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Pain after surgery for LABRUM TEAR, SUBACROMIAN DECOMPRESSION. Treatment?

Resolved Question:

Hello Dr.,

Thank you for answering my question. I'm a 29 yr. old male, who has had a total of 4 surgeries on his L. shoulder. The first was a subacromial decompression, the second was a labrum repair, as was the next, and the most recent was for adhesive capsulitis that had developed following the previous procedure.

I am over 3 years removed from my last surgery, but was semi-recently stretching my arms over head and felt a painful sensation in my L. shoulder, which has led to intermittent pain at the back of it, a feeling of general looseness in it, as well as bicep pain. My shoulder no longer seems to be in its normal upright position, but instead depressed, with my whole left arm feeling as though it's hanging off of my body. This has affected my walking gait and caused me to develop a little bursitis on the outside of my left hip. (This happened when I previously had labrum tears in my shoulder.)

I have been seeing Dr. Warner at Mass General, and he sent me for a CT arthrogram, which showed a labrum tear, but no instability. Then, he recommended I have a bicep tenodesis (BT) based on my shoulder pain, bicep pain, and hist. of shoulder probs.

I know that a BT should relieve the pain in my shoulder and bicep, but honestly, while this pain is certainly bothersome, it's something I could most likely put up with for a while longer. I'm more concerned about the feeling of looseness/hanging in my shoulder whereas it disturbs my gait, thanks to my own peculiar anatomy. I cannot for the life of me understand what could be causing this looseness/hanging other than decreased stability in my shoulder caused by the tear. It doesn't seem like having a BT will increase my shoulder's stability, though, but instead, may actually decrease it further...

So, here's the big question: is performing a BT accompanied with a labrum repair something surgeons can/would do? I would simply ask Dr. Warner about this, but I don't want him to think I have fibromyalgia or something. From what I've been able to discern over the years, a disturbed gait and hip pain are not typically associated with a labrum tear in your shoulder.

Thank you again,
Sincerely,
Jeffrey


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have read your question with diligence.
I am also sorry to be late to answer your question.
Nowadays it is a routine practice to do tenodesis in comparison to tenotomy of long head of biceps .This has some advantage in young active person as it gives good muscle strength as well as avoid abnormal appearance of biceps muscle in arm. Mild depressed appearance of shoulder may be due to shifting of long head of biceps from its original location during the process of tenodesis.
Hope this will help you.
Regards.
Please review the reply by a different specialist :
I read your query and I have found that you are having a complaint of looseness at your shoulder ,there are also some pain at your shoulder and at your biceps region.This problem may be due to bicipital teniditis & dysfunction of LHB.If such case is associated with labral tear then it will be good for you to have bicipital tendinosis with labral repair & your surgeon can do this in a sitting.
Please get back to me if you have further queries.


Patient replied :

I have not had a bicep tenodesis yet. My question is whether or not a surgeon would consider performing a bicep tenodesis and labrum repair at the same time. My reason for asking this is detailed in my first post.
Thank you


Expert:  Dr. Mukesh Tiwari replied 3 Days.

Yes, the surgeon can consider for the bicipital tenodesis & labral tear in one sitting.
Regards.


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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