as possible--who doesn't--but you have to consider that if you have the operation, how long will that keep you out of commission? I'm guessing three or four months at minimum.

In the end, it's your decision. Consult a sports specialist if you have to.

So says GuyJin, the wannabe writer who wishes you a speedy recovery.

[litljay]

Hi litljay.

As far as I can remember, the window of opportunity for a quick fix is about 4 weeks. Anything beyond that is still operable but the procedure is a bit more demanding as it is usually no longer possible to manually extend the bicep to it's original length due to atrophy. As per your question I am not event going to attempt to make you change your mind. It's your body and your god-given freedom to decide what to do with it.

Good luck and all the best whatever you decide to do.

You're correct. The second surgeon suggested that if we wanted to go forward with surgery, that it needs to happen within the next week.

You have called and I have answered!

In all seriousness, I googled the injury and most of the sites say to leave it alone for the most part and that surgical intervention is rarely done. The sites also say that it will resolve itself in time with NSAID's, ice, and rest. In your case, since it's harvest time, rest is not necessarily an option.

If it's swelling up and your range of motion is becoming increasingly limited then surgery may be an option...or hire someone to take over the harvesting chores for this year. I'm not a doctor at all, but every single site I've looked at says it usually resolves itself over time for the most part. I realize that you want to look symmetrical as possible--who doesn't--but you have to consider that if you have the operation, how long will that keep you out of commission? I'm guessing three or four months at minimum.

In the end, it's your decision. Consult a sports specialist if you have to.

So says GuyJin, the wannabe writer who wishes you a speedy recovery.

I would say that the use is becoming increasingly better. 3 days ago, I couldn't pull up my pants without pain. Now, it's not even a thought.

You're guess of 3-4 months out of commission is pretty accurate if not liberal. I've seen guesstimates of 3-6 months.

[JimmyJonny]

Mine snapped Easter weekend. I had 2 surgeries on my right shoulder. Part of the 2nd surgery (Feb 26th) was detaching my tendon and reanchoring it. Easter weekend the anchor came out, bicep dropped.

If you even had surgery tomorrow you wouldnt even work the end of harvest. Its a long recovery and the chance of it not working is very high.

It is true that there is only a 4 weeks-ish window for repair........now or never deal.

[anonymous]

They sound like a pair of clowns, an X-ray on a tendon rupture ? Seriously?

Do you have a good PPO insurance plan? Or at least one which lets you pick the best sports surgeon in your area ? Get to one who treats pro or at least high level athletes ASAP and get that repaired!

Where there warning signs from your shoulder this last month? Did you do anything out ofthe ordinary? I dread an injury like that, good luck!

[Iceman1800]

Get it fixed. I just had a distal rupture fixed and the window of opportunity thing has proven to be bs. I wouldn't wait but it doesn't have to be right this second. The surgeon who did mine said he fixed one that was 9 months old before.

[fittofattofit]

I've had both LHBs ruptured. The long head provides around 20-30% of biceps strength and not repairing it leaves a deformity ... the 'popeye' arm because your ruptured and free long head will continue to bunch up. The first time was my right arm and the surgeon did a tenodesis. I was 49 at the time. The left arm LHB tendon ruptured a year later at age 50. At that stage the surgeon advised me 'at my age' not to bother because he didn't think I'd be worried about
1. the loss of strength
2. the deformity
I reassured him that it mattered greatly to me and he went ahead. I have had very good functional and cosmetic results from both procedures. One of the reasons that they won't recommend it is that they are used to seeing 60 year old ladies with this injury. Ask him what he would do for a 30 yo athlete>

The procedure is quick (about an hour) and easy ... through a scope

This is the procedure I had done and it is the usual method now

I guarantee that you won't regret having this done and you should insist on what you would like to happen and what outcomes matter to you. I had an advantage in that I'm a doctor and I know what my rights are and I know what the drivers are for surgeons offering particular treatments. Ask to see a surgeon who specialises in upper limb injuries and who has a sports based practice

[fittofattofit]

The results for me:


it's not immediately obvious but you can see the deep gap between the belly of the biceps muscle and the delt on the before pic. The second pic was taken about 15 months after the op. It's the left arm (first pic is in a mirror)

[Bando]

Fuark Man, I don't have any experience/advice with this but scary story - sorry to read this

[litljay]

Mine snapped Easter weekend. I had 2 surgeries on my right shoulder. Part of the 2nd surgery (Feb 26th) was detaching my tendon and reanchoring it. Easter weekend the anchor came out, bicep dropped.

