Tuesday, December 3, 2013

Case Study: Shoulder Biceps Tenodesis

A 58 year old male came into the office for a second opinion approximately one year after shoulder surgery in Florida. The previous surgery entailed “shaving” of a labral tear, but no evidence of repair. The labrum is soft, fibrous tissue that surrounds the shoulder joint. Despite the previous surgery, he continued to experience pain with overhead activities, was unable to lift and had trouble sleeping due to the pain. The pain was not relieved with cortisone injections. 

Our first goal was to determine the exact source of the patient’s pain. An MRI of his shoulder revealed a labral tear and damage to his biceps tendon. The biceps tendon is attached to the labrum, which is located between the ball and socket joint. Following injury, this biceps tendon can pull the labrum off the shoulder joint and create constant tension and pain. Once this tension is released by cutting the biceps tendon, the labrum returns to its normal position and pain is reduced. The biceps can then be placed in another anatomic location so that it will function properly and not cause pain.
We then performed an ultrasound guided biceps tendon sheath injection. If the injection provided relief, we would be able to confirm that pain was coming from the biceps tendon. The patient experienced relief from the pain after the injection; therefore our suspicion was confirmed.  

For treatment, opted to perform an outpatient shoulder arthroscopy and perform a biceps tenodesis.  In this procedure, the biceps tendon is released and then reattached arthroscopically. One week after surgery, the patient stated his pre-operative pain had significantly improved and he was sleeping well at night. He started physical therapy 3 weeks after surgery and wore a sling for 4 weeks to protect the repair. 9 weeks post-op, the patient stated his pain was absent, his range of motion was almost completely restored, and his strength was improving. He was discharged in excellent condition 15 weeks after surgery. 

Dr. Vitolo, who specializes in shoulder and knee arthroscopy, performs a unique arthroscopic biceps tenodesis. This arthroscopic procedure eliminates the need for a large incision, metal anchors, or significant soft tissue trauma. This arthroscopic biceps tenodesis is the latest advancement in shoulder arthroscopy performed by Dr. Vitolo for specific injuries. 

For more information on Dr. Vitolo and shoulder injuries, please visit http://www.advocareorthosportsmed.com or check us out on facebook: facebook.com/johnvitolomd.