I'm looking a biceps tenodesis right in the face - I don't know if it's the best option.. yet.

Bones, joints and muscles
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I'm a 21 almost 22 year old female. I've been suffering from shoulder pain for the past idk 8+ weeks.

Here's how it all started:

I suddenly had a onset of shoulder pain in my left shoulder. It felt like I slept on it funny the night before but it got progressively worse. Stiff, muscle spasms, weakness etc. I went to my PCP and told him what was going on. I'm a ft student and I work part time in a sports bar as a server. I thought it may have been an overuse thing from carrying 10-12lb trays on that arm. He diagnosed me with muscle spasms and sent me on to ortho.

I didn't play around, I went to a shoulder surgeon. He looked at me and suspected a SLAP tear involving the biceps anchor (my biceps tendon isn't stable. It flips and it flops). He suggested we try PT for 4 weeks since it was a new problem. I went to PT with a specialized shoulder therapist. It was terrible. I went 2x a week and ended up having to do isometric contractions since the pain became unbearable and my arm couldn't do more than 3-5 reps without getting tired and sloppy. This agony continues for 3 weeks until my therapist called my surgeon and said we need to do an MRI. He agreed, wrote the script. They wanted to do an athrogram. I said no way to it unless they knock me out. They said no. So I went with a regular MRI - no contrast. Shockingly but I guess not too too surprising since it had its limitations , it came back relatively normal. Except excessive fluid coming from an unknown place.

My doctor was stumped. He believes it's my biceps tendon long head causing all my problems and I'm totally agreeing. That's where my pain is, I get shooting pain into my biceps muscle stopping above my elbow. Weakness with IR and ER, as well as overhead. It just doesn't stay where it needs to. I was ready to do hop skips and backflips to the OR to get it fixed. He wasn't ready to just start cutting at that point. He insisted I take one cortisone injection. He got me right in the coracoid process. I had cortisone flare like no other for 2-3 days. Then I thought I felt okay lol I was wrong increased pain, more episodes of shooting pain into my biceps muscle. Tomorrow will be my two week mark after the shot. I haven't noticed a major difference or much improvement. Some days I'm alright and it's tolerable. Other days I'm ready to chop off my arm

I'm following up 6/13. At my last appointment when I was injected. We agreed therapy stops and I take it easy. Which I have. If the shot works, awesome we're done and move on. If it doesn't, he's saying a biceps tenodesis is my best bet, arthroscopic proceedure and he'd take a look at the RC and labrum while in there. Just to be sure.

For some unknown reason, im the poster child for MRI machines not picking up tears. I had a fully ruptured tendon in my hand that was ripped off the bone and exploded into many many pieces. MRI didn't show it at all. I'm not fully trusting of those scans after that.

Let me put it this way. I'm not afraid of surgery. I am afraid of losing the full potential of my arm (which I have thus far). However, I do not want this surgery. I've read the proceedure, the recovery and about the immobilization. It sounds HORRIBLE. Plus I don't have an exact diagnosis. What if he's not right and it's all done for nothing?

Has anyone had a similar thing? Any input/advise would be greatly appreciated.

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Hi Nicole, I had a bicep tendonectomy in conjunction with a supraspinatus tendon repair. I wanted a tendonesis but they wouldn't do it at my age. Anyway, if it helps I have not had any problems. No pain (after recovery period) and no restrictions. I even do bicep curls as part of my strengthening program.

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How was your recovery period? How much physical therapy did you have to do? I know you had a slightly different proceedure but I just want a general sense.

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Six weeks in a sling with moderate pain that had to be managed (about 2 weeks of opiates then paracetamol for another 2 weeks- basically a mix of good days with no pain killers followed by mild to moderate pain days requiring attention) Stiffness and "odd" feeling in the arm/bicep. Then there was about 6 weeks of physiotherapy that I followed very closely. After that there was a gradual improvement in the "odd" feeling sort of like a feeling of swelling in the bicep area.

Anyway, from what I have read here, the pain and recovery is a very individual experience. I think a tendonesis may be more problematical than simply "cutting it out" like they did with me but if it goes well it should be a better outcome. I think you're worrying too about whether that is actually the fix you're looking for.

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Hi Nicole,

I am a PT and am 4 months post rotator cuff repair and and unexpected bicep tenodesis. my MRI did not show the bicep tendon problem...other than tendinopathy. I had a bike crash that resulted in injury but I think the bicep tendon was just worn out from decades of activity. I am 58 and very active in sports of all kinds. 

I was somewhat dismayed when I woke up to find I had had a bicep repair. I did not have time to research the techniques or ask questions about it. To be very honest, the tenodesis recovery has been the hardest part of this whole recovery. I have chosen to believe that the Dr did what he felt was the  best for my future based on what he saw when he went in arthroscopically, and he did take pictures and show me how shredded the bicep tendon was. I will never know how things would have been had he just repaired the rotator cuff and left the bicep alone. There are several different tenodesis techniques and he did not do "his favorite approach" and I don't know why he chose the particular approach that he die. Again, I can only assume that it was the best approach based on what he initially was going in to repair. I think it would be nice to be familiar with the different approaches and have a discussion with the surgeon and have him explain his rationale in detail. It's important to be comfortable with the surgeon.

That being said, I am recovering fairly well. I was in a sling for 6 weeks and the rehab was very conservative because of the tenodesis. No strengthening exercises allowed till 10-12 weeks. Range of motion exercises started 3 days after surgery, passive only and progressing to active assist at 4 weeks and active range by 6 weeks. As Sparkery stated, pain is individual. I was off narcotics after 5 days and just use tramadol and tylenol and cold packs for pain management. My Dr and therapist agree that I am doing very well. They say that at 4 months, I am more like someone at 6 months. I got back to hiking with progressive difficulty within 2 weeks of surgery. I am still not back to work because I need to be able to lift people with disabilities and the bicep is not ready for that yet. But I can do all my housework and cooking. Things were going pretty well by 8-10 weeks. Driving was no problem by 7 weeks. I was able to drive at 3 weeks...but confident by 7. I did need help at home the first 2 weeks.

It's a touch decision and you are very young. If possible, maybe you could get a second opinion. I know it's not always possible. I did not because there were only 2 Dr's in my HMO available to me and one I already knew I didn't like based on previous experience with my knee. So far, I think my outcome has been good. I am back to riding my road bike 25 miles and 4 miles of hill climbing (no mtn bike yet). I wish you the best with your situation. 

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Hello,

I had bicep tenodesis done 6 weeks ago, and first 4-5 weeks were great. I had almost no pain and PT thinks I’m recovering well. However all of the sudden, for last week, it hurts every night - I wake up at 4 am and it feels very sore plus sort of “tiny electric shock” kind of a pain. I’m not aware of doing anything to aggrevate it - however I went for a long walk (not hike, just 20miles walk) I wonder if this could cause it (I was in a sling, and had no pain during the activity).

Anyone experienced something similar?