Author Topic: Partial Tear - Surgery?  (Read 3241 times)

Offline wtkob

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Partial Tear - Surgery?
« on: February 11, 2010, 04:09:22 PM »
It's been 265 days since I damaged my biceps tendon playing hockey. 

I have:

1. Consulted three orthopedics
2. Got an elbow and shoulder MRI (showed very little)
3. Got an xray
4. Prescribed (and used) Voltaren, Ibuprophen, Ketoprophen and Celebrex (this one scared me)
5. Did 2 months of physical therapy (resulted in more pain)
6. Tried Platelet-Rich Plasma injection (no difference other than less money in my wallet)

Here's what the elbow MRI said:

1. Mild biceps tendinosis/tendinopathy or even tendinitis but without a significant tear identified.
2. No mass in the region of the palpable abnormality of the biceps muscle.
3. If there is any clinical suspicion for a proximal biceps tendon tear, then an MRI of the shoulder and proximal humerous may be of benefit.

The shoulder MRI basically said I have an impingement but I really didn't expect much.  The pain for me is almost exclusively distal.  I have had mild shoulder pain for most of my life.

I'm 42 years old and I've never had anything like this before.  In my climbing days I would get sore tendons and broken fingers but neither would stop me for more that a few days.  This injury stopped me in my tracks and for the last 9 months I have not been able to get out of first gear...

It all started when I got back into playing hockey and probably hit it too hard.  I was averaging three days a week in the rink between Tues-Fri and I think the arm just started to wear down.  What started as mild pain in the middle of my arm picking up my bag soon turned into difficulty picking up a cup of coffee or brushing my teeth. There was NO swelling, NO deformation, NO bruising and NO pain in the shoulder at the time of injury.  Not knowing the first thing about giving your tendons a rest, I figured I would just grind through it.  Bad idea.

It finally got so bad I had to keep my right arm at the waist and use my left for everything.  After about three days I felt like I could pick up a fork again and I switch the mouse at work back.  On a scale of 1-10 with 10 being the max I have felt during the worst time  I'm now around a 3-4.  While that is quite a reduction, the pain NEVER goes away.

It affects everything I do in life: picking up the kids, shaking hands, washing dishes, brushing teeth, picking anything up and yes, playing hockey.  That's the short list.

The first two orthopedics I consulted prescribed every NSAID on the market.  Started with Ibu, then used Voltaren.  After a brief break, I tried a ketoprophen cream and wrapped up my chemical experiment with Celebrex.  I swear, anytime I was using these drugs my arm would hurt MORE.  Especially the Celebrex.  I quit that one after one week of use after reading about the side-effects and class action law suits.

Initially I thought the PT was going well but I really think that it was just in my head.  The more I pushed it, the more my arm started to hurt.  After about 14 sessions, I was off to another ortho.  He immediately suggested I look into PRPT and agreed that the anti inflamitories really wouldn't help in my case anymore.  I signed up and took the shot right before xmas. 

The first week after the injection the outside of my arm hurt quite a bit but not enough to require any pain killers. After about three days I started to get my pre-op ROM back and by a week I thought things were really looking up.  The second week my bicep tendon pain really started to flare up and stayed that way for the next three weeks. By week five, things settled down a little and I resumed my normal level of pain and discomfort.

I am now coming up on 8 weeks post injection and I really don't have much hope for more improvement.  I feel that I have been smart about my rehab of this injury by initially staying away from any type of motion that would aggravate the injury.  Yet here I am, 9 months down the road and considering surgery as an option.  Never in my life have I stood on the sidelines like this for so long.  I have been active my whole life and the sedentary lifestyle does not work for me. These days I spend my time working on cardio in the gym before work and throw in public ice time when I take the kids to the rink but that's about it.

My current doctor asked me to call back in next week to discuss my progress but I have to say, I'm losing faith. None of the orthos I have seen seem to want to cut my tendon but that may be where I am headed.  I asked about which procedure he preferred and he said he only does the suture anchor technique.  He recommended against the endobutton based on some issue with the bone breaking?  I'll get more details on this the next time we speak.

Here are options I have not tried yet but considering:

1. Trying Cissus Quadrangularis
2. Acupuncture
3. Active Release Technique

Sorry for the long winded report but I thought I would get it out there in hopes someone else has been down this road.  I will continue to post back here with and progress (or lack of) in the future. 

