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.