If you even had surgery tomorrow you wouldnt even work the end of harvest. Its a long recovery and the chance of it not working is very high.

It is true that there is only a 4 weeks-ish window for repair........now or never deal.

So, I'm guessing you didn't go back for another surgery and still have a detached tendon?

They sound like a pair of clowns, an X-ray on a tendon rupture ? Seriously?

Do you have a good PPO insurance plan? Or at least one which lets you pick the best sports surgeon in your area ? Get to one who treats pro or at least high level athletes ASAP and get that repaired!

Where there warning signs from your shoulder this last month? Did you do anything out ofthe ordinary? I dread an injury like that, good luck!

The x-ray was to establish there was no other damage to the shoulder joint that caused the rupture to the tendon. X-Ray showed a little arthritis, but no other issues in the joint.
This group does do high level athletes. In fact, in both doctor's offices had multiple signed photos of athletes thanking them. I did a little research on the group prior to going to this appointment and the first doctor I saw is assigned to the local College's baseball team and the second doctor is assigned to the Football team (Fresno State).

Get it fixed. I just had a distal rupture fixed and the window of opportunity thing has proven to be bs. I wouldn't wait but it doesn't have to be right this second. The surgeon who did mine said he fixed one that was 9 months old before.

I've had both LHBs ruptured. The long head provides around 20-30% of biceps strength and not repairing it leaves a deformity ... the 'popeye' arm because your ruptured and free long head will continue to bunch up. The first time was my right arm and the surgeon did a tenodesis. I was 49 at the time. The left arm LHB tendon ruptured a year later at age 50. At that stage the surgeon advised me 'at my age' not to bother because he didn't think I'd be worried about
1. the loss of strength
2. the deformity
I reassured him that it mattered greatly to me and he went ahead. I have had very good functional and cosmetic results from both procedures. One of the reasons that they won't recommend it is that they are used to seeing 60 year old ladies with this injury. Ask him what he would do for a 30 yo athlete>

The procedure is quick (about an hour) and easy ... through a scope

This is the procedure I had done and it is the usual method now

I guarantee that you won't regret having this done and you should insist on what you would like to happen and what outcomes matter to you. I had an advantage in that I'm a doctor and I know what my rights are and I know what the drivers are for surgeons offering particular treatments. Ask to see a surgeon who specialises in upper limb injuries and who has a sports based practice

There is one other well known surgeon in my area that I might call and get another opinion. That video is not the plan of action though as they mentioned a 2-3 inch incision in order to retrieve the tendon.
Like I said above, the second doctor did say that he was willing to suggest the surgery because I'm not a 60 year old lady that sits on the couch all day.

Fuark Man, I don't have any experience/advice with this but scary story - sorry to read this

Thanks Bando.

On the harvest issue, it's not really like I have to do anything physical. I have employees for that, but I do need to be mobile and coherent in order to give directions.

[litljay]

Lee Priest:

[Phattso]

I don't understand not doing anything, either. How would it repair itself on its own if it is ruptured? If I were in your position, I would heavily consider surgery. If you don't lift weights or exercise, then surgery may not be that important. But, you do.

[bigtallox]

I see a Dr. Johnson and he takes a look at my arm and says, "the best course of action is to do nothing." Huh? I'm thinking WTF? So, I say, "really?"

Seriously? My opinion of the medical profession just dropped another notch (again). I'd run like hell. Go find another doctor that willing to help. I thought they only suggested not getting it fixed if you were like 70 years old or something.

I get a little run down that strength will not be effected other than supination strength, I'll still be able to play baseball and golf without limitation, and will still be able to lift weights all I want. He then reminds me that Brett Favre, John Elway, and Curt Schilling all had this tendon either cut or ruptured and still performed at a very high level without repair.