For everyone else who has contributed their experience and support I thank you.  I have found this forum to be the most helpful and informative of all.  Much appreciated,

tk

Offline Jeff

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Re: Partial Tear - Surgery?
« Reply #1 on: February 12, 2010, 12:47:57 AM »
I think most just have the Distal Tendon repaired. 
Youi said the MRI DIDNT show any damage to the Distal Tendon?

And the Ortho's you saw were Sports Ortho Surgeons? ( it seems odd they didnt recommend surgery to repair your arm)

I hate to suggest it...but find another Ortho.  Youi seem to be in too much pain to put up the other recommendations.  And although its been several months..youi can still have surgery.



Offline Bill C

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Re: Partial Tear - Surgery?
« Reply #2 on: February 12, 2010, 09:37:32 AM »
 Sorry to hear about all the difficulties you have been through. I experienced a greater than 90 % tear of my right Distal Tendon on 10/17/2009 and had surgery to repair it on 12/21/2009.

 The problem is that most Doctors don't know what to do with partial tears, my Doctor explained this to me on my first visit. He said that there isn't a lot of info out there on recovery rates and such. I had three weeks of PT and put into a ROM brace to stop me from rotating my arm, but I was still allowed to bend my arm up and down. I had no improvement and the pain in the elbow got worse, just like you. I opted for surgery, it was my choice and I do not regret it. I am almost 7 weeks post-op and completely pain free. I have full ROM and am working on strengthening my arm now with the help of PT.

 My Doctor has done 3 partial tear surgeries in the last year and we are all doing great, but he has one patient that has decided against surgery and is miserable and in pain.It almost sounded like he would like to write a paper on his experiences and success with the surgeries.
 I would also recommend that you find an Ortho Doctor who has experience dealing with partial tears. Your arm will not get better and the pain will not leave, I was in your shoes not to long ago and know what you are going through and it was very frustrating for me.
 Good luck.

  • Hospital: UMMC Batavia,NY
  • Repair Method: Toggle Loc with Zip Loop
  • Surgeon: Dr. Landfrield
  • Surgery Date: Right12/22/09 Left 3/19/11

Offline wtkob

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Re: Partial Tear - Surgery?
« Reply #3 on: February 12, 2010, 10:05:05 AM »
Thanks for the input guys!

One ortho said there was no tear and the other two said there was but that I'm probably in the category of patients that do not have a significant tear > 50%

Bill, my doctor said similar things to me and he too has done a number of Partials.  I think he was really hoping the platelet treatment would work.  He did warn me that there really weren't and concrete studies suggesting that there would be any benefit at all other than some anecdotal evidence and his own experience with his patients. That said, he gave me 50/50 odds.

It's not that my current doctor does not want to do surgery, he just wants to be sure the PRP injection I received last December has reached full benefit.  Also, I have a high deductible so any surgical option will not be cheap.  My PRP injection ran me about $2000.00 last year.

Overall, I'm happy with the ortho I am currently working with; seems intelligent, confident and comes with a good resume (experience).

I'm posting here for a couple of reasons:

1. I want to hear from people like Bill with similar symptoms and find out what got them better.  Did you wait it out, PT, PRPT, ART, surgery or whatever.  How long did you go with a partial tear?  Are you just living with the pain?  Do you have pain or just a loss of strength?  Muscle atrophy?

2. I want to provide details on my experience so that others can benefit. For me, I have pain right in the inside crook of the elbow where the tendon attaches to the bone. Palm down I have pretty good strength but palm up, elbow bent 90 degrees I get pain in the distal biceps tendon that radiates upward to the center of the muscle.  If I bend my elbow and try to touch my fist to my shoulder I get a lot of pain too.

When I load the arm and feel pain, I have to slowly extend the arm because the tendon feels tight.  I get this if I play guitar even doing something as simple as finger picking.  In the nine months that I've had this I would have to say that it has improved slightly but it seems very easy to aggravate.

I read a lot about folks who have complete ruptures but not so many who have partial tears.  Many times I see a thread started where someone explains exactly what I'm experiencing but there is no follow-up.  

Thanks again for your input,

tk

Offline wtkob

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Re: Partial Tear - Surgery?
« Reply #4 on: October 26, 2010, 03:19:13 PM »
Update:

It's been a while so I thought I would drop in for an update. 

Feb 2010 I went back to the Ortho for one last consult on my situation.  After essentially 9 months of PT with limited results I wanted to discuss surgical options so we talked about the various options and then reviewed the cost.  I was looking at a  bill of around 4-5k and 6 months to 1 year of rehab. 

