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Shoulder surgery

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Hello,
I just had left shoulder surgery three weeks ago. I had lots of issues such as 2 bone spurs, arthritis, degeneration distal disease of four muscles that attach to the joint. I also had distal clavice excision and long head bicep tenotomy. I thought I was going to have bicep tenotomy with a screw to attach it to my humerus but my doctor just cut it. I was shocked and it sure feels weird. I asked my doctor if he can do bicep tenodesis and he said no because he already cut and retracted. I found that hard to believe that he said no. I believe it can be done. I'm only 50 and very active. Can doctor do bicep tenodesis after having bicep tenotomy?
Miserable


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
Thanks for your consult at DoctorSpring.com. I have read your question with diligence.

In your case with arthritis, degeneration, age above 40 both procedure of tenodesis & tenotomy can be performed but present results do not favor one one procedure above other. Instead long post operative rehabilitation is required in tenodesis while this is not in case of tenotomy-

http://www.ncbi.nlm.nih.gov/pubmed/18762669?dopt=Abstract&holding=f1000,f1000m,isrctn

The above is one of the good studies for your reference.

In case of tenotomy the only complication is presence of mild bulging at arm of biceps belly. Most of studies did not find difference in power after surgery in both procedures.

Hope this will help you. Please feel free to discuss further.

With best wishes.


Patient replied :

Hello,
This is the second time that I have written to you. There is an error I made. I had degenerative "joint" disease, not distal, but I also have DDD both side of my neck anyway. That is not my main concern as of right now. My main concern is the swelling. I had left shoulder surgery back in November 19th and I am still suffering and I still have limited movement. I have been to physical therapy for two weeks now. Every time I go there or when I do a lot with my left arm, my shoulder ends up swelling and numb all the way down from my shoulder to my fingers. It feels like the circulation is cut off and I have to move certain areas to keep circulation. I keep calling my doctor and he said it is normal since he did the extensive debridement and the swelling will last 3 months. My physical therapy does not think it is normal and my swelling is very noticeable. I don't feel it is normal and I worry because it is in my left arm, you know it goes to my heart that I'm concerned of. I don't feel right... What am I supposed to do? I take medicine daily (Ibuprofen) and I put ice on my shoulder 2 to 3 times a day. Please get back with me asap. Thanks...Miserable


Expert:  Dr. Mukesh Tiwari replied 3 Days.

Hello,

Thanks for the follow-up.

It looks that your problem is not due to any heart problem.

Most likely possibility is your surgery and pre existing joint disease. In case of heart problem there is no swelling on use, there is also severe pain instead of numbness.

Your surgeon is right that it may take time .Your shoulder is debrided so lot of tissue regeneration abd repair activity is there. This increases the blood flow and swelling in that area. You shouldn't worry and wait and follow your surgeon advice.

Hope this will help you, please feel free to discuss further.

Regards


Patient replied :

Hello,
It has been 10 weeks since I had the left shoulder surgery. I felt "crap" ever since I had the surgery because it feels like my shoulder has been dropped or whatever it is. So hard for me to do normal activities, especially lifting any weights, and very little sleep at nights. I saw that surgeon twice but he said it takes time. My physical therapy, two massage, and my primary doctor all said it is not normal. My left arm is swelling, a little bigger than my right arm. There is a dip from the top of my shoulder to the middle of my upper arm. Below that it is swelling and bulging. Frustration, I saw my primary doctor and finally ordered the ultrasound at the different hospital. That doctor is specialized in shoulder muscle. This is what he finds:
-There is retraction of the long head of the biceps tendon into the upper arm, compatible with prior sternotomy. There is only a small amount of fluid in the bicipital groove.
-There is moderate tendinosis of the subscapularis, and evidence of a small articular surface tear of the cranial fibers.
-There is moderate tendinosis of the supraspinatus, and a high-grade tear at the greater tuberosity. This measures approximately 1 cm AP and 1.5 cm transverse. There is nearly full thickness involvement. There is moderate fluid in the overlying subdeltoid bursa.
-There is moderate tendinosis of the distal infraspinatus. There is mild multifocal bursal and articular surface irregularity. There is no full thickness defect or retraction. There is a small amount of fluid in the overlying subdeltoid bursa.

Impression:
1. Rotator cuff tendinosis with high-grade articular surface defect of the distal supraspinatus accompanied by subacromial-subdeltoid bursitis.
2. Evidence of prior tenotomy of the long head of the biceps. (this one I understand)

Can you explain everything to me. Do I have more than one tear? Should my doctor who did my shoulder take this seriously? I told my primary doctor office to fax this report to the doctor that did the surgery on me ten weeks ago. The doctor (the radiology) told me that I need to have MRI to check for the deltoid and he told me I have atrophy on back of my shoulder and possibly on the side of my arm where the deltoid is. Explain to me in plain English. What next step should I do? Thanks for your time.
Still Miserable


Expert:  Dr. Mukesh Tiwari replied 2 Days.

Admin Message -

Hello,
Your consult has been closed. Either you have utilized all 3 follow-up queries or your consult is now older than 1 month. If you have further queries, I request you to initiate a new consult. You could consult the same Doctor as well, please mention the same in the new consult with reference as 93409.

Hope this communication was fruitful. Wish you good health.

Thank you
In-house Physician
DoctorSpring.com


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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