That's BS, your strength will be affected. I've heard it'll cut your strength in that arm by about 30-40% from what I've heard ( I've torn my bicep twice but not the tendon either time ). The doctor probably just doesn't understand what "strength" really means to some people. Carrying groceries and golf is not "strength" in my book.

How would it repair itself on its own if it is ruptured?

It won't repair itself.

[mslman71]

My opinion: x2 on Andrew's (fittofattofit) advice. Get it fixed and get it fixed yesterday. The longer you wait the more difficult the repair is likely to be, but even after long durations it's still completely possible. It will never be exactly the same but it will be close.

They tend to make recommendations based on the generic patient but lifters aren't generic patients.

[JimmyJonny]

I wasnt able get mine reattached. Its a long story why but basically my 3rd doctor called me 12 hours before my surgery and cancelled on me. He basically couldnt do it on his own. Then my insurance gave me troubles , ......it just dont end.

If I were you , I would get it done. I know Im not happy, but it is what it is. My biggest hang up is dealing with a 4th recovery on the same shoulder since Feb 20,2012. Ive been through hell lifting but Im still at it.....

[litljay]

I don't understand not doing anything, either. How would it repair itself on its own if it is ruptured? If I were in your position, I would heavily consider surgery. If you don't lift weights or exercise, then surgery may not be that important. But, you do.

Technically, it doesn't. What does happen though is that the torn away section still connected to the muscle "may" re-attache itself to the humerus (same process after anchoring). It's my understanding though that the self attachment is no where near as strong as a surgical repair "if" it does re-attach. It's iffy though with active people that it sits still long enough for that process.

Seriously? My opinion of the medical profession just dropped another notch (again). I'd run like hell. Go find another doctor that willing to help. I thought they only suggested not getting it fixed if you were like 70 years old or something.




That's BS, your strength will be affected. I've heard it'll cut your strength in that arm by about 30-40% from what I've heard ( I've torn my bicep twice but not the tendon either time ). The doctor probably just doesn't understand what "strength" really means to some people. Carrying groceries and golf is not "strength" in my book.




It won't repair itself.

Thanks BTO and I kind of agree. I'm not sure they completely "get" it if you're not an active athlete in College.

My opinion: x2 on Andrew's (fittofattofit) advice. Get it fixed and get it fixed yesterday. The longer you wait the more difficult the repair is likely to be, but even after long durations it's still completely possible. It will never be exactly the same but it will be close.

They tend to make recommendations based on the generic patient but lifters aren't generic patients.

Thanks mslman. I agree. Need to get it fixed.

I wasnt able get mine reattached. Its a long story why but basically my 3rd doctor called me 12 hours before my surgery and cancelled on me. He basically couldnt do it on his own. Then my insurance gave me troubles , ......it just dont end.

If I were you , I would get it done. I know Im not happy, but it is what it is. My biggest hang up is dealing with a 4th recovery on the same shoulder since Feb 20,2012. Ive been through hell lifting but Im still at it.....

Sorry to hear that.

So, I called them today and am getting it fixed. I go in next Tuesday for a Pre-Op appointment. Not sure exactly what that means, but I guess we'll see. I've been scouring the internet for stories/info on this issue. I was surprised that all the patients that have had it done, NEVER regretted their decision. However, those that opted not to repair had. In fact, I've even found a couple of folks that waited 18 months for the repair and was successful and weightlifters. Lee Priest is one of them (waited a year). So, here we go...

[GuyJin]

Best of luck in your recovery!

[litljay]

Best of luck in your recovery!

Thanks GuyJin. I'm a bit nervous with the inactivity for 6-9 months, but I'll take it if it means close to 100% recovery.

[fittofattofit]

Thanks GuyJin. I'm a bit nervous with the inactivity for 6-9 months, but I'll take it if it means close to 100% recovery.

I was back doing leg work within a week and deads within a month. The way they anchor the tendon into the humerus depends on bone healing which is very solid at 6 weeks. There is no reason with progressive loading that you shouldn't be back to your full range of strength activity within 6 months and generally a lot earlier

[JimmyJonny]

Thats great op, you'll be much happier getting it fixed.

Ive trying to get a hospital grant since mine detached. It takes up to 6 months but its only been 3+. Im gonna call today to see if it can be sped up. The doctor did tell me to come see him in six months.......... I wondered why if it cant be fixed, it appears they can be redone.