My Dr. basically said stop fixating on the injury and get on with your life.  The next week I started playing local pickup hockey again and I haven't stopped since.  I can honestly say my arm is slightly better and definitely not worse.  It still hurts most of the time but nothing like it used to.  Any time I work the arm, I put it on ice and that seems to help.

I'm about a year and a half into this thing and I feel like I'm headed in the right direction.  At this point, the pain that I feel is not enough to justify the cost, risk or rehab required with surgery.   It is entirely possible that the PRP injection helped because at about 10 weeks post op, the arm really started to feel better and recover from load quicker.

I just wanted to get this out there for anyone with minor partial tear looking for a case history.

Offline Jeff

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Re: Partial Tear - Surgery?
« Reply #5 on: October 27, 2010, 12:37:40 AM »
a greater > then 50% is not a minor tear.
I am glad youre happy with your decision...though Im still curious if any of the orthos was a Specialist in Sports Medicine? 
And what did that Ortho, in particular, recommend?

Offline Djldoc

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Re: Partial Tear - Surgery?
« Reply #6 on: October 27, 2010, 05:00:20 AM »
Just curios, but did you ever try ART. I was not a member for your prior posts, but have had experience as both a physician and a patient. I have found that ART and Graston techniques seem to be very effective with chronic injuries. Also, I would see a PT that specializes in shoulders and be evaluated as you mentioned an impingement syndrome. I cannot say for sure if any of this will work as I never reviewed your MRI, but it's worth a try.

Offline markoc

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Re: Partial Tear - Surgery?
« Reply #7 on: December 12, 2010, 11:59:53 AM »
I had a partial tear to my rt. distal biceps tendon in August of 2009 lifting a heavy patient on a backboard. The doc put a brace on my arm for 4 weeks, and then physical therapy for 12 sessions after that. No surgery.
I got normal strength back around December, I took it slow. If I use my arm a lot, (weights, work, etc.) I have some pain. It has swelled up on me twice, but rest, ice, ibuprofen resolved it in a few days.
The doc said that I should only fix it if it tweeks out again, it hasn't.
Surgical procedure : Endobutton with Tenodesis screw

Offline Kruzer

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Re: Partial Tear - Surgery?
« Reply #8 on: December 16, 2010, 06:04:59 AM »
Your story hear is a good one. I had a partial tear about 5 years ago and I've lived with the pain up until today. My surgery is schedule for this afternoon and I'm not looking forward to it. I will say that my pain is probably less than what you have experienced but the problem has been that I constantly have to favor it. I can still curl a 30 pound weight but it hurts. And then there's the everyday things in life like picking up my kids or even shoveling snow where I continue to get the shooting almost burning pain. After a day of splitting wood I broke down and scheduled the surgery. My surgeon will use the two incision technique and will take the tendon off and re-attach. Hope his all works out.

Offline wtkob

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Re: Partial Tear - Surgery?
« Reply #9 on: November 03, 2011, 12:14:01 PM »
Just checking back to provide an update.  Sorry I missed so many posts!

Quote
Just curios, but did you ever try ART. I was not a member for your prior posts, but have had experience as both a physician and a patient. I have found that ART and Graston techniques seem to be very effective with chronic injuries. Also, I would see a PT that specializes in shoulders and be evaluated as you mentioned an impingement syndrome. I cannot say for sure if any of this will work as I never reviewed your MRI, but it's worth a try.

I was going to try ART but the arm healed up to the point where it was no longer impacting my life style.  Regarding shoulders, this has become my new weak link and it is something I need to address with a better PT regimen.

Quote
a greater > then 50% is not a minor tear.
I am glad youre happy with your decision...though Im still curious if any of the orthos was a Specialist in Sports Medicine? 
And what did that Ortho, in particular, recommend?

My case was much less than 50% tear.  More along the lines of 15-25%.  Yes, the Ortho was  a specialist in Sports Medicine and he first suggested PT followed by a PRP injection.  He, along with the other 2 Orthos, strongly discouraged cutting the tendon and reattaching.  They all felt this would heal on it's own so  I guess they were right.

As of today, I am no longer experiencing the pain or reduced motion I used to have.  It really took about a year of PT and patience to get back to a place that I would call normal.  The PRP injection may or may not have helped the recovery process but I can say that about three months after the surgery, I was good to go.

If anything changes for the worse, I'll check back in.  I wish you all well!