I had my entire tendon cut and reattached so I have more than one anchor. If I get the one fixed Im waiting more than 6 weeks for any activity. Mine broke at around 8 weeks. I grabbed a van door as it was opening. When I stopped the doors motion and went to shut it......it snapped, just like that. It took nothing to snap..... I couldnt believe how easy it broke.

When I started pt, the first thing they told me is the anchor can come out, they see it all the time.......and me being there 2x a week, I saw them, it happens.

You pre op appointment will be insurance info, blood work, meet who puts you under, instructions on not eating & prewashing, your date, your post surgery & pt start date. I had mine done during winter.....not again,,,,,, dressing for the cold is painful, lol.

[litljay]

The pain has decreased so much lately it's amazing. I'm able to lift things out of the bed of my pick up (lifted a computer out).

I swung a golf club in my front yard also without pain. Think I'll go play a round before I'm laid up for a while.

[JimmyJonny]

The pain has decreased so much lately it's amazing. I'm able to lift things out of the bed of my pick up (lifted a computer out).

I swung a golf club in my front yard also without pain. Think I'll go play a round before I'm laid up for a while.

Yea after it snaps there isnt any pain. Like my mother for example. Her tendon was hurting so instead of going through surgery to repair it she had it snapped. I think they just use a needle to do it. Its very common for elderly folks to have it done. In fact my shoulder feels perfect since mine broke....... I just hate the look of it......and I lost strength without a doubt.

[fittofattofit]

The pain has decreased so much lately it's amazing. I'm able to lift things out of the bed of my pick up (lifted a computer out).

I swung a golf club in my front yard also without pain. Think I'll go play a round before I'm laid up for a while.

There's no pain because the nerve endings are free and not being stretched. A partial tear is painful but a rupture hurts at the time but then should be pretty much painless. The only thing that does happen though is that the balled up long head muscle can start to cramp, also you should avoid doing any activity at the moment because it will cause the muscle to contract and shorten so that the free end of the tendon may be harder to find and pull back to length for the repair

[blkbelt42]

Find another Dr. & get it fixed.

[tornmuscle123]

Just remember to reevaluate your exercise selection and form - too often I have seen guys get shoulders repaired - go back to lifting the same way and reinjuring the shoulder

[litljay]

There's no pain because the nerve endings are free and not being stretched. A partial tear is painful but a rupture hurts at the time but then should be pretty much painless. The only thing that does happen though is that the balled up long head muscle can start to cramp, also you should avoid doing any activity at the moment because it will cause the muscle to contract and shorten so that the free end of the tendon may be harder to find and pull back to length for the repair

That's one of the comments the doc made was that he may have to fish for the tendon. It's getting fixed though for sure. I see him again on Tuesday for the Pre-Op appt. We'll see what he says this time around.

Find another Dr. & get it fixed.

It's getting fixed.

Just remember to reevaluate your exercise selection and form - too often I have seen guys get shoulders repaired - go back to lifting the same way and reinjuring the shoulder

I actually think that the original damage occurred during my many years of playing baseball (pitcher).

I've completely laid off any upper body workouts. I've seen the gym 3 times this week and squatted (Front or Hack Slide) 3 times. My quads feel like they have a perma pump

[litljay]

ok, Monday morning is the scheduled surgery time. Should get MRI done this week.

[anonymous]

all the best on that, keep us updated.

I have to say after reading this I am now super paranoid about this happening. F2f, what are the causative factors for this? Is it untreated tendinosis combined with acute trauma?

[litljay]

all the best on that, keep us updated.

I have to say after reading this I am now super paranoid about this happening. F2f, what are the causative factors for this? Is it untreated tendinosis combined with acute trauma?

So, here's what I've read (without any links for proof).

1. It's most prevalent in people that play/have played overhead sports (baseball, volleyball, etc.).
2. Rotator cuff injuries can cause damage to the Long Head bicep tendon also and be the cause of failure.
3. One site I read claimed that the failure occurs most often just as mine did. Raising the shoulders with the elbow bent.

here's a quick rundown: http://orthopedics.about.com/cs/shou...srupture_2.htm